What Are Hemorrhoids? Symptoms, Causes and Treatment Options

What Are Hemorrhoids?

Hemorrhoids, commonly known as piles, are a very common disease of the anorectal region.

In normal anatomy, the anal canal contains hemorrhoidal structures made up of blood vessels and connective tissue. These tissues are normal anatomical structures that contribute to bowel control.

Hemorrhoidal disease arises when these tissues enlarge, shift downwards and begin to cause complaints. For this reason, defining hemorrhoids simply as “varicose veins of the anus” is not entirely accurate.

Hemorrhoidal disease can occur in different grades and does not cause the same symptoms in every patient.

What Causes Hemorrhoids?

There is no single cause behind the development of hemorrhoidal disease. Long-standing constipation and excessive straining during bowel movements are among the most important factors.

In addition, sitting on the toilet for long periods, a low-fiber diet, pregnancy, obesity and conditions that increase intra-abdominal pressure can contribute to hemorrhoidal complaints.

With advancing age, weakening of the connective tissues that support the hemorrhoidal cushions can also play a role in the development of the disease.

What Are the Symptoms of Hemorrhoids?

Hemorrhoid symptoms can vary according to the type and grade of the disease.

One of the most common symptoms is bleeding from the anus during bowel movements. The blood is usually bright red and may be noticed on the toilet paper, on the stool or in the toilet bowl.

In addition, swelling at the anus, tissue that protrudes during bowel movements, itching, moisture and a feeling of discomfort may occur.

An important point is this: not all rectal bleeding is due to hemorrhoids. Various other conditions — including colon and rectal polyps, anal fissure, inflammatory bowel disease and colorectal cancer — can also cause rectal bleeding.

For this reason, particularly with recurrent bleeding, one should not simply assume “it’s just my hemorrhoids.”

What Is the Difference Between Internal and External Hemorrhoids?

Hemorrhoids are generally classified by their anatomical location as internal and external hemorrhoids.

Internal hemorrhoids originate from the hemorrhoidal tissue in the upper part of the anal canal. Bleeding and protrusion during bowel movements — known as prolapse — are common symptoms of internal hemorrhoids.

External hemorrhoids are related to the vascular structures in the outer part of the anal canal. In particular, if a clot suddenly forms within an external hemorrhoid, a thrombosed external hemorrhoid can develop, producing a painful lump.

The treatment of these two conditions can differ.

What Are the Grades of Hemorrhoids?

Internal hemorrhoids are generally divided into four grades.

Grade 1 hemorrhoids: The hemorrhoidal tissue remains inside the anal canal. The most common symptom is bleeding.

Grade 2 hemorrhoids: They protrude during bowel movements but return inside on their own.

Grade 3 hemorrhoids: They protrude during bowel movements and may need to be pushed back in manually.

Grade 4 hemorrhoids: The hemorrhoidal tissue is permanently outside and usually cannot be pushed back in.

However, the treatment decision is not made based on the grade of the hemorrhoid alone. The amount of bleeding, prolapse, pain, the impact on daily life and previous treatments must all be evaluated together.

How Are Hemorrhoids Diagnosed?

The patient’s history and physical examination play an important role in diagnosing hemorrhoids. Assessment of the anal region, digital rectal examination and, when needed, anoscopy allow the internal hemorrhoidal tissue to be examined.

However, particularly in patients with rectal bleeding, it must be confirmed that the bleeding is not caused by another disease. Depending on the patient’s age, family history, changes in bowel habits and other risk factors, additional investigations such as colonoscopy may be required.

How Are Hemorrhoids Treated?

Hemorrhoid treatment is determined by the grade of the disease and the patient’s complaints. Not every hemorrhoid patient needs surgery.

Particularly in early-stage disease, regulating bowel habits forms the foundation of treatment. Adequate fiber intake, sufficient fluid intake and preventing constipation are important. Not sitting on the toilet for long periods and avoiding unnecessary straining can also help reduce hemorrhoidal complaints.

