Haemorrhoids
Symptoms, Causes & Treatment
Haemorrhoids (piles) affect around 75% of people at some point in their lives. They are the most common cause of rectal bleeding. Most respond well to dietary modification and topical treatment, with office-based procedures available for those that don’t.
What are Haemorrhoids?
Haemorrhoids are swollen vascular cushions in the anal canal that become symptomatic when engorged and prolapsed. Internal haemorrhoids arise above the dentate line and are typically painless but bleed with defecation. External haemorrhoids arise below and can cause pain, particularly when thrombosed. Haemorrhoid grade (I–IV) determines appropriate treatment, from dietary modification to surgical haemorrhoidectomy.
Symptoms of Haemorrhoids
Haemorrhoid symptoms depend on whether they are internal (typically painless, bleeding) or external (may be painful, especially when thrombosed).
Bright red bleeding from the rectum during or after defecation · Blood on toilet paper · Itching, soreness, or discomfort around the anus · Mucus discharge from the anus · Feeling of incomplete emptying · Soft lump or swelling at the anal margin (prolapsed haemorrhoid)
Heavy or persistent rectal bleeding · Rectal bleeding in adults over 50 · Change in bowel habit with rectal bleeding · Unexplained weight loss with rectal symptoms · Lump inside the rectum — these require urgent assessment to exclude colorectal cancer
Heavy rectal bleeding · Rectal bleeding over age 50 · Change in bowel habit with bleeding · Unexplained weight loss with rectal symptoms — see a GP urgently. Do not assume bleeding is from haemorrhoids without examination.
What Causes Haemorrhoids?
Haemorrhoids develop from increased pressure in the pelvic venous plexus. Understanding the cause guides prevention and treatment selection.
Internal haemorrhoids arise above the dentate line and are typically painless but bleed with defecation. They are graded I–IV by degree of prolapse. External haemorrhoids arise below the dentate line and can cause pain, especially when thrombosed.
Straining at stool from constipation, low-fibre diet, prolonged sitting, pregnancy, and obesity are the most common predisposing factors. Increased intra-abdominal pressure engorges the anal cushion venous plexus, leading to haemorrhoid formation.
Pregnancy increases pressure on the pelvic veins and increases blood volume, causing haemorrhoids in up to 50% of pregnant women. Haemorrhoids often resolve after delivery but may require treatment in the postnatal period.
A thrombosed external haemorrhoid occurs when a blood clot forms in an external haemorrhoid, causing sudden severe anal pain and a tender blue-purple lump at the anal margin. It resolves over 7–10 days or can be excised for immediate relief.
Haemorrhoid treatments range from dietary modification and topical creams to office-based procedures (banding, sclerotherapy, infrared coagulation) and surgical haemorrhoidectomy for large or refractory haemorrhoids.
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) causes abdominal pain, bloody diarrhoea, weight loss, and fatigue. Early diagnosis with colonoscopy and calprotectin testing prevents disease progression and complications.
Key Risk Factors
Diagnosing Haemorrhoids
Proctoscopy or sigmoidoscopy confirms the diagnosis and grades haemorrhoids. Any rectal bleeding over age 50 or with associated features requires colonoscopy to exclude colorectal cancer.
Treatment for Haemorrhoids
Treatment is stepwise: dietary modification and topical creams first, then office procedures (banding, sclerotherapy), and surgery for refractory or prolapsed haemorrhoids.
Supportive Measures
High-fibre diet and adequate hydration prevent constipation. Warm sitz baths 3 times daily relieve discomfort. Topical Anusol HC reduces inflammation. Avoid prolonged sitting on the toilet. Use a footstool to adopt a squatting posture. Avoid straining.
Managing Recurrent Haemorrhoids
Recurrent haemorrhoids require treatment of the underlying cause (constipation) alongside repeat banding or definitive surgical haemorrhoidectomy. Long-term high-fibre diet, adequate hydration, and avoidance of straining prevent recurrence.
When to Seek Help
Heavy or persistent rectal bleeding · Change in bowel habit with bleeding in adults over 50 · Unexplained weight loss with rectal symptoms — see a GP urgently to exclude colorectal cancer.
