What are haemorrhoids?
What people often call piles or haemorrhoids are basically swollen veins around your bottom. They can show up inside or outside the anus.
Sometimes cause itching, pain or a bit of bleeding when you go to the toilet.
They’re very common and generally not dangerous.
Does everyone have haemorrhoids?
Yes, everyone actually has haemorrhoids. They’re a normal part of your body.
Haemorrhoids are cushions of blood vessels that sit just under the inner lining of your lower rectum and anus. Their job is to help seal the area, keeping things watertight and airtight so stool or gas doesn’t leak out. In fact, they play a small but important role in control, about 20% of your baseline continence.
These blood vessels can temporarily swell when you strain, such as when lifting something heavy, and this helps them do their job more effectively.
When people say they ‘have haemorrhoids’ or piles, they usually mean these normal structures have become swollen, irritated or are giving symptoms.
What causes haemorrhoids to flare up and cause problems?
Haemorrhoids become problematic when they swell, stretch or become irritated, turning them into ‘symptomatic haemorrhoids’. Repeated pressure or strain can make them more prone to irritation and ongoing symptoms.
The most common trigger is straining during bowel movements, often due to constipation (hard stools) or, less often, diarrhoea. Straining increases pressure inside the abdomen, which pushes more blood into these veins and causes them to enlarge.
Other contributing factors include:
- Pregnancy, due to increased pelvic pressure and reduced blood return.
- Heavy lifting or chronic coughing.
Modern toilet posture also plays a role, as it can encourage more straining compared to a natural squatting position.
Genetics may also play a part, some people may have naturally weaker supporting tissue or differences in their blood vessels that make them more likely to develop symptomatic haemorrhoids, although this isn’t fully understood.
In most cases, it’s a combination of factors rather than a single cause.
Types of haemorrhoids
Haemorrhoids are usually described based on where they sit in relation to something called the dentate line. The dentate line is a natural boundary in the anal canal that separates the rectal lining (inside) from the skin around the anus (outside), which affects how haemorrhoids feel and behave.
- Internal haemorrhoids
These sit above the dentate line, inside the rectum. They’re covered by the same lining as the bowel and they’re usually not painful. - External haemorrhoids
These are below the dentate line, under the skin around the anus. Because this area is more sensitive, they can be painful or itchy . They feel like small lumps.
Some people have a combination of both internal and external haemorrhoids, these are called mixed haemorrhoids.
Why do they cause different symptoms?
The difference in pain between internal and external haemorrhoids comes down to nerves.
Internal haemorrhoids are inside the rectum and have nerves that sense pressure, so you usually don’t feel pain. They are part of the autonomic nervous system.
External haemorrhoids, on the other hand, are under the skin around the anus and have nerves that sense pain and temperature (somatic nerves), which is why they can be so sore or tender.
Knowing the type helps your doctor decide the best treatment approach.
Itch, pain, lumps? Could be haemorrhoids
Haemorrhoids become problematic when they swell, stretch or their supporting tissue weakens. This can lead to bleeding, discomfort, itch or even tissue protruding outside the anus.
Internal Haemorrhoids
Most symptoms come from internal haemorrhoids that stretch over time and cause:
- Bleeding
Usually painless and bright red, often seen on toilet paper, less often dripping in the toilet bowl. - Prolapse (tissue bulging)
The haemorrhoid may stick out during bowel movements. Sometimes it comes back in on its own and sometimes it needs to be gently pushed back in. - Itchiness or irritation
Large internal haemorrhoids can interfere with continence, allowing small amounts of stool or mucus to leak and irritate the skin. - Mucus discharge and soiling
Prolapsed haemorrhoids can leave mucus on the skin around the annus causing staining or soiling of underwear. - Rectal pressure or fullness
You may feel a bulge or heaviness in the rectum after bowel movements.
Pain is uncommon with internal haemorrhoids unless they prolapse severely and become trapped.
