Hemorrhoids are a widespread health condition affecting many people globally, yet they remain surrounded by misinformation and embarrassment.

Understanding their nature, causes, symptoms, and treatments is essential for managing and preventing discomfort effectively.

What Are Hemorrhoids?

Hemorrhoids are naturally occurring vascular structures located in the canal that function in maintaining continence by helping to close. Everyone has them, but they become problematic only when these blood vessel cushions swell, enlarge, or inflame, leading to noticeable symptoms. Although often called "piles," hemorrhoids themselves are normal anatomical features essential for controlling bowel movements. Problems arise primarily from changes in pressure or strain affecting these vessels.

Causes and Risk Factors

Increased pressure in the lower is the main trigger for hemorrhoid swelling. This pressure can result from several factors such as chronic constipation, frequent straining during bowel movements, prolonged sitting on the toilet, pregnancy, and obesity. Besides mechanical strain, aging contributes to weakening supportive tissues, making hemorrhoids more likely to protrude or enlarge in older.

Dietary habits also play a crucial role; low fiber intake leads to harder stools that require more effort to pass, increasing pressure on the veins in the region. This interplay creates a cycle where untreated constipation exacerbates hemorrhoid symptoms.

Symptoms and Types

Hemorrhoids are classified mainly into internal and external types, each presenting somewhat differently. However, when they prolapse or protrude outside, they may result in discomfort or bleeding during bowel movements, often noticeable as bright red blood on toilet paper or stool surface.

Evidence-Based Treatment Approaches

Initial treatment focuses on lifestyle modifications that reduce strain on the anorectal area. Increasing dietary fiber intake and fluid consumption softens stools, making bowel movements easier and less painful. A 20-minute sitz bath—sitting in warm water after bowel movements—aids symptom relief by reducing inflammation and soothing irritated tissue.

Topical treatments like over-the-counter creams and suppositories offer temporary symptom control but may not address the underlying causes. When conservative measures fail, minimally invasive procedures like rubber band ligation or infrared coagulation can shrink internal hemorrhoids. Surgery remains an option for severe cases but is typically reserved until less invasive treatments have been exhausted.

Addressing Misconceptions and Long-Term

Many patients fear that hemorrhoids may lead to more serious health problems. Despite occasional symptoms, hemorrhoids typically do not worsen indefinitely or lead to life-threatening conditions. Ongoing prevention by maintaining healthy bowel habits and avoiding prolonged straining can keep symptoms under control for most individuals.

According to Dr. Amir Ashrafi, a gastrointestinal and laparoscopic surgeon practising in Northern Sydney, both surgical and non-surgical techniques are tailored to haemorrhoid severity—surgical haemorrhoidectomy for advanced cases and rubber band ligation (RBL) for symptomatic internal haemorrhoids that don’t respond to conservative measures. Research supports RBL as a safe, effective, minimally invasive outpatient procedure: multiple studies report success rates between 70 %–80 % for grades I–III internal haemorrhoids, with shorter recovery and lower pain than haemorrhoidectomy.

Hemorrhoids, though common, are often misunderstood. They are natural vascular cushions that play a functional role in continence but can cause distress when swollen due to increased pressure and strain. Factors like constipation, diet, and aging contribute to their development. The symptoms vary depending on whether hemorrhoids are internal or external, with treatments ranging from lifestyle adjustments to minimally invasive procedures.