Hemorrhoids

Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus. They can be classified as internal or external. Internal hemorrhoids develop inside the anal canal and usually cause painless bright red bleeding during bowel movements; external hemorrhoids form under the skin around the anus and may cause itching, irritation, swelling, or pain, especially if a blood clot forms (thrombosis). In some cases hemorrhoids protrude through the anus (prolapse).

Causes and risk factors include increased pressure on the anorectal veins from straining during bowel movements, constipation, or diarrhea; prolonged sitting; pregnancy; aging; obesity; heavy lifting; and certain liver or venous disorders. A family history of hemorrhoids may also be a factor.

Diagnosis is typically based on symptoms and a physical examination. A digital rectal exam and visual inspection are common, with anoscopy or proctoscopy used to view the internal hemorrhoids. In appropriate adults, screening for other conditions such as colorectal cancer may be recommended based on age and risk factors.

Management focuses on relieving symptoms and preventing recurrence. Conservative measures include a high-fiber diet with adequate fluids, stool softeners if needed, regular exercise, and avoiding prolonged straining. Topical over-the-counter treatments, sitz baths, and cold packs can provide symptomatic relief. For persistent or more pronounced internal hemorrhoids, office procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be used. Larger hemorrhoids or those with significant symptoms may require surgical options such as hemorrhoidectomy or stapled hemorrhoidopexy. Thrombosed external hemorrhoids may require urgent evaluation and sometimes drainage.

Prognosis is generally good with appropriate treatment, though symptoms can recur. Prevention emphasizes maintaining soft stools, hydration, regular bowel habits, and avoiding unnecessary straining.