Hemorrhoids: Causes, Symptoms, and Treatment

Hemorrhoids: Causes, Symptoms, and Treatment Options


Hemorrhoids, commonly known as piles, are swollen and inflamed blood vessels in the anus and rectum that can cause discomfort and pain. While they are a common condition, affecting millions of people worldwide, they can significantly impact an individual’s quality of life. This article will delve into the risk factors, causes, types, signs and symptoms, investigations, treatment options, prevention strategies, and lifestyle changes recommended by the World Health Organization (WHO) for managing hemorrhoids.

Risk Factors

Certain factors increase the likelihood of developing hemorrhoids, including:

  1. Age: Hemorrhoids become more prevalent as people age, with the highest incidence occurring between the ages of 45 and 65.
  2. Obesity: Being overweight or obese puts extra pressure on the rectal area, increasing the risk of hemorrhoids.
  3. Pregnancy: Hormonal changes and increased pressure on the veins during pregnancy can lead to the development of hemorrhoids.
  4. Chronic constipation or diarrhea: Straining during bowel movements or experiencing prolonged diarrhea can contribute to hemorrhoid formation.
  5. Sedentary lifestyle: Sitting or standing for extended periods without breaks can hinder blood flow and increase the risk of developing hemorrhoids.


Hemorrhoids can develop due to various factors, including:

  1. Increased pressure: Straining during bowel movements, heavy lifting, chronic coughing, or vomiting can cause increased pressure on the veins in the rectal area, leading to hemorrhoid formation.
  2. Weakened connective tissue: Weaknesses in the walls of the blood vessels in the rectal area can make them more susceptible to swelling and inflammation.
  3. Genetic predisposition: Some individuals may have an inherited tendency to develop hemorrhoids.
  4. Low-fiber diet: Insufficient fiber intake can lead to constipation, which in turn can contribute to the development of hemorrhoids.


  1. Internal hemorrhoids: These occur within the rectum and are usually painless. Symptoms may include bright red blood during bowel movements, a feeling of incomplete evacuation, and protrusion of hemorrhoid tissue during straining.
  2. External hemorrhoids: These develop under the skin around the anus and can be painful. Symptoms may include itching, pain, swelling, and the presence of a lump or a sensitive, hard mass around the anus.


When diagnosing hemorrhoids, healthcare professionals may perform the following investigations:

  1. Physical examination: A healthcare provider may perform a visual examination of the anus and rectal area to assess for the presence of hemorrhoids.
  2. Digital rectal examination (DRE): By inserting a gloved, lubricated finger into the rectum, a doctor can check for any abnormalities or internal hemorrhoids.
  3. Colonoscopy or sigmoidoscopy: These procedures involve using a flexible tube with a camera to examine the colon and rectum for any underlying conditions or complications.


Treatment for hemorrhoids typically involves a combination of medical interventions and lifestyle modifications. The WHO recommends the following approaches:

  1. Conservative measures: Increasing dietary fiber intake, drinking an adequate amount of water, and avoiding excessive straining during bowel movements can help alleviate symptoms and prevent further complications.
  2. Topical medications: Over-the-counter creams, ointments, or suppositories containing hydrocortisone or witch hazel can provide temporary relief from itching and discomfort.
  3. Procedures: In more severe cases, medical procedures such as rubber band ligation, sclerotherapy, or surgical removal may be necessary to treat hemorrhoids.

Grades of Hemorrhoids

Understanding the Severity Levels and Treatment Approaches

Hemorrhoids are often classified into different grades or severity levels based on their size, prolapse, and symptoms. Understanding the grades of hemorrhoids can help healthcare professionals determine the most appropriate treatment approach. In this article, we will explore the different grades of hemorrhoids and their corresponding characteristics.

Grade 1 Hemorrhoids: Grade 1 hemorrhoids are considered the mildest and least severe. Key characteristics include:

  • Internal hemorrhoids that do not prolapse or protrude outside the anus.
  • Minimal or no symptoms, with occasional bleeding during bowel movements.
  • No significant discomfort or pain.

Grade 2 Hemorrhoids: Grade 2 hemorrhoids are slightly more severe than grade 1. Important details include:

  • Internal hemorrhoids that may prolapse or protrude outside the anus during bowel movements.
  • Spontaneous retraction of prolapsed hemorrhoids back into the rectum after bowel movements.
  • Symptoms can include bleeding, mild discomfort, and itching.

Grade 3 Hemorrhoids: Grade 3 hemorrhoids are considered moderately severe. Key characteristics include:

  • Internal hemorrhoids that prolapse or protrude outside the anus during bowel movements and require manual manipulation to retract them.
  • Prolapsed hemorrhoids may spontaneously retract but can also remain outside the anus.
  • Symptoms can include bleeding, discomfort, itching, and difficulty maintaining hygiene.

Grade 4 Hemorrhoids: Grade 4 hemorrhoids are the most severe and often require medical intervention. Important details include:

  • Internal hemorrhoids that remain prolapsed or protruded outside the anus and cannot be manually retracted.
  • Prolapsed hemorrhoids may become trapped outside the anus, leading to complications such as thrombosis (blood clots) or strangulation (restriction of blood supply).
  • Symptoms can include bleeding, significant pain, itching, discomfort, and difficulty maintaining hygiene.

Treatment Approaches for Different Grades of Hemorrhoids

The treatment approach for hemorrhoids depends on their grade or severity level:

  • Grade 1 and 2 hemorrhoids: These milder cases often respond well to lifestyle changes, such as increasing dietary fiber, staying hydrated, and using over-the-counter creams or ointments for symptom relief. Minimally invasive procedures like rubber band ligation or sclerotherapy may also be considered.
  • Grade 3 hemorrhoids: These cases may require more advanced procedures like rubber band ligation, infrared coagulation, or other minimally invasive techniques to shrink and treat the hemorrhoids. Surgical removal may also be considered for persistent or severe symptoms.
  • Grade 4 hemorrhoids: Surgical removal, known as hemorrhoidectomy, is often recommended for grade 4 hemorrhoids due to the complexity and severity of the condition. Other advanced techniques like hemorrhoidal artery ligation or stapled hemorrhoidopexy may also be considered.

Prevention and Lifestyle Changes

To prevent hemorrhoids or minimize their recurrence, the following lifestyle changes are recommended:

  1. Maintain a high-fiber diet: Consuming foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, helps prevent constipation and promotes regular bowel movements.
  2. Stay hydrated: Drinking an adequate amount of water throughout the day helps keep stools soft and easy to pass.
  3. Avoid prolonged sitting or standing: Take regular breaks and engage in physical activity to improve blood circulation and reduce pressure on the rectal area.
  4. Practice good bathroom habits: Avoid straining during bowel movements and use the bathroom as soon as the urge arises.
  5. Manage weight: Maintaining a healthy weight through regular exercise and a balanced diet helps reduce the risk of developing hemorrhoids.

Hemorrhoids can be a painful and disruptive condition, but with the right knowledge, preventive measures, and treatment options, individuals can manage and alleviate symptoms effectively. By following the lifestyle changes recommended by the WHO, individuals can reduce their risk of developing hemorrhoids and improve their overall well-being. It is always advisable to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.

Author: Dr. Rabia
Dr Rabia Akhtar, MBBS(Bachelor of Medicine and Bachelor of Surgery), has perceived her graduation from India. Special Interest: Surgery, Chronic disease, Emergency Medicine, Paediatrics, Women's Health.
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