Hemorrhoids: Symptoms, Causes and Treatments

It is estimated that 1 in 3 people suffer from haemorrhoids, and their daily life is greatly affected. Do you want to know more about this gastrointestinal pathology? Read on!
Hemorrhoids: Symptoms, Causes and Treatments

Last update: 25 March, 2023

Hemorrhoids are one of the most frequent ailments, and they affect millions of people around the world. It is a group of inflamed veins that cause different symptoms and can vary from slight bleeding to severe pain.

According to various published studies, in the United States, 10 million people a year are diagnosed with this pathology. The most affected are Caucasians between the ages of 45 and 65, due to the effects of constipation and aging.

This inflammation can appear in different situations, however, an increase in intra-abdominal pressure is a common factor. At present, there are therapeutic options to treat them and thus eliminate their symptoms.

What are hemorrhoids?

Also known as piles, it’s a symptomatic inflammation of the veins located on the outside of the anus or inside the rectum. They’re a collection of vascular, connective tissue, and smooth muscle that are arranged in columns along the rectal canal.

According to their location, they can be classified into two types. This classification is of great importance, as it influences its presentation and treatment. The two classes of hemorrhoids are the following:

  • Internal: those located above the dentate (pectinate) line, inside the rectum, covered by rectal mucosa.
  • External: those located below the dentate line, in the skin that covers the anus, covered by the same tissue as the skin.
A man with hemorrhoids.
Constipation is a risk factor for suffering from hemorrhoids.

What are its causes?

The precise cause of the protrusion of hemorrhoids is unknown in most cases. It’s a pathology that’s under constant study and, currently, many supposed etiologies have been ruled out. An example of this is rectal varicose veins, which are a different condition.

It’s considered a multicausal condition. Different situations that increase intra-abdominal pressure or in the rectal area can be the triggering factor. In addition, the weakness in the muscles of the pelvic area can also have some influence.

In this way, among the conditions associated with the appearance of hemorrhoids, the following stand out:

  • Pregnancy
  • Constipation
  • Constant lifting of heavy objects
  • Aging due to weakness in the pelvic muscles
  • Being overweight or obese
  • Regular consumption of alcohol.
  • Frequent anal intercourse.

On the other hand, various studies have ruled out the impact of some risk factors, among which are sexual activity in women under 40 years of age. In this sense, the relationship between vaginal sexual practice and the appearance of hemorrhoids has not been proven.

Symptoms of hemorrhoids

The symptoms experienced by a patient may vary depending on the type of hemorrhoids. The main difference will be in the pain, as internal hemorrhoids are not painful because the area has a poor sensory innervation.

The symptoms presented by people with internal hemorrhoids are the following:

  • Bleeding during defecation without pain.
  • A sensation of rectal occupation.
  • In severe cases, there may be a rectal prolapse and cause pain to touch.

In the case of external hemorrhoids, the symptoms presented are greater and may include the following conditions:

  • Protrusion of a visible lump
  • Pain in the region of the anus
  • Itching or itching in the anal area
  • Bleeding when defecating
  • A sensation of rectal occupation or incomplete emptying

How is it diagnosed?

To confirm the presence of external hemorrhoids, only a direct observation of the area is necessary, as the lump will generally protrude. On many occasions, patients can infer their presence without the need for medical observation, due to the pain.

On the other hand, internal hemorrhoids are more difficult to diagnose, as the most obvious symptom is usually bleeding. In these cases, it’s necessary to go to the doctor, who should rule out the presence of more severe pathologies, such as an anal fistula. To do this, tests such as an anoscopy or a colonoscopy are usually recommended.

What’s the treatment for hemorrhoids?

Fortunately, these days there are several therapeutic options available to treat this very common ailment. The methodology to follow will vary depending on the severity and recurrence that the patient experiences. The treatment can be symptomatic or require a surgical process.

Symptomatic treatment

Hemorrhoids may not be so severe and may subside on their own, so symptomatic treatment is usually more than enough. In this sense, fecal emollients can be recommended in order to improve intestinal flow and reduce constipation.

Warm sitz baths for 10 minutes after a bowel movement help reduce pain and swelling. When the discomfort is very intense, ointments with anesthetics, such as lidocaine, can be applied, and non-steroidal anti-inflammatory drugs taken orally, such as ibuprofen.

Outpatient procedures

When a person has internal hemorrhoids it’s necessary to perform a surgical procedure. In the case of not being so severe, grade 1 or 2 of its classification, an outpatient approach can be carried out in the clinic or hospital.

One of the most used procedures is injectable sclerotherapy. It consists of the application of 5% phenol in the area with vegetable oil to temporarily stop bleeding.

Another method used is rubber band ligation, in which the hemorrhoid is pierced and compressed on a regular basis until the tissue dies and falls off. Usually 5 or 6 sessions are necessary to achieve the desired results and several protrusions can be tied at the same time.


Surgical tissue resection will only be recommended in patients with severe internal hemorrhoids or those who don’t respond to previous treatments. This is a surgical procedure that carries few risks and seeks to permanently eliminate all affected tissues.

Despite being a quick procedure with few complications, postoperative pain is very common, as are constipation and urinary retention.

Surgery for hemorrhoids.
Some surgery for hemorrhoids can be performed on an outpatient basis in the office.

How to prevent hemorrhoids?

Hemorrhoids are a multi-causal condition in which various risk factors are involved. Therefore, there are several measures that can be applied to prevent its appearance. Among the indications that can be followed, the following stand out:

  • Increase fiber intake to improve intestinal transit.
  • Drink at least 2 liters of water during the day.
  • Don’t make excessive efforts during defecation and avoid holding the urge.
  • Don’t sit for a long time.
  • Do physical exercise on a regular basis.

Following these simple but effective practices is usually enough to reduce the possibility of suffering from the pathology. It’s important to see a doctor immediately when hemorrhoids are suspected, especially if they’re internal, since rectal prolapse is a serious complication.

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