When needed, medications and local treatments aimed at reducing symptoms can be used. However, these treatments should be planned according to the grade of the hemorrhoidal disease.

Can Hemorrhoids Be Treated Without Surgery?

Some internal hemorrhoids can be treated without a surgical operation, using methods that can be performed in an outpatient setting.

One of the best known of these is rubber band ligation. In this procedure, a small rubber band is placed at the base of the appropriate hemorrhoidal tissue, reducing its blood supply.

Beyond this, different interventional methods can also be used in selected patients.

However, not every method offered under the label “non-surgical hemorrhoid treatment” is suitable for every patient. The treatment must be chosen according to the anatomy and grade of the disease.

When Is Hemorrhoid Surgery Necessary?

Surgical treatment may come onto the agenda for patients with advanced prolapse, recurrent bleeding, or insufficient results from conservative and interventional methods.

Classic hemorrhoidectomy — the surgical removal of hemorrhoidal tissue — is one of the effective methods. In addition, different surgical or interventional techniques can be used according to the characteristics of the patient’s hemorrhoidal disease.

The important point here is not simply to choose the method marketed as the “newest” or “most painless.” Each method has a different group of patients for whom it is suitable.

What Is Laser Hemorrhoid Treatment?

Laser hemorrhoid treatment is one of the methods patients have frequently researched in recent years. There are techniques that use laser energy to reduce the volume of the hemorrhoidal tissue.

In some selected patients, it can offer advantages in terms of post-operative pain and recovery time.

However, laser is not a single method that replaces classical surgery in all grades of hemorrhoids. Particularly for large, severely prolapsing hemorrhoids, other surgical methods may be more appropriate.

For this reason, in choosing treatment, the anatomy and grade of the patient’s hemorrhoidal disease matter more than the device used.

What Is a Thrombosed External Hemorrhoid?

The sudden formation of a clot inside the external hemorrhoidal vessels is called a thrombosed external hemorrhoid. It usually presents as a suddenly developing, tender and painful lump at the anus.

Treatment can vary depending on when the complaint started, the severity of the pain and the patient’s general condition. In some patients, medication and local care are sufficient, while surgical intervention may be considered in suitable patients.

Can Hemorrhoids Turn into Cancer?

Hemorrhoidal disease does not turn into colon or rectal cancer. However, some symptoms of hemorrhoids and colorectal diseases can resemble each other. Rectal bleeding, in particular, can occur in both.

The real risk is that the bleeding is automatically attributed to hemorrhoids and the evaluation of a different underlying disease is delayed.

For this reason, in new or recurrent rectal bleeding, the necessary evaluations should be performed according to the patient’s clinical characteristics.

Can Hemorrhoids Be Prevented?

It is not always possible to prevent hemorrhoidal disease completely, but regulating bowel habits can help reduce the risk and the complaints.

Eating a balanced, fiber-rich diet, drinking enough fluids, exercising regularly and preventing constipation are important. Not postponing the urge to go to the toilet and not sitting on the toilet longer than necessary can also be helpful.

Hemorrhoid Treatment Should Be Individualized

Although hemorrhoids are a very common condition, they are not treated the same way in every patient. The treatment of grade 1 hemorrhoids with mild bleeding is not the same as that of advanced hemorrhoidal disease that is permanently prolapsed.

When planning treatment, the type and grade of the hemorrhoids, the amount of bleeding and prolapse, the patient’s age, bowel habits and previous treatments must all be evaluated together.

Most importantly — particularly in patients with rectal bleeding — it must be confirmed that the complaint really is caused by hemorrhoids. The correct diagnosis is therefore the first step of appropriate hemorrhoid treatment.

Information Note

This content has been prepared for general information purposes. It is not a substitute for diagnosis or individual treatment advice. Medical evaluation is important for the correct diagnosis of rectal bleeding and anal complaints.

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