See a GP if haemorrhoids are not responding to home treatment, if bleeding is persistent, or if you have a prolapsed haemorrhoid that won’t reduce. Rectal bleeding over age 50 always requires examination.
Preventing Haemorrhoids
Most haemorrhoids can be prevented or their recurrence reduced through dietary fibre, hydration, and avoiding straining.
Eat 25–30g of dietary fibre daily. A high-fibre diet prevents constipation, reduces straining, and is the single most effective measure for preventing haemorrhoid development and recurrence.
Drink at least 1.5–2 litres of fluid daily. Adequate hydration softens stools, reduces straining, and prevents haemorrhoid formation and recurrence.
Do not strain on the toilet. Allow a natural urge before going and avoid prolonged sitting. A footstool raising the knees above the hips creates a squatting posture, facilitating easier defecation without straining.
Regular aerobic exercise promotes bowel motility, prevents constipation, and reduces intra-abdominal pressure. Aim for 150 minutes of moderate exercise per week.
Treat constipation proactively with dietary fibre, hydration, and osmotic laxatives. Chronic constipation is the primary modifiable risk factor for haemorrhoid development and recurrence after treatment.
See a GP if rectal bleeding occurs, particularly if over 50, if bleeding is heavy, or if accompanied by change in bowel habit or weight loss. Haemorrhoids are common but rectal bleeding always requires assessment to exclude serious causes.
Getting Treatment for Haemorrhoids
A GP can examine and grade haemorrhoids, prescribe topical preparations, and refer for banding or surgery. An online consultation can facilitate initial assessment and provide dietary and topical treatment advice.
Expert clinical advice, when you need it.
Haemorrhoids — Frequently Asked Questions
Haemorrhoids (piles) are swollen and inflamed veins in the rectum and anus. They develop when increased pressure in the pelvic veins causes the venous plexus in the anal cushions to become enlarged and prolapsed. Constipation, straining, pregnancy, obesity, and low-fibre diet are the most common causes.
Rectal bleeding is always from haemorrhoids until proven otherwise in a young, otherwise healthy person with typical haemorrhoidal symptoms. However, in adults over 50, or if bleeding is accompanied by change in bowel habit, weight loss, or a lump felt on rectal examination, colonoscopy is needed to exclude colorectal cancer.
The most important first steps are increasing dietary fibre to 25–30g per day, drinking 1.5–2 litres of fluid daily, avoiding straining, and using a footstool on the toilet. Topical haemorrhoidal creams (Anusol HC) reduce inflammation and itch. Warm sitz baths provide comfort. Stool softeners and osmotic laxatives prevent straining.
Rubber band ligation (banding) is the most effective office-based procedure for grade II–III internal haemorrhoids, with a success rate of 80–90%. The band cuts off the blood supply, causing the haemorrhoid to shrivel within 1–2 weeks. It is performed as an outpatient procedure without anaesthesia.
Haemorrhoids in pregnancy commonly develop due to increased pelvic pressure and blood volume. They usually improve or resolve after delivery. Anusol or Germoloids cream is safe during pregnancy. High-fibre diet, hydration, and avoiding straining are the most important preventive measures during pregnancy.
A thrombosed external haemorrhoid develops when a blood clot forms in an external haemorrhoid, causing sudden severe anal pain and a tender blue-purple lump. Pain is worst in the first 48–72 hours. Most resolve spontaneously over 7–10 days. Surgical excision provides immediate relief if done within 48–72 hours of onset.
Haemorrhoids can recur after treatment, particularly if the underlying cause (constipation, straining, low-fibre diet) is not corrected. Rubber band ligation has a 30–50% recurrence rate at 5 years. Haemorrhoidectomy has the lowest long-term recurrence rate but carries a longer recovery and more post-operative pain.
See a GP for rectal bleeding (especially over age 50), prolapsed haemorrhoids that cannot be pushed back, thrombosed haemorrhoids with severe pain, anaemia from haemorrhoidal blood loss, or haemorrhoids not improving with conservative measures. A GP can perform a digital rectal examination and arrange referral for banding or surgery.