What Are Hemorrhoids?

Hemorrhoids, also known as piles, are swollen and inflamed veins located in or around the anus and lower rectum. They are similar to varicose veins that appear in the legs but occur in the anal region due to increased pressure. Hemorrhoids can develop internally within the rectum or externally under the skin around the anus.

This condition is very common and can affect people of all ages and genders. While not typically dangerous, hemorrhoids can cause significant discomfort, irritation, and even bleeding, especially during bowel movements or when sitting for prolonged periods.

Types of Hemorrhoids

Hemorrhoids are generally classified based on their location:

Internal hemorrhoids:

  • Located inside the rectum beneath the mucosa lining

  • Typically painless but may bleed during bowel movements

  • May prolapse, bulging out of the anus during straining

External hemorrhoids:

  • Develop under the skin around the anus

  • Can become irritated or thrombosed (filled with blood clots)

  • Often more painful and itchy than internal hemorrhoids

Some individuals may experience both types simultaneously.

Signs and Symptoms

The symptoms of hemorrhoids vary depending on their type and severity:

Internal hemorrhoid symptoms:

  • Painless rectal bleeding

  • Bright red blood on toilet paper or in the bowl

  • A feeling of incomplete evacuation

  • Mild irritation if prolapsed

External hemorrhoid symptoms:

  • Itching or burning around the anus

  • Swelling or hard lumps near the anal opening

  • Pain when sitting or during bowel movements

  • Discomfort when wiping

Severe cases of prolapsed or thrombosed hemorrhoids can cause intense pain and require urgent medical attention.

Causes and Risk Factors

Hemorrhoids form when increased pressure in the rectal veins causes them to swell and become inflamed. Common contributing factors include:

Causes:

  • Chronic constipation or diarrhea

  • Straining during bowel movements

  • Prolonged sitting on the toilet

  • Pregnancy-related pressure on the pelvis

  • Heavy lifting or strenuous physical activity

  • Low-fiber diet and poor hydration

Risk factors:

  • Age over 50

  • Obesity

  • Sedentary lifestyle

  • Smoking

  • High blood pressure

  • Gastrointestinal diseases such as IBS or Crohn's disease

How It’s Diagnosed

Diagnosing hemorrhoids is typically straightforward and involves a review of symptoms and a physical examination.

Diagnostic steps include:

  • Medical history review

  • Visual inspection of the anal area for external hemorrhoids

  • Digital rectal exam to detect internal hemorrhoids

Additional tests may include:

  • Anoscopy: Inserting a short, lighted tube to view internal hemorrhoids

  • Proctoscopy or sigmoidoscopy: To evaluate the rectum and lower colon for other conditions

If symptoms include unexplained bleeding, your provider may recommend a colonoscopy to rule out colorectal disease.

Treatment Options

Treatment depends on the severity of the hemorrhoids and whether symptoms are acute or chronic. The primary goals are to reduce discomfort, resolve swelling, and prevent recurrence.

Lifestyle and dietary changes:

  • Increase fiber intake (25–30 grams per day)

  • Drink 8–10 cups of water daily

  • Avoid prolonged sitting and straining

  • Establish regular bowel habits

Over-the-counter treatments:

  • Topical creams (hydrocortisone, lidocaine)

  • Witch hazel pads or ointments

  • Sitz baths (warm water baths for the lower body)

  • Oral pain relievers (acetaminophen or ibuprofen)

Advanced treatment options:

  • Rubber band ligation: Cutting blood supply to internal hemorrhoids with a tight band

  • Sclerotherapy: Injection of a solution to shrink the hemorrhoid

  • Infrared coagulation: Heat therapy to harden and destroy internal hemorrhoid tissue

  • Hemorrhoidectomy: Surgical removal of hemorrhoids, typically for severe or prolapsed cases

  • Stapled hemorrhoidopexy: Minimally invasive surgery to reposition and cut off circulation to hemorrhoid tissue

Prevention Tips

You can reduce your chances of developing hemorrhoids by adopting the following habits:

  • Eat a diet rich in fiber (fruits, vegetables, whole grains)

  • Stay well-hydrated

  • Exercise regularly to stimulate bowel movement

  • Avoid straining or sitting too long on the toilet

  • Respond to the urge to defecate promptly

  • Use a footstool to elevate your feet during bowel movements

  • Manage chronic conditions that contribute to constipation or diarrhea

Possible Complications

While hemorrhoids are generally not dangerous, untreated or severe cases can result in complications:

  • Thrombosis: Formation of blood clots in external hemorrhoids, leading to intense pain

  • Anemia: Due to chronic blood loss

  • Infections: Resulting from open sores or poor hygiene

  • Skin tags: Left behind after a thrombosed hemorrhoid heals

  • Strangulated hemorrhoids: Prolapsed internal hemorrhoids with restricted blood supply

Timely treatment and proper hygiene can minimize risks.

Living With Hemorrhoids

For most people, hemorrhoids are a manageable condition. Many cases improve with simple lifestyle changes and self-care. However, for chronic or recurring hemorrhoids, ongoing management may be needed.

Tips for living well with hemorrhoids:

  • Maintain a bowel routine

  • Use gentle cleansing methods after bowel movements

  • Wear loose, breathable clothing

  • Avoid heavy lifting

  • Track symptoms and seek medical attention if they worsen

If surgery or advanced treatment is needed, follow post-procedure care instructions closely to promote healing and prevent recurrence.

Frequently Asked Questions

Are hemorrhoids permanent? No, most hemorrhoids resolve with treatment. Chronic cases may recur and require ongoing management.

Can hemorrhoids lead to cancer? Hemorrhoids themselves do not cause cancer, but rectal bleeding should always be evaluated to rule out more serious conditions.

Can you prevent hemorrhoids entirely? You can greatly reduce your risk by maintaining good bowel health and adopting a high-fiber, active lifestyle.