Chronic bleeding is usually minor and rarely leads to anaemia.
External Haemorrhoids
External haemorrhoids form under the skin around the anus and usually cause:
- Itching, irritation and moisture
Enlarged veins can make the area uncomfortable and harder to clean. Soiling and moisture can lead to itchiness. - Lumps or bumps
You can often feel or see soft or firm lumps around the anus. - Pain
If a blood clot forms inside an external haemorrhoid can be extremely painful. This is called a thrombosed haemorrhoid and appears as a firm, blue or purple lump.
Once a thrombosed haemorrhoid resolves, it can leave a leftover skin tag – these look like small flaps of skin near the anus. They usually shrink over time, but may not disappear completely, sometimes causing mild irritation or cleaning difficulty.
Checking what’s going on
Most of the time, haemorrhoids are diagnosed clinically – meaning your doctor can work it out based on your symptoms and a simple examination. This usually involves asking about your history and having a look at the area.
In some cases, a small instrument called an anoscope may be used to look just inside the anal canal to confirm the diagnosis.
Haemorrhoids are also found during a colonoscopy, particularly if it was done to investigate bleeding.
Bright red bleeding is often caused by haemorrhoids, but it’s still a good idea to mention it to your doctor to rule out other causes. This is particularly important if you’re over 45 or notice any changes in your bowel habits.
Other conditions, such as polyps, inflammatory bowel disease, diverticular disease or even colorectal cancer can also cause bleeding.
Treatment options
Most haemorrhoids improve with simple care. Your doctor will suggest different approaches depending on your symptoms.
Bowel habits and diet
Hard stools can cause straining and put pressure on haemorrhoids, while loose stools can be irritating. Frequent bowel movements may also worsen symptoms.
A helpful first step in easing the symptoms of haemorrhoids is improving your bowel habits. Ideally, your poo should be soft, smooth and easy to pass, while still holding its shape.
You can achieve this by increasing both your fibre and water intake. Most adults should aim for around 25–50 grams of fibre each day and about 2 litres of water daily.
Fibre helps to bulk and soften the stool, making it easier to pass without straining.
The good news is that you don’t need expensive foods – basic everyday foods like legumes, fruits, vegetables and whole grains can easily help you meet your daily fibre needs.
Some people may need extra fibre if they are not able to get enough from food alone or if constipation or straining continues despite dietary changes. This can be achieved with a fibre supplement such as psyllium. It should always be taken with plenty of water to avoid bloating or worsening constipation.
You could also try taking 1–2 teaspoons of olive oil daily, as it may help lubricate the stool and make it easier to pass, which can reduce straining.
Avoid a high-fat, low-fibre diet, as this can contribute to constipation and straining.
If constipation continues even after improving your diet and increasing your water intake, you may need stool softeners or laxatives to help make your stools softer and easier to pass, but these are best used short-term rather than on a regular daily basis.
Avoid straining and try not to sit on the toilet for long periods of time – this includes scrolling on your phone or reading!
Going to the toilet should only take a few minutes. If nothing happens, it’s best to get up and try again later when you feel the urge return.
Other helpful strategies
Do regular exercise, as it helps keep your bowels moving, reduces constipation and lowers the need to strain.
A toilet stool can help put your body into a more natural squatting position. This straightens the bowel slightly, which can make it easier to pass stool and may reduce straining, especially for people with constipation or pelvic floor dysfunction.
Warm sitz baths or soaking in the bath tub can also be very soothing. Sitting in warm water for about 10–15 minutes, especially after a bowel movement, can help relax the muscles around the anus and reduce pain, swelling and itching from haemorrhoids. In some cases, it may help them go back in if they come out. Sitz baths help with symptom relief and many people find them very comforting.
If irritation from external haemorrhoids is your main problem, it can help to be gentle when cleaning. Dry, rough toilet paper can sometimes make irritation worse, especially with repeated wiping. Instead, try using water (like a bidet, shower or a damp cloth) when possible, or use unscented alcohol-free wipes.
