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Living with Hemorrhoids
You can find all the necessary information to understand Hemorrhoids, its global impact, its causes and consequences, and how to get Hemorrhoids under control.
Hemorrhoids

What causes hemorrhoids

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Hemorrhoids are clusters of swollen veins in your anus and lower rectum, similar to varicose veins.1

They are a result of increased pressure on the blood vessels in your anal canal and can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids), often leading to anal discomfort, bleeding, itching or pain.1

What do hemorrhoids look like

External hemorrhoid
Internal hemorrhoid
Anal canal anatomy

External Hemorrhoids

External Hemorrhoids are what most people think of when they picture hemorrhoids. Location is the only difference between the two different types of piles, but the difference in discomfort can be considerable. External hemorrhoids form on the outside of the anus, directly on the opening where there are lots of nerve endings, so can be particularly itchy and painful.

Internal Hemorrhoids

Internal Hemorrhoids are formed deep inside the anus and are not usually visible. They can resolve without treatment, but occasionally they will swell and protrude from the anus. Prolapsed hemorrhoids are internal hemorrhoids that have grown to the point that they protrude from the anus.

Symptoms of Hemorrhoidal Disease

The symptoms of hemorrhoids are many and varied. Typically, hemorrhoidal swelling leads to anal discomfort and itchiness and you might feel a bulge in your bottom, experience anal discharge, redness and inflammation, or see blood when using the toilet.1,2 If you experience this or any of the illustrated symptoms for the first time (or if your symptoms extend beyond a couple of days), you should consult a doctor to rule out other conditions instead of self-treating right away.
Incomplete evacuation
Bleeding
Anal itching
Pain or discomfort

Treat Your Symptoms Early

Hemorrhoidal symptoms can start off quite mildly and often resolve on their own, but this isn’t always the case. Understand the benefits of taking action to treat and prevent hemorrhoid symptoms.1

Grade 1

  • Bleeding
  • Visible on proctoscopy
  • Protusion on straining
  • No prolapse

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Grade 1

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There may be bleeding, discomfort and itching, and protrusion on straining, but no evidence of prolapse. It is nonetheless essential that you treat from this first stage to avoid worsening symptoms.

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Grade 2

  • Bleeding
  • Protusion on straining
  • Prolapse visible at anal margin during straining
  • Spontaneous return when straining ends

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Grade 2

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Without treatment, your condition may worsen, leading to pain when using the toilet, bleeding and hemorrhoids that tend to prolapse when straining, but reduce when straining ceases.

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Grade 3

  • Bleeding
  • Protusion on straining
  • Visible on proctoscopy
  • Prolapse requiring manual reduction

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Grade 3

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When hemorrhoids progress to Grade 3, bleeding is more frequent and your piles will prolapse on straining and need to be pushed back in. You can do this yourself. If there is a thrombosis (blood clot inside the vein) as well, the pain may be very strong.

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Grade 4

  • Bleeding
  • Discharge
  • Permanent and irreductible prolapse

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Grade 4

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Is the most serious stage. You will have permanent piles that you can’t push back in yourself without pain in addition to previous signs and symptoms. Surgery in addition to venoactive treatments becomes essential.

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The main symptoms of Hemorrhoidal Disease that can occur at all grades of the disease are bleeding, pain, itching and discomfort.

Risk factors of Hemorrhoidal Disease

Low dietary fiber diet, spicy diet, alcohol intake

Obesity

Age

Pregnancy

Sedentary lifestyle

Chronic straining during defecation

Prolonged sitting on the toilet

Constipation and diarrhea

Hemorrhoidal Disease affects people from all walks of life at various stages in their lives. Main risk factors for hemorrhoidal disease include chronic constipation, obesity, increasing age or pregnancy. But there are many reasons you might find yourself looking for solutions to hemorrhoids, some of which you can take steps to change.3

Show references

References

1
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World Journal of Gastroenterology 2012;18(17):2009-2017
2
Journal of Gastroenterology 2012. May 7;18 (17): 2009-2017. Chronic venous and HemORrhoidal diseases evalUation and Scientific research; Godeberge P.J Gastroenerol Hepatol. 2020;35:557-87
3
De Marco S, Tiso D. Lifestyle and Risk Factors in Hemorrhoidal Disease. Front Surg. 2021 Aug 18;8:729166. doi: 10.3389/fsurg.2021.729166. PMID: 34485376; PMCID: PMC8416428.
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The content is not intended to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Last modified date: 11/14/2023
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