The exact cause of haemorrhoids is unknown. However, they are associated with an increase in pressure in the lower rectum which can cause the blood vessels in the lower rectum to become swollen and inflamed. The following factors can increase pressure within the lower rectum and hence may increase the risk of developing haemorrhoids:
- Straining to have a bowel movement
- Sitting for long periods of time, especially on the toilet
- Chronic (long lasting) constipation or diarrhoea
- Being overweight or obese
- Anal intercourse
- Low-fibre diet
- Spinal cord injury
- Poor posture
- Family history of haemorrhoids.
Haemorrhoids are common and occur in most people at some stage during their lives. They tend to occur more frequently later in life due to age-related weakening and stretching of the tissues supporting the veins in the rectum and anus.
Signs and symptoms
Symptoms often depend on whether a haemorrhoid is located on the inside or outside of the body.
Internal haemorrhoids lie inside the rectum and usually do not cause discomfort. However, straining or irritation when passing a stool can damage the surface of a haemorrhoid causing it to bleed. Sometimes, straining can push an internal haemorrhoid through the anal opening resulting in a protruding or prolapsed haemorrhoid, which can cause pain and irritation.
External haemorrhoids lie under the skin around the anus. When irritated they can itch or bleed. Blood can pool inside an external haemorrhoid and form a clot, which causes severe pain, swelling, and inflammation.
Signs and symptoms of haemorrhoids may include:
- Pain or discomfort, especially when sitting
- Pain during bowel movements
- Itching or irritation around the anal region
- Bright red blood on your stools, toilet paper or in the toilet bowl
- Swelling around the anus
- One or more lumps near the anus, which might be tender or painful.
Bleeding during bowel movements is the most common sign of haemorrhoids. Rectal bleeding can, however, indicate a more serious condition, such as bowel cancer or anal cancer. You should consult your doctor if:
- Your haemorrhoids bleed frequently or excessively
- Your haemorrhoids do not respond to self-treatment
- Your haemorrhoid symptoms have been accompanied by an obvious change in bowel habits
- You are passing black or maroon-coloured stools
- Blood clots have formed
- Blood is mixed in with the stool.
Haemorrhoid symptoms often settle down after a few days. Haemorrhoids that occur during pregnancy usually resolve after giving birth.
A visual inspection should allow your physician to see if you have external haemorrhoids.
Tests and procedures to diagnose internal haemorrhoids may include:
- A digital rectal examination in which your doctor inserts a lubricated gloved finger into your rectum to feel for anything unusual, such as growths
- A visual inspection of the inside of your anal canal and rectum using a viewing device such as an anoscope, proctoscope or sigmoidscope
- A colonoscopy may be performed to do a more extensive examination of your entire bowel (colon) if your signs and symptoms suggest that you might have another digestive system disease (such as ulcerative colitis or Crohn's disease) or if you have risk factors for colorectal cancer.
Most cases of haemorrhoids can be self-treated. More serious or repeat cases may require medication or a surgical procedure. Haemorrhoids can recur after treatment; hence, they are controlled rather than cured.
Home treatment is often all that is required to relieve mild pain, swelling, and inflammation associated with haemorrhoids. Home treatments include:
- Use of non-prescription haemorrhoid ointments, creams, suppositories, or pads containing a mild corticosteroid, e.g. hydrocortisone, or witch hazel extract
- Soaking the anal area in warm water for 10 to 15 minutes two or three times a day
- Using stool softeners, which help stools to be passed more easily
- Ensuring that the anal area is kept clean by bathing or showering daily – soap is not necessary, and the affected area can be dried with a hair dryer
- Using moist towelettes or wet toilet paper (that do not contain perfume or alcohol) rather than dry toilet paper, to help keep the anal area clean after passing a stool
- Applying ice packs or cold compresses on the affected area can relieve swelling
- Taking oral pain medication, such as paracetamol or ibuprofen, can help to relieve discomfort.
Non-surgical and surgical procedures
For an external haemorrhoid in which a clot (thrombosis) has formed, prompt relief can be obtained from your doctor performing a haemorrhoid thrombectocmy, which is a simple 'incision and drainage' procedure to remove the clot.
For persistent bleeding or painful haemorrhoids, the following non-surgical procedures to destroy the haemorrhoid can be performed in a doctor’s office:
- Rubber band ligation, which involves using a rubber band to cut off the blood supply to the haemorrhoid causing it to shrivel and die
- Injection (sclerotherapy), which involves injecting a substance into the haemorrhoid to make it harden and shrink
- Electrotherapy (electrocoagulation), which is a type of heat treatment that causes the haemorrhoid to harden and shrivel.
If non-surgical procedures are not successful or if the haemorrhoids are particularly large, one of the following surgical procedures may be necessary:
- Haemorrhoidectomy - removal of a haemorrhoid with a scalpel or laser, usually under general anaesthetic
- Haemorrhoid stapling - removal of an internal haemorrhoid with a special staple gun that also inserts a ring of staples to close the wound and prevent bleeding.
Keeping your stools soft is the best way to prevent haemorrhoids from occurring. The following steps can help to prevent haemorrhoids from occurring and reduce symptoms of existing haemorrhoids:
- Eat high-fibre foods
- Drink plenty of fluids
- Consider using fibre supplements
- Avoid straining when on the toilet
- Go to the toilet as soon as you feel the urge
- Get plenty of exercise
- Lose weight if you are overweight
- Avoid sitting for long periods
- Avoid taking medication that can cause constipation, eg. codeine based painkillers.
Mayo Clinic (2018). Hemorrhoids (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268 [Accessed: 17/04/18]
MedlinePlus (2017). Hemorrhoids (Web Page). Bethesda, MD: U.S. National Library of Medicine. [Accessed: 17/04/18]
O’Toole, M.T. (Ed.) (2013). Hemorrhoid. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Thornton, S.C. (2017). Hemorrhoids treatment and management (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/775407-overview [Accessed: 17/04/18]
Updated: April 2018