Cease smoking, as it can worsen blood vessel health, which may contribute to haemorrhoid symptoms.
Over the counter remedies
Creams and suppositories may give short-term relief, but they don’t fix the underlying problem. Try not to use them for more than 7 days, especially steroid-containing ones, as they can irritate the skin or cause thinning of the delicate skin over time.
Simple options like cold packs can help with discomfort. If needed, anti-inflammatory medications (like ibuprofen) may also help.
In some countries, medications called phlebotonics are used to help improve vein tone and reduce haemorrhoid symptoms. However, they are not commonly used or part of standard treatment in Australia.
Rubber band ligation or banding
Banding is a common and quick procedure used to treat internal haemorrhoids that continue to cause symptoms despite diet and bowel habit changes. It can be done during a colonoscopy if one is needed to investigate your symptoms, or it may be done in a clinic setting.
A small rubber band is placed 2cm above the dentate line, close to the base of the haemorrhoid, which cuts off its blood supply. Over the next few days, the haemorrhoid shrinks and falls off naturally when you go to the toilet. People go home straight afterwards and continue normal activities.
After the procedure, it’s common to feel a sense of pressure or fullness in the rectum for 1-2 days. It is also expected to have some bleeding about 5–7 days later, when the haemorrhoid tissue falls off—this usually settles on its own quickly.
This treatment is only used for internal haemorrhoids, as external haemorrhoids have a rich nerve supply and banding them would be extremely painful.
Sclerotherapy
Nowadays, it is hardly used. It involves injecting a special solution (a sclerosant) into the internal haemorrhoid, which causes it to become inflamed, scar down, shrink and stick to the rectal wall.
The procedure is relatively simple, but symptoms often come back over time – typically within a few years. Some discomfort or pain can occur, especially in the first 48 hours after the procedure and like any invasive treatment there are risks involved.
Surgical treatment
Only a small number of people with haemorrhoids end up needing surgery. This is usually used when symptoms don’t improve with diet changes or simple treatment or when they keep coming back.
Stapled haemorrhoidopexy
It is a surgical procedure that uses a circular stapling device to remove a ring of excess tissue from just above the haemorrhoids. This lifts the haemorrhoids back into their normal position and reduces their blood supply, which helps them shrink over time.
It is used for internal haemorrhoids that are prolapsing (coming down), it does not treat external haemorrhoids.
Haemorrhoid artery ligation (HAL)
Doppler-guided haemorrhoid artery ligation is a procedure that uses a small probe with ultrasound to find the arteries supplying the haemorrhoids. Once identified, these arteries are tied off to reduce blood flow, which helps the haemorrhoids shrink.
If there is also tissue coming down (prolapse), a internal stitch may be added to lift and secure the tissue back into place.
A key advantage of this procedure is that no tissue is cut away, which often means less pain and a quicker recovery compared to traditional surgery.
Haemorrhoidectomy
It’s usually reserved for more severe cases – like large, prolapsing haemorrhoids or when symptoms haven’t improved with less aggressive treatments. There are a few different surgical techniques, but they all involve removing the haemorrhoid tissue.
It’s very effective and gives long-term relief for most people. The main downside is that recovery can be quite uncomfortable, with significant pain in the first couple of weeks after surgery, which is why it’s generally only used when other treatments haven’t worked.
Prevention tips
Preventing flare-ups often comes down to lifestyle.
- Eat enough fibre (fruit, vegetables, legumes and whole grains) to keep stools soft.
- Drink plenty of water to help fibre work properly.
- Exercise regularly to support normal bowel function.
- Go when you feel the urge – don’t hold on. This can make stools harder.
- Avoid long periods of sitting, and don’t sit on the toilet for too long or use it for reading or scrolling.
- Take breaks from sitting during the day when possible.
These small changes can go a long way in reducing symptoms and helping prevent haemorrhoids from causing trouble.
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