Language:   English   |     العربية   |     German




hemorrhoid-content-imageIt is the most common anorectal complaint; some studies claim that almost half of adults have experienced the symptoms of hemorrhoids by the age of 50. Hemorrhoids are enlarged and engorged anal veins.

Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop at the anus. Hemorrhoids are popularly known as piles.


Symptoms associating internal hemorrhoids

Most often, internal hemorrhoids have no symptoms but are only found if there is bleeding with a bowel movement or if the hemorrhoid prolapses so that it can be felt outside of the anus. This may lead to itching and pain as well as the bleeding. Hemorrhoids may also cause anal itching (pruritus ani), and a constant feeling of needing to have a bowel movement (tenesmus).

Internal hemorrhoids can be graded into:

Grade I: Intra-anal non prolapsing hemorrhoids.

Grade II: Intra-anal hemorrhoids that prolapse on straining, but are reduced up spontaneously.

Grade III: Intra-anal hemorrhoids that prolapse on straining, and require manual reduction up.

Grade IV: Extra-anal hemorrhoids that are prolapsed and non-reducible.


Symptoms of external hemorrhoids

External hemorrhoids are a sore ailment. Blood clots sometimes form within prolapsed external hemorrhoids, causing a very painful condition called a thrombosis. If that happens, the hemorrhoid can turn purple or blue, and my possibly bleed. The pain is usually worse with bowel movements and may increase with sitting. Despite its appearance, it’s usually not serious, apart from the pain. It may resolve spontaneously in a couple of weeks. Nevertheless, If it persistent, your trusted surgeon doctor can remove it if the pain is unbearable.

It involves the pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. When the venous pressure within these veins increases, thy swell and dilate. This leads to the most common symptoms of bleeding and swelling.

Despite the fact that scientists are divided on what exactly causes hemorrhoids, traditionally they are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which hinder blood flow to and from the area, causing it to pool and engorge/enlarge the veins. This could be a logical explanation for the common occurrence of hemorrhoids with pregnancy, when the enlarging uterus presses on the veins.

Medical history intake and clinical bed-side examination may be enough to diagnose hemorrhoids. Your treating surgeon may request for an additional diagnostic tool if he feels anything abnormal internally; proctoscopy, through which your doctor can get a clear view of the inside of your rectum.

Grade I & II can be treated conservatively by the following:

  • Home treatment: You need to strive to avoid constipation with increased liquid/water intake, increased intake of dietary fibers. Over-the-counter stool softeners and laxatives can be used but prolonged self-intake (without medical consultation) can have its hazardous effect on colonic motility. Topical rectal anti-inflammatory creams and suppositories could also be helpful.
  • Non-surgical treatment: Your treating surgeon can proceed for laser treatment or Sclero-injection which are successful. These are easy and pain-free treatments giving relief for months to years. Such procedures are done in the outpatient clinic and you resume your routine life activities immediately afterwards.


Grade III and Grade IV hemorrhoids are treated by surgery. It is done in hospital under general or spinal anesthesia.

  • The surgical treatment will be as a lifting procedure called Recto-Anal-Repair. The prolapse will be reduced by knotting cork-screw structures. Hemorrhoids will be smaller after the procedure and are anchored on their normal position.
  • It’s a nearly pain-free procedure and usually after 10-14 days you can go back to your normal daily activities.


Dr. Diethart Bayer

General Surgery Specialist