Service
Hemorrhoids (piles): symptoms and treatment
- Section
- Services
- Specialist
- Op. Dr. Dilara Hasanova
- Clinic
- Modern Hospital, Baku
- The doctor's practice — examinations and treatments Dr. Hasanova performs herself
- General information — educational text about diseases and methods
What are hemorrhoids?
Short answer
Hemorrhoids (piles) are a condition caused by enlargement, swelling and downward slipping of the vascular cushions in the anal canal. Hemorrhoidal tissue is present in every person and is part of normal anatomy. When it causes symptoms, it is called “hemorrhoidal disease.” The most common symptoms are bright red blood during a bowel movement, hemorrhoids protruding outside, itching and discomfort.
Types
- Internal hemorrhoids — located inside the anal canal. They usually show up as painless bleeding and hemorrhoids protruding outside.
- External hemorrhoids — located at the edge of the anus, under the skin. They cause swelling and discomfort. When a clot forms inside the blood vessel (thrombosis), there is sudden, severe pain and a bluish, hard lump.
- Combined hemorrhoids — both types occurring together.
Grades of internal hemorrhoids
| Grade | What happens? |
|---|---|
| I | The hemorrhoids do not protrude; the main symptom is bleeding |
| II | The hemorrhoids protrude during straining and go back in on their own |
| III | The hemorrhoids protrude and can only be pushed back in by hand |
| IV | The hemorrhoids are outside all the time and cannot be pushed back in |
Grades of internal hemorrhoids
Grade I
Do not protrude; main symptom is bleeding
Grade II
Protrude on straining, go back in on their own
Grade III
Protrude; can only be pushed back in by hand
Grade IV
Always outside, cannot go back in
Symptoms
- Bright red blood during or after a bowel movement (on the toilet paper, on the stool, as drops)
- A lump protruding from the anus, a “foreign body” sensation
- Itching, wetness, mucous discharge
- Discomfort when sitting
- Sharp pain and swelling with thrombosis
Internal hemorrhoids usually do not cause pain. If there is pain, a thrombosed hemorrhoid, an anal fissure or a perianal abscess should also be considered.
Causes and risk factors
- Chronic constipation or diarrhea, hard straining during bowel movements
- Sitting on the toilet for a long time (phone, book)
- Pregnancy and childbirth
- A sedentary lifestyle, sitting in the same position for a long time (drivers, office workers)
- Heavy physical work, heavy lifting, some sports (horseback riding, cycling, wrestling, weightlifting)
- Excess weight, alcohol, a low-fiber diet
- Weakening of connective tissue with age, hereditary predisposition
- Other conditions that raise intra-abdominal pressure
Rectal bleeding does not always mean hemorrhoids
Blood coming from the anus is most often related to hemorrhoids or an anal fissure, but the same symptom can also occur with polyps, inflammatory bowel disease and colon cancer. For this reason, bleeding should never be regarded as normal, and it requires a doctor's examination. Colonoscopy is recommended for patients over the age of 40–45, when there is colon cancer in the family, or when the nature of the bleeding is suspicious.
Diagnostics
- Listening carefully to your complaints
- Inspection of the anus and a digital rectal examination
- Anoscopy, rectoscopy or video proctoscopy
- Colonoscopy when indicated
Treatment
General information
Treatment is chosen according to the grade of the hemorrhoids, the symptoms and the patient's general condition.
- Conservative treatment: a fiber-rich diet (about 25–35 g of fiber a day), enough fluids during the day (usually 1.5–2 liters, unless the doctor advises otherwise), resolving constipation and diarrhea, venoactive (venotonic) drugs, topical ointments and suppositories, and warm sitz baths. The doctor prescribes the medications. Drug treatment is usually given as a course, and the next step is chosen according to the result.
- Non-surgical (office) procedures: rubber band ligation, sclerotherapy and infrared coagulation for internal hemorrhoids. These procedures do not require anesthesia and take little time. Read more: Non-surgical treatment of hemorrhoids
- Surgical treatment: used for advanced (grade III–IV), frequently bleeding or complicated hemorrhoids, or hemorrhoids that do not respond to other methods. Hemorrhoidectomy is performed by the classic technique or with energy devices (LigaSure, Harmonic scalpel). In selected cases, stapled hemorrhoidopexy (PPH, Longo procedure) and laser techniques are also used. For a thrombosed external hemorrhoid, cutting out the lump within the first 48–72 h can quickly relieve severe pain; at a later stage, conservative treatment is usually chosen.
The doctor's practice
Examinations and treatments Dr. Hasanova performs herself
- In the early stages of hemorrhoids, Dr. Hasanova prescribes a course of conservative treatment and evaluates the result at a follow-up visit.
- In the initial stages of hemorrhoids, she uses sclerotherapy.
- For surgical treatment, she mainly performs LigaSure hemorrhoidectomy, including for grade IV hemorrhoids and hemorrhoids complicated by thrombosis. Read more: LigaSure hemorrhoidectomy
- For thrombosed hemorrhoids, including in pregnant women, she performs thrombectomy.
- When needed, she also treats anal polyps, an anal fissure or a rectocele in the same operating session.
- She performs operations mainly under spinal anesthesia. Patients are often discharged home the same day or the next day.
After surgery
- The first dressing change is usually done after 24 h.
- In the first days, pain relievers and stool softeners are prescribed.
- Warm sitz baths, hygiene, fiber-rich food and enough fluids are recommended.
- Several planned follow-up visits are held during the first month.
- The recovery time depends on the extent of the operation and usually ranges from 1 to 4 weeks.
- Possible complications: pain, bleeding, temporary difficulty urinating, infection and, rarely, anal narrowing and recurrence.
When should you see a doctor?
- When you see blood for the first time, or when the bleeding comes back
- When there is pain, swelling or a lump that protrudes
- When such symptoms start for the first time after the age of 40–45
- When your bowel habits change, or when there is unexplained weight loss or anemia
Frequently asked questions
Will hemorrhoids go away on their own?
Mild symptoms may ease when diet and bowel habits are corrected. But enlarged hemorrhoids usually do not return to their former state on their own. If there is bleeding, pain or a lump that protrudes, an examination is needed, because the chance of treatment without surgery is higher at an early stage.
Which doctor should you see for hemorrhoids?
Hemorrhoids and other diseases of the anal region are examined by a proctologist (coloproctologist) or a general surgeon. The proctologist examines the anus and rectum with special instruments to clarify the cause of the bleeding, determine the grade of the hemorrhoids and choose the appropriate treatment.
Can hemorrhoids turn into cancer?
No, hemorrhoids do not turn into cancer. However, the symptoms of hemorrhoids, especially bleeding, can also occur in conditions such as colon cancer and polyps. That is why it is important to establish the cause of bleeding by examination.
Are hemorrhoids treated with suppositories alone?
Usually not. Suppositories and ointments reduce symptoms, but treatment also includes relieving constipation, changing the diet and, when needed, medications that increase blood vessel tone. The doctor prescribes treatment according to the grade of the hemorrhoids.
When can you return to work after LigaSure surgery?
It depends on the extent of the operation and the type of work. Recovery usually takes 1–4 weeks. Most patients with sedentary jobs return to work sooner, while heavy physical work requires a longer break. The doctor determines the exact time at the follow-up visit.
Can hemorrhoids be treated during pregnancy?
Yes. During pregnancy, treatment is based mainly on diet, hygiene and topical medications that are safe in pregnancy. For a thrombosed hemorrhoid, a minor surgical procedure is possible to relieve severe pain. Planned surgery is usually postponed until after childbirth. Read more: Hemorrhoids in pregnancy and after childbirth