Haemorrhoids, also known as piles, are swollen blood vessels around the anus or in the lower rectum. The condition affects both men and women and can cause itching, discomfort, lumps around the anus and rectal bleeding.
Constipation and straining during bowel movements are among the factors associated with haemorrhoids. However, stress is not established as the most common cause, and symptoms should not automatically be attributed to the condition without a medical assessment.
According to the US National Institute of Diabetes and Digestive and Kidney Diseases, other contributing factors include chronic diarrhoea, a low-fibre diet, prolonged sitting on the toilet, ageing and pregnancy. These factors can increase pressure on the blood vessels around the anus and rectum.
How haemorrhoids affect daily life
Symptoms vary depending on whether the haemorrhoids are internal or external. Internal haemorrhoids may cause bright red bleeding during bowel movements, while external haemorrhoids can cause itching, tenderness and pain, particularly when a blood clot develops.
Although haemorrhoids are common, not all anal pain or bleeding is caused by them. Anal fissures, which are small tears in the lining of the anal canal, can produce sharp pain and bleeding. Other possible causes include infections and inflammatory bowel diseases.
Bleeding during intimate activity should not automatically be blamed on haemorrhoids. Injury, anal fissures and other medical conditions can also cause bleeding. Persistent or recurrent symptoms require medical assessment to establish the cause.
Constipation and related complications
Chronic constipation can contribute to haemorrhoids, particularly when a person repeatedly strains to pass hard stools. Increasing dietary fibre, drinking sufficient fluids and avoiding prolonged straining can help prevent or relieve constipation.
However, constipation does not mean that a person has haemorrhoids, and the two conditions do not necessarily produce the same symptoms. Persistent abdominal pain, changes in bowel habits or rectal bleeding should be assessed by a healthcare professional.
Other conditions that may cause pain
Several conditions mentioned in discussions about anal discomfort require separate diagnoses rather than being treated as causes of haemorrhoids.
Irritable bowel syndrome (IBS), for example, is a digestive disorder that can cause abdominal pain, bloating, diarrhoea or constipation. Its exact cause is not fully understood, and its symptoms vary between individuals.
Anal fissures can develop when hard stools or straining damage the lining of the anal canal. Treatment depends on the severity and duration of the tear and may include measures to soften stools, prescribed medication or a procedure in persistent cases.
Pelvic inflammatory disease (PID), meanwhile, is an infection of the female reproductive organs. It is often associated with sexually transmitted infections, including chlamydia and gonorrhoea, although other bacteria can also cause it. Symptoms may include lower abdominal pain, fever, unusual vaginal discharge and pain during sexual activity. Untreated PID can lead to complications, including difficulty becoming pregnant.
Cervical dysplasia is another distinct condition. It involves abnormal changes in cells on the cervix and is not the same as cervical enlargement or rectal prolapse. It does not directly cause haemorrhoids.
Gout, a form of inflammatory arthritis associated with uric acid crystal deposits in the joints, can cause severe joint pain and swelling. It is not an established cause of haemorrhoids. Similarly, peptic ulcers and ulcerative colitis are separate medical conditions that require appropriate investigation and treatment.
When to seek medical attention
Anyone experiencing rectal bleeding should seek medical advice rather than assume that haemorrhoids are responsible. A clinician may examine the area and recommend further tests depending on the symptoms and medical history.
Severe anal pain accompanied by fever, persistent bleeding, dark or black stools, or a large amount of blood requires prompt medical assessment.
Treatment for haemorrhoids depends on their severity. Mild cases may improve with dietary changes, adequate fluid intake and measures to reduce straining. Persistent or severe cases may require medication or medical procedures.
The National Institute of Diabetes and Digestive and Kidney Diseases advises people with rectal bleeding to seek medical evaluation because bleeding can also indicate other digestive tract conditions, including inflammatory bowel disease and colorectal cancer.
