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Haemorrhoids (Piles): Types, Causes, Symptoms And Treatment

Piles, also known as haemorrhoids, is the thickening of the blood vessels in the anus which leads to swelling or itchiness in the rectum or anus. This can lead to severe pain while passing stools. Haemorrhoids can be of two types, namely, internal haemorrhoid and external haemorrhoid. Most people suffer from a single type of piles at a given time, while some can suffer from both.

The rare type of haemorrhoids is termed as thrombosed haemorrhoids. Piles can restrict even the simplest of your daily activities, causing discomfort and thereby posing limitations in your day-to-day action[1] [2] .

According to a survey, an estimated 40,723,288 patients are suffering from piles or haemorrhoids in India and each year, more than a million new cases are reported. 3 out of 4 adults will develop haemorrhoids at some point in their lives [3] . However, that does not state that one will develop haemorrhoids only once in their lifetime.

Types Of Haemorrhoids

There are 3 types of haemorrhoids and they are as follows [4] :

Internal haemorrhoids: These type of piles are located inside the rectum and are not usually visible. Internal ones rarely cause any discomfort but can be painful when straining or passing stool.

External haemorrhoids: These type of haemorrhoids develop under the skin around the anus and can be extremely painful.

Thrombosed haemorrhoids: These are similar to external haemorrhoids but have no blood flow due to a blood clot in the vein [5] .

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Causes Of Haemorrhoids

It is asserted that haemorrhoids are caused due to increased pressure in the lower rectum. As the veins under around the anus stretch due to pressure, it can bulge or swell. The causes of the condition are as follows [6] :

  • Regular heavy lifting
  • Obesity
  • Anal intercourse
  • Straining during bowel movements
  • Having chronic diarrhoea or constipation
  • Sitting for long periods
  • Pregnancy
  • Eating a low-fibre diet

Symptoms Of Haemorrhoids

The signs of the condition usually develop depending on the type of haemorrhoid.

For internal haemorrhoids, the symptoms are as follows [7] :

  • Painless bleeding during bowel movements
  • A protruding haemorrhoid near the anal opening
  • Pain
  • Irritation

For external haemorrhoids, the symptoms are as follows [7] :

  • Pain or discomfort
  • Itching or irritation in your anal region
  • Bleeding
  • Swelling around your anus

For thrombosed haemorrhoids, the signs are as follows [8] :

  • Swelling
  • Severe pain
  • A lump near the anus
  • Inflammation

Risk Factors Of Haemorrhoids

One of the major risk factors of haemorrhoids is age. That is, as you age, the tissues that support the veins in your rectum and anus becomes weak and stretched out[9] .

Apart from ageing, pregnancy can also pose as a risk factor.

Complications Of Haemorrhoids

It is rare but in some cases, haemorrhoids can cause the following complications [10] :

Strangulated haemorrhoid: When the blood supply to an internal haemorrhoid is cut off, it can become strangulated and cause severe pain.

Blood clot: Sometimes, a blood clot can develop in the haemorrhoids and can cause discomfort and pain.

Anaemia: In very rare cases, chronic blood loss from haemorrhoids may cause anaemia.

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Diagnosis Of Haemorrhoids

The doctor will be able to see and examine external haemorrhoids. For the internal haemorrhoids, the examination of the anal canal and rectum are required [11] .

A digital examination and a visual examination will be carried out to confirm the diagnosis.

Treatment For Haemorrhoids

For most cases, the doctors will prescribe oral pain relievers and topical treatments such as over-the-counter haemorrhoid cream, ointments, suppositories or pads.

In severe cases, an external haemorrhoid thrombectomy will be carried out. Apart from that, minimally invasive procedures such as rubber band ligation, sclerotherapy (injection) or coagulation (infrared, laser or bipolar) will be prescribed [12] [13] .

Only a small percentage of people with haemorrhoids require surgery. Procedures such as haemorrhoid removal (hemorrhoidectomy) or a haemorrhoid stapling will be done.

View Article References
  1. [1] Luchtefeld, M., & Hoedema, R. E. (2016). Hemorrhoids. In The ASCRS Textbook of Colon and Rectal Surgery (pp. 183-203). Springer, Cham.
  2. [2] Yang, J. Y., Peery, A. F., Lund, J. L., Pate, V., & Sandler, R. S. (2019). Burden and cost of outpatient hemorrhoids in the United States employer-insured population, 2014. American Journal of Gastroenterology, 114(5), 798-803.
  3. [3] Ratto, C., Parello, A., & Litta, F. (Eds.). (2018). Hemorrhoids. Springer.
  4. [4] Goldin, A., Horton, L., Thapa, N., & Chan, W. W. (2018). Vaginal Delivery Is Independently Associated With Internal Hemorrhoids: 169. American Journal of Gastroenterology, 113, S95.
  5. [5] Higuero, T., Abramowitz, L., Castinel, A., Fathallah, N., Hemery, P., Duhoux, C. L., ... & Staumont, G. (2016). Guidelines for the treatment of hemorrhoids. Journal of visceral surgery, 153(3), 213-218.
  6. [6] Sandler, R. S., & Peery, A. F. (2019). Rethinking what we know about hemorrhoids. Clinical Gastroenterology and Hepatology, 17(1), 8-15.
  7. [7] Mott, T., Latimer, K., & Edwards, C. (2018). Hemorrhoids: Diagnosis and Treatment Options. American family physician, 97(3).
  8. [8] Erbay, M. Ş., & Sarı, A. (2018). Plants used in traditional treatment against hemorrhoids in Turkey. Inf., Int, 19(23), 17.
  9. [9] Cintron, J., Abcarian, A. M., Abcarian, H., Makiewicz, K., & Brand, M. I. (2017). Hemorrhoids. In Complications of Anorectal Surgery (pp. 61-108). Springer, Cham.
  10. [10] Piskun, G., Gutelius, P., & Shikhman, O. (2018). U.S. Patent No. 9,883,879. Washington, DC: U.S. Patent and Trademark Office.
  11. [11] Jacobs, D. (2018). Hemorrhoids. Current Opinion in Gastroenterology, 34(1), 46-49.
  12. [12] Wilson, M. Z., & Notaro, J. R. (2019). Management of Hemorrhoids. In Clinical Algorithms in General Surgery (pp. 289-291). Springer, Cham.
  13. [13] Maurello, J., & Rosenblum, A. (2017). U.S. Patent Application No. 15/530,461.

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