Key points
- Hemorrhoids are a common condition that produces symptoms when the vascular cushions in the anal canal enlarge or prolapse outward.
- Bleeding, itching, swelling, prolapse, and discomfort may occur; severe pain can develop particularly in thrombosed external hemorrhoids.
- Fiber, adequate fluids, and reducing straining on the toilet are the foundation of treatment.
- Not all rectal bleeding is hemorrhoids; new or recurrent bleeding should be properly evaluated.
What are hemorrhoids?
Hemorrhoidal cushions are normal structures of the anal canal. When these tissues enlarge, prolapse, or develop clots, symptoms referred to as “hemorrhoidal disease” may develop. Internal hemorrhoids are located inside the anal canal, while external hemorrhoids are located in the skin-covered outer section.
What are the symptoms?
- Bright red blood on toilet paper or on the stool
- Fullness, swelling, or protruding tissue in the anus
- Itching, moisture, and irritation
- Discomfort during bowel movements
- Sudden-onset tender, purplish swelling and pain
What causes them?
Constipation, hard stools, prolonged straining, spending excessive time on the toilet, pregnancy, excess weight, and the weakening of supporting tissues with age can increase the risk. Rather than a single cause, bowel habits and individual predisposition play a role together.
How are they evaluated?
Evaluation includes a medical history, external examination, digital rectal examination, and anoscopy when necessary. Additional investigations such as colonoscopy may be required depending on age, family history, anemia, changes in bowel habits, or the characteristics of the bleeding.
Basic steps that can be taken at home
- Gradually increase fiber intake with vegetables, fruits, legumes, and whole grains.
- Consume an amount of fluid appropriate for your health status.
- Do not delay the urge to have a bowel movement; do not strain for prolonged periods and avoid lingering on the toilet.
- Incorporate regular physical activity into daily life.
- If necessary, use bulk-forming fiber or stool softeners upon a physician’s recommendation.
Treatment options
If symptoms do not improve with basic measures, outpatient procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be considered depending on the type and grade of the hemorrhoid. In cases of significant prolapse, recurrent bleeding, or failure to respond to other methods, surgical options may be considered. Current guidelines support considering outpatient procedures before surgery in appropriate stages.
When should an evaluation be sought without delay?
Evaluation should not be delayed if there is heavy or recurrent bleeding, black stools, dizziness, anemia, unexplained weight loss, fever, purulent discharge, or progressively worsening pain. Prompt medical consultation for a sudden, severely painful external swelling can increase treatment options.
Approach in our clinic
Our priority is to accurately determine the cause of bleeding and pain, and to protect the individual from unnecessary anxiety and unnecessary procedures. Bowel habits, nutrition, medications used, and accompanying diseases are evaluated together; if necessary, a referral is made to the relevant surgical or gastroenterology specialty.
Frequently asked questions
Do hemorrhoids turn into cancer?
Hemorrhoids do not turn into cancer. However, because symptoms such as bleeding can be confused with other diseases, new or recurrent bleeding should not be assumed to be “hemorrhoids.”
Do hemorrhoids go away completely?
In many people, symptoms can be significantly controlled with lifestyle modifications and appropriate treatment. The risk of recurrence depends on whether factors such as constipation and straining persist.
