Hemorrhoids: The Good, the Bad and the Ugly

Hemorrhoids, a condition also referred to as “piles”, is one of the most common conditions of the lower part of the gastrointestinal system, specifically the anorectal area. The “bad” of hemorrhoids is that they can be a persistent uncomfortable condition that gets triggered very easily. This medical condition may affect both men and women alike. Age-wise, it is more common in adults than it is in children.

Therefore, the big question, what are hemorrhoids? Anatomically, hemorrhoids are a vascular condition in which veins called hemorrhoid plexuses, found in the rectal or anal area become swollen, inflamed or thrombosed. An unwanted buildup of pressure in these veins creates an edematous state leading to piles. We will explore the common causes of hemorrhoids, the different types and classifications of hemorrhoids, as well as treatment and preventive measures one can take to avoid getting hemorrhoids or minimize the severity of it.

Causes of Hemorrhoids

There are various causes of hemorrhoids, and we will look at how and why these factors lead to this uncomfortable condition. As mentioned that hemorrhoids happen when there is vascular pressure in the anorectal veins, causes include any risk factor that contributes to this pressure.

1.       Chronic constipation or diarrhea: one of the biggest causes of hemorrhoids or piles, is constipation. This happens when your stools become hardened due to sluggish peristalsis in your intestines coupled with lack of sufficient water hydration and fiber consumption. On passing the hardened stool, during straining, pressure builds up against the rectal walls leading to venous swelling. Similarly, chronic diarrhea irritates the lining of the rectum causing inflammation which leads to venous swelling around the rectum and anus and leads to piles.

2.        Obesity: being overweight is another high-risk factor for piles. Obesity means that you are carrying more body mass than your bone structure is built for. The extra weight comes in the form of accumulated fat, particularly around the abdomen. The gravitational heaviness of the extra weight in the midsection or waist area leads to constant pressure building in the pelvic region.

3.       Pregnancy: Like obesity, pregnancy is also a common cause of hemorrhoids. This is most experienced in the third trimester of pregnancy in which the growing baby increases the pelvic region pressure. Additionally to the baby’s descending weight, an elevated increase of progesterone secretion which relaxes vasculature, worsens the case of piles in pregnant women. Because of a slowed metabolism during pregnancy, most women suffer from constipation which is the number one risk factor for hemorrhoids.

4.       Straining on defecation: Though it sounds normal to strain when having a bowel movement, it is however something to avoid, especially when one is already prone to hemorrhoids. Constant straining inadvertently leads to venous pressure buildup in the rectal veins, causing piles. In the same vein, sitting on the toilet for prolonged periods of time contributes to hemorrhoid formation. It follows a similar process as that of pregnancy hemorrhoids or obesity hemorrhoids- the pelvic pressure buildup.

5.       Heavy lifting: lifting heavy objects, especially for people who work in industries where heavy lifting is part of their daily operation is another contributing risk factor for piles. Again, this action increases the pressure in the abdomen, resulting in piles.

Classification of Hemorrhoids

Hemorrhoids are classified according to their severity and presentation. They can either be found internally or externally, can be prolapsed or thrombosed. Internal hemorrhoids are found inside the rectum while external hemorrhoids are located under the skin of the anus. Internal hemorrhoids are less painful than external hemorrhoids and the visibility of both differs, as internal hemorrhoids are usually tucked inside the rectal canal (unless prolapsed), but external hemorrhoids can be clearly seen and felt at the anal area and often leave skin tags. Internal hemorrhoids are graded from the least severe to the most severe case and fall within 4 categories, 1st degree hemorrhoids being least severe to fourth degree hemorrhoids being the most severe.

First degree hemorrhoids are found located internally in the anal canal. Though the vascular swelling can be felt with a finger examination, they do not project out of the anus. They remain tucked within the rectal canal. They may or may not bleed.

 Second degree hemorrhoids begin to protrude through the anus when one strains during a bowel movement. They do, however, automatically go back inside the anus on their own post defecation.

Third degree hemorrhoids are also prolapsed hemorrhoids which come out on straining and require manual retraction back into the anal canal.

Fourth degree hemorrhoids are the most severe cases of internal hemorrhoids as they are constantly protruding from the anus and cannot be pushed back in manually. These require medical intervention for correction.

Treatment and Prevention of Hemorrhoids

The “good” thing about hemorrhoids is that they can be well managed at home through various means. The first line of treatment or prevention of piles is lifestyle change and adjustment. However, If piles get severe, one should consult a physician. Let us first look at how you can prevent, treat or decrease your risk of getting hemorrhoids or manage them while they are still mild or moderate in severity.

