Haemorrhoids — also called piles — are enlarged blood vessel cushions inside or around the back passage (anal canal). They are very common, affecting up to one in two adults at some point in life.
There are two types. Internal haemorrhoids form higher up inside the canal and are usually painless. External haemorrhoids develop lower down near the skin and can be tender. Internal haemorrhoids are graded from I to IV based on how severe they are — Grade I means no prolapse (they stay inside), and Grade IV means they have permanently come out and cannot be pushed back in.
The main culprit is straining when you go to the toilet, which puts pressure on the blood vessels and causes them to swell. Other contributing factors include chronic constipation or diarrhoea, not eating enough fibre, sitting for long periods, pregnancy, and sometimes a family tendency to develop them. The good news is that for most people, haemorrhoids are very manageable with some straightforward changes.
The most common symptom is bright red bleeding — usually noticed on the toilet paper or in the pan after a bowel motion. Other things you might notice:
- Itching or discomfort around the back passage
- A feeling that your bowel has not fully emptied
- A small amount of mucus discharge
- The sensation of a lump if the haemorrhoid has prolapsed (come out)
It is important not to assume that bleeding is always from haemorrhoids. Rectal bleeding should always be checked by a doctor to rule out other causes, including bowel cancer — even when haemorrhoids are visible, that does not mean they are the only thing going on.
Most of the time, haemorrhoids are diagnosed through a straightforward examination and a proctoscopy — a short, simple camera look inside the lower bowel done in the clinic. If you are over 45 or have other risk factors for bowel cancer, a colonoscopy may also be recommended to get a fuller picture and make sure nothing else is going on.
The right treatment depends on how severe your haemorrhoids are and how much they are bothering you. There are several options, used in a stepwise way:
- Dietary measures — for smaller, milder haemorrhoids (Grade I–II), increasing fibre and fluids and using a topical cream for comfort is often enough on its own.
- Rubber band ligation — the most widely used non-surgical treatment for internal haemorrhoids. A small rubber band is placed around the base of the haemorrhoid, cutting off its blood supply so it shrinks away. Published series report high long-term success rates, and the procedure is performed in hospital under short sedation.
- Haemorrhoidectomy — formal surgical removal of the haemorrhoid. Used for larger haemorrhoids or those that have not responded to simpler treatments.
- HALRAR (Haemorrhoidal Artery Ligation and Rectoanal Repair) — a sphincter-preserving technique that ties off the blood supply and lifts the tissue back into place, without external wounds.
- Rafaelo procedure — uses radiofrequency energy to shrink the haemorrhoid. A minimally invasive option for selected patients.
The right technique for you depends on the grade of your haemorrhoids, your anatomy, and what matters most to you. This is discussed in detail at your consultation.
Mr Nguyen always tries the gentlest, least invasive approach first. Rubber band ligation — the most widely used non-surgical treatment — is performed in hospital under short sedation at Warringal Private Hospital or Epworth Eastern rather than in a standard outpatient clinic, which makes a real difference to your comfort during the procedure.
If surgery is the right next step, the decision between haemorrhoidectomy, HALRAR, and the Rafaelo procedure is made at your consultation — based on the grade of your haemorrhoids, your anatomy, and what matters most to you.
Please do not ignore rectal bleeding, even if you have had haemorrhoids before — it is always worth getting it checked to make sure nothing else is going on.
Seek urgent review if you experience severe pain, if a prolapsed haemorrhoid will not go back in, or if you have heavy or persistent fresh bleeding.
Your GP will arrange a referral, and most patients are seen within one to two weeks. At the consultation, a history is taken, the area is examined, and the most appropriate treatment is discussed — for many people, dietary changes and a rubber band ligation procedure are all that is needed. If a procedure is recommended, it is done as a day case under sedation and most patients return to normal activity within a few days. A follow-up appointment confirms that things have settled as expected.
Not necessarily. Haemorrhoids are the most common cause of rectal bleeding, but other conditions — including bowel cancer, polyps, and inflammatory bowel disease — can also cause bleeding. Any bleeding from the back passage that is persistent or unexplained should be properly investigated, not assumed.
No — the majority do not. Most haemorrhoids respond well to dietary changes and rubber band ligation, which is done under sedation in hospital and is usually very well tolerated. Surgery is only recommended when haemorrhoids are large, causing significant symptoms, or have not responded to other treatments.
They can return, particularly if the underlying causes are not addressed — mainly straining and a low-fibre diet. Keeping your stool soft and easy to pass with plenty of fibre and fluids is the best long-term prevention strategy.
Mild symptoms often improve with more fibre and fluids in your diet, avoiding straining, and using over-the-counter topical preparations for comfort. But if symptoms are persisting, worsening, or you are worried, it is worth getting a specialist assessment — there is no need to simply put up with it.
Have questions about haemorrhoids?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.