Haemorrhoids

Haemorrhoids, sometimes called piles, are one of the most common digestive conditions seen by gastroenterologists. While they can cause considerable discomfort and concern, they are well understood and, in most cases, very manageable. Understanding what haemorrhoids are, why they develop, and what can be done about them is an important first step toward getting the right care.

What are haemorrhoids?

Haemorrhoids are varicose veins of the rectum or anus. Small blood vessels and veins in and around this area carry blood back toward the heart, and when that return flow is disrupted or under sustained pressure, those vessels can become distended, swollen, and enlarged. Over time, this process produces the lumps and discomfort associated with the condition. Haemorrhoids are particularly common in middle and later life, often developing gradually as the result of years of chronic constipation.

Types of haemorrhoids

There are three distinct forms of haemorrhoids, each with different characteristics and levels of severity.

Internal haemorrhoids form inside the rectum. They are generally painless but tend to bleed, and many people only become aware of them when they notice blood on toilet paper or in the bowl after a bowel motion.

Prolapsed haemorrhoids represent a more advanced and often more painful form of internal haemorrhoid. In these cases, the enlarged veins push through the anus and protrude outside the body, particularly after passing a bowel motion. In more severe instances, the veins may remain prolapsed permanently, and the anal sphincter can strangulate the protruding tissue, which requires prompt medical attention.

External haemorrhoids develop under the skin around the outside of the anus. They present as firm, tender lumps and are sometimes described as small bleeds beneath the skin surface.

What causes haemorrhoids?

The primary cause of haemorrhoids is straining on the toilet as a result of constipation. When bowel motions are hard and difficult to pass, the effort required increases pressure on the blood vessels of the rectum and anus, causing them to swell over time.

Several other factors are known to contribute to their development. Pregnancy places additional weight and pressure on the abdomen and bowel, and constipation is common in pregnancy, making haemorrhoids particularly common during this period. Hereditary factors also play a role, meaning some people are more predisposed to the condition than others. Heavy manual labour (especially frequent heavy lifting) and prolonged sitting on the toilet or hard surfaces can further increase the likelihood of haemorrhoids forming.

Recognising the symptoms

Bleeding is the most frequently reported symptom. This typically appears as bright red blood on the toilet paper or as streaks in the faeces. It is important to have any rectal bleeding assessed by a doctor promptly, as bleeding from the bowel can sometimes signal other conditions, including bowel cancer, which require investigation.

Other symptoms may include itchiness, discomfort, or pain in the anal region. In cases of prolapsed haemorrhoids, a lump protruding from the anus may be noticed, particularly after passing a bowel motion. External haemorrhoids may feel like hard, tender lumps around the outside of the anus.

Many people experience only mild symptoms that resolve within a few days, while others find haemorrhoids more persistent and disruptive to daily life.

When to see a doctor

Any episode of rectal bleeding should be assessed by a medical professional, even when haemorrhoids seem the most likely explanation. The symptoms of haemorrhoids can closely resemble those of more serious bowel conditions, and a proper examination is the only way to determine the cause with confidence. A doctor should also be consulted if symptoms are persistent, worsening, or causing significant discomfort.

How haemorrhoids are diagnosed

A doctor will take a history of your symptoms and examine the anal passage to look for any signs of swelling or abnormality. This may involve a digital rectal examination, where a gloved, lubricated finger is gently inserted to feel for any changes, or a proctoscopy, which uses a small instrument with a light source to view the interior of the rectum directly. While these examinations may cause some discomfort, they are generally not painful, and haemorrhoids are a very common reason for this type of assessment.

In some cases, a referral to a gastroenterologist or colorectal surgeon may be recommended for further evaluation and to discuss treatment options.

Treatment options

Dietary and lifestyle changes

Both the prevention and treatment of haemorrhoids centre on addressing constipation. A diet rich in vegetables, fruit, cereals, and wholegrains helps to produce soft, regular bowel motions that require less effort to pass. Drinking adequate water throughout the day supports this process, as dietary fibre absorbs moisture and works most effectively when fluid intake is sufficient. Regular physical activity also helps maintain healthy bowel function.

It is equally important to respond promptly to the urge to have a bowel motion rather than delaying it, and to avoid spending extended periods sitting on the toilet, which places unnecessary pressure on the anal region.

Medications

A range of over-the-counter preparations are available for the symptomatic relief of haemorrhoids, including medicated creams, ointments, and suppositories. These products can help to reduce pain and inflammation in the short term. Where inflammation is more significant, a corticosteroid cream may be prescribed by your doctor.

Non-surgical procedures

When haemorrhoids do not respond to conservative management, a number of office-based or outpatient procedures may be considered. Rubber band ligation involves placing a small elastic band around the base of the haemorrhoid via a proctoscope, cutting off its blood supply so that it eventually detaches and is passed from the body. Injection sclerotherapy involves injecting a chemical solution directly into the haemorrhoid, which causes it to shrink. Infrared photocoagulation uses infrared light energy to achieve a similar effect. These approaches are commonly used for internal haemorrhoids and are generally well tolerated.

Surgery

Surgical removal of haemorrhoids, known as haemorrhoidectomy, is typically reserved for more severe cases where other treatments have not provided adequate relief. The procedure is carried out under general anaesthetic and is considered a last resort when other approaches have been exhausted.

Preventing haemorrhoids

Maintaining consistent bowel health is the most effective way to reduce the risk of haemorrhoids developing or returning. This means eating a high-fibre diet, staying well hydrated, exercising regularly, and avoiding habits that strain the bowel, such as sitting on the toilet for long periods or ignoring the urge to pass a motion. Where dietary fibre intake is inadequate through food alone, fibre supplements may be a useful addition, though any increase in fibre should be introduced gradually to allow the digestive system to adjust. If overweight, losing weight may also help prevent the development of haemorrhoids.

Possible complications

Complications from haemorrhoids are uncommon. In cases where bleeding is persistent and significant, anaemia may develop as a result of blood loss. External haemorrhoids can occasionally develop a blood clot within them, a condition known as thrombosis, which can cause acute pain and requires medical review. It is worth noting that haemorrhoids are not associated with any increased risk of developing bowel cancer.

Seeking further care

If you are experiencing symptoms that may indicate haemorrhoids, your GP is the appropriate first point of contact. A referral to a gastroenterologist can provide access to specialist assessment, diagnosis, and a full range of treatment options tailored to your individual circumstances. Queensland Gastroenterology offers specialist gastroenterology care across Brisbane and South East Queensland. You can learn more about our Gastroenterologists here.

If you have received a referral to see one of our doctors, you can request an appointment, or contact our rooms directly on (07) 3321 1500.

This information has been sourced and adapted from education resources developed by Better Health Victoria and Health Direct (Australia).