Haemorrhoids are swollen veins in the anus and lower rectum and resemble varicose veins. Commonly called piles, haemorrhoids can be internal and develop inside the rectum, or external – under the skin around the anus.

Internal haemorrhoids are made up of small hemorrhoidal vessels and a part of the blood supply to the anus. External haemorrhoids are veins. In their normal state, we are not aware of them at all, but sometimes they develop problems.

Problems with internal haemorrhoids are referred to as “internal haemorrhoidal disease.” The patient may develop symptoms occasionally or the problems could be chronic and long-term.

Problems with external haemorrhoids develop when a blood clot forms in one of the veins at the opening of the anus. This condition is called a thrombosed external haemorrhoid. The patient develops a firm external lump, often accompanied by anal pain and bleeding between bowel movements.

Research shows that nearly three of four adults develop haemorrhoidal problems from time to time.

Risk factors:

The risk of hemorrhoids increases with:

1- Age as tissues that support veins in the rectum and anus area become weak and stretch.

 2-Pregnancy: also increases the risk of haemorrhoidal problems as the increased weight in the uterus puts pressure on the anal region. 

3- Constipation

4-Increase pressure intrabdomen like(chronic cough, straining,…).

5-Severe diarrhea.


The symptoms of external haemorrhoids include itching or irritation in the anal region, pain and discomfort, swelling around the anus and bleeding. Patients often experience rectal bleeding, usually bright red blood, during and sometimes between bowel movements. Anal pain may be felt during or after bowel movements. There may be a prolapse or bulging of the internal haemorrhoids during bowel movements. This condition may get corrected on its own or may need to be pushed back.

If you suffer from internal haemorrhoids then straining or irritation during bowel movements can lead to painless bleeding – with bright red blood. You could also get a prolapsed or protruding haemorrhoid that pushes through the anal opening and causes pain and irritation.

Causes of hemorrhoidal problems:

An increase in the pressure in the lower rectum may be caused by a number of different factors and can lead to haemorrhoidal problems. Possible causes include:

  • Straining or pushing during bowel movements.
  • Lifting heavy loads.
  • A low fiber diet.
  • Chronic diarrhea or constipation.
  • Sitting on the toilet for a long duration.
  • Pregnancy and vaginal delivery.
  • Anal intercourse.

Diagnosis of haemorrhoids

If you suffer any symptoms of haemorrhoids you should consult a specialist Dr. Khaldoun Ghareb and get proper diagnosis. You cannot assume that rectal bleeding is due to haemorrhoids as there are other conditions that cause the same symptom and may need to be ruled out. If you have large amounts of rectal bleeding or feel faint, you should seek emergency care.

When you meet the physician, the diagnosis will start with a physical exam. The doctor may use a lubricated gloved finger or an instrument to examine the anus. Instruments called anoscope or proctoscope may be used in order to view the condition. 

Your doctor may recommend additional tests for rule out other conditions. These tests could include:

  • Sigmoidoscopy: Used to examine the lower colon, or sigmoid.
  • Colonoscopy: Used to examine the entire colon.
  • High resolution anoscop

Prevention of haemorrhoids

You can reduce your chances of getting haemorrhoidal problems and also manage your symptoms if any by following these practices:

  • Eat a high fibre diet: A high fiber diet keeps the stools soft and increases their bulk, so patients don’t need to strain or push. More fruit, vegetables and whole grains in your diet can help to prevent haemorrhoids. You could also consider having fiber supplements such as psyllium. If you take fibre supplements you must remember to drink at least 8 glasses of water every day or you could suffer from constipation.
  • Exercise: Being active and exercising helps to prevent constipation and reduces pressure on veins that may occur due to long periods of standing or sitting. Exercise can also help to overcome obesity which is a contributing factor for haemorrhoids.
  • Avoid sitting for long periods: Sitting for long durations, especially on the toilet, increases the pressure on the anal veins.
  • Drink plenty of fluids: You should consume 6 to 8 glasses of water and other non-alcoholic liquids every day to prevent haemorrhoids.

Haemorrhoid treatments

Patients whose symptoms do not reduce with home treatment it and preventive measures may require specific interventions. The recommended treatment depends on the size of the haemorrhoids and the severity of the symptoms.

A thrombosed external haemorrhoid usually does not need surgery. As the blood clot dissolves, it shrinks. The doctor may decide to remove the clot or cut the thrombosed external haemorrhoid completely. This is a minor procedure and is usually performed in the office.

Other treatment options for haemorrhoids include:

  • Rubber band ligation: In this procedure, rubber bands are placed at the base of the internal haemorrhoid in order to cut off the blood supply and cause the haemorrhoid to fall off. This procedure can be performed without sedation.
  • Sclerotherapy: In sclerotherapy, a chemical agent, also called a sclerosing agent, is injected into the internal haemorrhoid. This leads to the creation of scar tissue that fixes the internal haemorrhoid in place.
  • Doppler-guided haemorrhoidal artery ligation: In this surgical procedure, a special anal probe equipped with a Doppler device is used. Blood vessels leading to the internal haemorrhoids are identified and then tied off (ligated). This makes them shrink, or stitches can be used to fix them in place. This procedure is done in the operating room under general anaesthesia.

Advantages of doppler treatment:
No surgery
No pain
No cutting
No stay in hospital
Early go back to work
No complication
No bleeding

  • Stapled haemorrhoidopexy, or Procedure for Prolapse and Hemorrhoids (PPH): This procedure involves the use of a special stapling device to remove a doughnut of the rectal lining. The bulging internal haemorrhoids are pulled back into the anus. This is performed in an operation theatre.
  • Excisional hemorrhoidectomy: The haemorrhoids are removed by cutting them surgically.
  • Infrared coagulation: The veins feeding the haemorrhoids are coagulated. This can be performed as an outpatient procedure.
  • Radiofrequency ablation under local anesthesia.

If you are a family member are experiencing symptoms of haemorrhoids visit Dr. Khaldoun Ghareb clinic to solve your problem.



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