Overview

Hemorrhoids (piles) are swollen blood vessels in and around the anus and lower rectum. They are very common in adults and are one of the most frequent causes of bright red blood on toilet paper.

Internal hemorrhoids form inside the rectum and usually cause painless bleeding. External hemorrhoids form under the skin around the anus and can itch, swell or hurt. Most hemorrhoids improve with simple changes in diet and toilet habits, and quick clinic treatments are available when they do not.

Symptoms

• Bright red blood on toilet paper or on the surface of stool
• Itching or irritation around the anus
• A soft lump that bulges out during a bowel movement and may go back in
• Pain or discomfort when sitting or passing stool
• A hard, very painful lump near the anus, which may be a blood clot (thrombosed hemorrhoid)
• Warning signs that need prompt care: heavy or ongoing bleeding, black or maroon stool, dizziness, or bleeding with weight loss or a change in bowel habits

Causes & Risk Factors

• Straining during bowel movements, often due to constipation
• A low-fiber diet and not drinking enough water, especially in hot weather
• Sitting on the toilet for a long time, often while using a phone
• Long hours of sitting at work or driving, and low physical activity
• Pregnancy and the months after childbirth
• Chronic diarrhea, heavy lifting and excess weight
• Getting older, as the supporting tissues weaken

Complications

• A blood clot in an external hemorrhoid, causing sudden severe pain
• Anemia from slow bleeding over a long time (uncommon)
• An internal hemorrhoid that stays outside and cannot be pushed back (strangulated), which needs urgent care
• Small skin tags left after the swelling settles
• Missing another cause of bleeding, such as an anal fissure, polyps or colorectal cancer, if bleeding is assumed to be piles without a check

Diagnosis

A doctor usually diagnoses hemorrhoids by asking about symptoms and examining the anal area, often with a gentle finger exam. A short scope called an anoscope may be used to see internal hemorrhoids. Colonoscopy may be advised when bleeding comes with warning signs or iron-deficiency anemia, or for adults aged 45 and older who are due for colorectal cancer screening.

Treatment

• More fiber from vegetables, fruit, whole grains and legumes, or a fiber supplement such as psyllium, with plenty of water
• Warm sitz baths for 10 to 15 minutes a few times a day to ease pain and itching
• Creams or suppositories for short-term relief, used only as advised
• Rubber band ligation, a quick clinic procedure for bleeding internal hemorrhoids
• Sclerotherapy or infrared coagulation for smaller internal hemorrhoids
• Surgery (hemorrhoidectomy or a stapled procedure) for large, prolapsing or recurring hemorrhoids
• Removal of the clot from a painful thrombosed hemorrhoid, usually within the first 72 hours

Prevention

• Eat fiber-rich foods every day and drink water through the day, especially in the heat
• In Ramadan, spread water intake between iftar and suhoor and keep fiber in both meals
• Go to the toilet when the urge comes and avoid straining
• Keep toilet time to a few minutes and leave the phone outside
• Walk regularly and break up long periods of sitting
• Keep a healthy weight

The General Surgery department at AlHayat Medical Center assesses rectal bleeding and hemorrhoids and discusses suitable treatment options.

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