Haemorrhoids, or piles, are swollen cushions of blood vessels in and around the anal canal. Internal haemorrhoids lie inside and are graded I to IV by how far they protrude. External haemorrhoids sit under the skin at the anal edge and cause trouble mainly when a clot forms in them.
They are very common and harmless. Most settle with softer stools and better toilet habits. Office procedures such as banding treat persistent bleeding or moderate prolapse, and surgery is kept for large or stubborn piles. Bleeding should not be assumed to come from haemorrhoids without an examination.
Symptoms
- Bright red blood on the paper, in the pan or coating the stool, usually painless
- A lump that comes out on straining and goes back on its own or with a finger
- Itching and irritation around the anus
- Mucus discharge or soiling of underwear
- A feeling of incomplete emptying
- Sudden painful, firm bluish lump at the anal edge when an external pile clots
Causes and risk factors
The anal cushions enlarge and slide downwards when their supporting tissue weakens and pressure in the veins rises. Contributors are straining and constipation, long periods sitting on the toilet, often with a phone, chronic diarrhoea, low-fibre diet, pregnancy and childbirth, excess weight, heavy lifting and ageing. They are not caused by sitting on cold surfaces or by spicy food, although the latter can irritate existing symptoms. Cirrhosis causes a different problem, rectal varices.
How it is diagnosed
- History and inspection: The doctor asks about bleeding pattern, bowel habit and family history of bowel cancer, and inspects the area at rest and on straining.
- Digital rectal examination: A gloved finger checks for lumps, tenderness and sphincter tone. Internal piles are soft and often not felt.
- Proctoscopy or anoscopy: A short lighted tube shows internal haemorrhoids and their grade, and excludes fissure. It takes a minute and needs no preparation.
- Sigmoidoscopy or colonoscopy: Advised for bleeding in people over about 45 to 50, with a change in bowel habit, anaemia, weight loss, dark blood mixed in the stool or a family history of bowel cancer.
Treatment options
- Fibre, fluids and toilet habits: 25 to 30 grams of fibre a day or a psyllium supplement, enough water, no straining, and no more than a few minutes on the toilet. This alone resolves many cases.
- Creams, suppositories and sitz baths: Short-term relief of itching and soreness. Steroid-containing products should not be used for more than a week or two.
- Rubber band ligation: A band is placed at the base of an internal pile in the clinic with no anaesthetic. The pile drops off in about a week. Best for grades I to III, sometimes repeated.
- Sclerotherapy and infrared coagulation: Alternatives to banding for small bleeding piles, and for people taking blood thinners.
- Haemorrhoidal artery ligation: Doppler-guided stitching of feeding arteries with a lifting stitch for prolapse. Less painful than excision, with a somewhat higher recurrence.
- Laser haemorrhoidoplasty: A laser fibre shrinks the pile from inside. Recovery is quick. Long-term recurrence data are less mature than for excision.
- Excisional haemorrhoidectomy: The most effective and lasting option for grade III to IV or mixed piles. Recovery is painful for 1 to 2 weeks.
- Clot removal: A thrombosed external pile can be opened under local anaesthetic if seen within the first 2 to 3 days.
When it is urgent
Seek urgent local care for heavy rectal bleeding that does not stop, passing clots, feeling faint, or black tarry stools. Also for a prolapsed pile that cannot be pushed back and becomes very painful, dark or swollen, or for severe anal pain with fever or difficulty passing urine, which may mean an abscess.
Travelling to Türkiye for treatment
Banding and similar office treatments are quick, but one or more repeat sessions may be needed weeks apart, which suits local care better. A planned operation such as haemorrhoidectomy, artery ligation or laser treatment can be done on a visit, with about 5 to 7 days in the city. Sitting through a long flight in the first week after excision is uncomfortable, so allow time, take stool softeners, and arrange who to call at home if delayed bleeding occurs around days 7 to 10.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Could the bleeding be something more serious?
It could. Haemorrhoids are the commonest cause of bright red bleeding, but polyps, inflammatory bowel disease and cancer can look the same. An examination, and colonoscopy where indicated, gives the answer.
Is laser treatment better than conventional surgery?
It is less painful with a faster return to work, and suits grade II to III piles. For large or external components excision remains more durable. Ask the surgeon which fits your grade.
Will haemorrhoids come back after treatment?
They can, particularly if constipation and straining continue. Recurrence is lowest after excision and higher after banding and laser.
Are haemorrhoids dangerous in pregnancy?
No. They are common in the last trimester and after delivery, and most shrink within weeks. Treatment is with fibre, fluids and soothing measures, and procedures are postponed.