Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

Do you notice specks of bright red blood during bowel movement? You probably have
varicose veins in the anus.

What are hemorrhoids?

Hemorrhoids, also called “piles,” are swollen veins around the anus or in the rectum. They are either under the skin around the anus (external hemorrhoid) or inside the rectum (internal hemorrhoid). External hemorrhoids may cause pain when irritated. Internal hemorrhoids are usually painless but tend to bleed.


Veins in the anus get inflamed because of frequent straining during bowel movements. Passing stool can irritate the delicate surface of already-formed hemorrhoids. That’s why they bleed (painless bleeding). Sometimes straining pushes an internal hemorrhoid through the opening (anus), known as prolapsed hemorrhoid. They now become painful when irritated.

Hemorrhoids also result from increased pressure on the veins during pregnancy, chronic (persistent) constipation or diarrhea, anal infections, sitting for long periods of time, and aging.

By age 50, about half of adults will have itching, bleeding, and pain that can signal the presence of hemorrhoids.


Hemorrhoids are very common in both men and women. Signs and symptoms of hemorrhoids include:

· Blood on the stool, on toilet paper, and in the toilet bowl (most common sign)
· Pain or discomfort
· Itching in the anus
· Swelling or presence of a lump around the anus
· Leakage of feces

When it’s time to see a doctor

Symptoms usually go away within a few days. However, if you have frequent or excessive bleeding, especially if you have never bled from hemorrhoids before, you should immediately see a physician. A physical examination will also rule out a more serious condition. Bleeding can occur with other diseases like colorectal cancer and anal cancer.
If you’re passing black, tarry, or maroon stools, and have blood or blood clots mixed in with the stool, this signals more extensive bleeding elsewhere in the gastrointestinal tract.
Seek emergency assistance if you experience bleeding, lightheadedness, dizziness, or faintness.

Most of the time, hemorrhoids can be managed with self-care and lifestyle changes. In cases of severe hemorrhoids, however, you may need to resort to medications and medical procedures.

For mild hemorrhoids, warm baths may help with the discomfort. Sitting in warm water (sitz bath) for 10 to 15 minutes will have a relaxing effect. Over-the-counter stool softeners can ease constipation and reduce straining. Creams with hydrocortisone can be used for pain and swelling. For itching, try applying witch hazel on cotton swabs on the itchy area and wear only cotton undergarments. Avoid scratching.

For larger hemorrhoids or hemorrhoids that do not respond to home remedies, a medical procedure may be necessary. Minimally invasive procedures may involve tying off the base of the hemorrhoid to make it wither and fall off (ligation) or injecting a solution into the lump to make it shrink (sclerotherapy). Coagulation therapy using infrared/laser light or heat is also used to dry up and shrink internal hemorrhoids.

A surgical procedure (hemorrhoidectomy) will completely remove large varicose tissue that causes extensive bleeding and persistent pain and discomfort.


Avoiding activities that can trigger the formation or worsening of hemorrhoids will spare you from health complications and economic costs.

Preventive steps are simple:
Drink plenty of fluids. Make a habit of drinking 6 to 8 glasses per day of water and other liquids (except alcohol).

Eat high-fiber foods. Keeping your stool soft will keep you from straining. A diet higher in fruits, vegetables, and whole grains will prevent constipation.

Consider fiber supplements. Sometimes it’s difficult to regularly maintain the recommended fiber intake (20 to 35 grams a day). Keeping supplements on hand helps prevent the reappearance of symptoms. Fiber supplements are to be strictly taken with at least six to eight glasses of water every day, otherwise, they make constipation worse.

Avoid straining as much as possible. Bearing down when passing stool puts pressure on the veins in the rectum.

Avoid sitting too long. Protracted sitting on the toilet weighs down on the veins in the anus.

Don’t postpone bowel movements. Waiting to pass stool or restraining an urge for a while can make the stool dry and harder to pass.
Exercise. Weight loss eases pressure on the veins, weight shifting distributes the load on the body, and muscle activity promotes good circulation.