Water hydration: Seeing that constipation is the number one contributing factor of hemorrhoids, it is advisable for one to increase their fluid intake. Minimum fluid hydration should be achieved, if not surpassed if one already suffers from hemorrhoids (6-8 glasses of water or more daily). Lack of adequate hydration may lead to slower peristalsis (movement of food through the intestines), leading to constipation.

Fiber Intake: Consuming foods high in fiber assists with managing your digestive system to function optimally, including its absorption and excretion processes. Fiber assists in softening stools, hence preventing constipation and fecal impaction. One should also limit the consumption of processed foods as they are low in fiber and high in saturated fats thus contributing to constipation and piles.

Alcohol Intake: Minimizing alcohol consumption is important if one wants to manage hemorrhoids well. Alcohol tends to irritate the connective tissue inside your rectum causing more pain from hemorrhoids. Alcohol is also well known to lead to dehydration, which ultimately may cause your constipation to worsen, with a ripple effect on your piles.

Pure Coconut Oil: the best home remedy for hemorrhoids is believed to be pure coconut oil, organic or virgin coconut oil. It is well known for its anti-inflammatory, analgesic and antibacterial properties. This is because pure coconut oil is composed of 50% lauric acid, a compound which strengthens the intestinal lining, maximizing lower gut digestion. It can be used topically or ingested in foods. While coconut oil is considered safe to use for most people, any sensitivity must be monitored. It is also not recommended to use coconut oil if your case of hemorrhoids is caused by diarrhea instead of other factors.

Over-the-counter Medication: there are now numerous medications one can get from local chemists which can be used to treat hemorrhoids. Corticosteroids like Anusol creams help relieve inflammation and itchiness from the anal area during a flare of piles. Some topical creams are local anesthetics which can numb the anal area, providing much-needed pain relief. Speak with your pharmacist.

Sitz Baths: are a shallow warm bath in which you soak in for approximately 15-20 minutes to treat your peri-anal area to soothe pain and the discomfort caused by hemorrhoids. Warm water lowers the anal sphincter pressure in the rectum thus relaxing its muscles. In this way, they promote vasodilation or blood flow. Sitz baths can be done at least twice a day, or as needed.

Surgical & Non-Surgical procedures: the most common surgical procedure for hemorrhoids is called hemorrhoidectomy, which is the excision of piles. Another common non-surgical procedure for piles is banding or band ligation, which is less invasive than a hemorrhoidectomy. It’s when a rubber band is used to tie off blood supply at the base of the hemorrhoid and it ends up falling off. There are other surgical and non-invasive procedure options available that one can discuss with their physician.

The “ugly” part about hemorrhoids is that if left untreated, they can become complicated, whether it is from incessant bleeding, constant anal pain or prolapse, at which instance one should seek urgent medical assistance. Complicated hemorrhoids can lead to more severe conditions like anemia, anal infections, and hemorrhoid strangulation. For more severe cases of hemorrhoids, surgical interventions may be required.

Remember that for any extreme cases of hemorrhoids, whether it is severe bleeding or severe pain, it is best to consult with a healthcare professional for medical advice and treatment options in order to avoid your hemorrhoids complicating.

References

LeWine, EH. (2024) Hemorrhoids and what to do about them. Available at: https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them (Accessed on: 28/04/2025)

Haemorrhoids (2024). Available at: https://www.healthdirect.gov.au/haemorrhoids-piles (Accessed on: 28/04/2025)

Badvie, S. (2023). Haemorrhoids (Piles). Available at: https://www.bupa.co.uk/health-information/digestive-gut-health/haemorrhoids (Accessed on: 30/04/2025)

Silver, N., Nunez, K. (2021). What to know about Pregnancy Hemorrhoids. Available at: https://www.healthline.com/health/pregnancy/pregnancy-hemorrhoids (Accessed on: 30/04/2025)

Rung, R. (2024) What do Hemorrhoid grades mean? Available at: https://www.healthline.com/health/hemorrhoid-grades (Accessed on: 06/05/2025)

Sareen, P. (2021) Coconut oil for Hemorrhoids. Available at: https://www.pristyncare.com/blog/coconut-oil-for-hemorrhoids-pc0135/ (Accessed on: 15/05/2025)

Assessed and Endorsed by the MedReport Medical Review Board