Haemorrhoids — also called piles — are enlarged blood vessel cushions inside or around the back passage (anal canal). They're very common, affecting up to one in two adults at some point in their lives. There are two types: internal haemorrhoids, which form higher up inside the canal and are usually painless; and external haemorrhoids, which develop lower down near the skin and can be tender. Haemorrhoids are graded from I to IV depending on how severe they are — Grade I means no prolapse (they stay inside), Grade IV means they've permanently come out and can't 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 — you might notice it on the toilet paper or in the pan after a bowel motion. Other symptoms can include itching or discomfort around the back passage, a feeling that your bowel hasn't fully emptied, a small amount of mucus discharge, or — if the haemorrhoid has prolapsed (come out) — the sensation of a lump. It's really important not to assume that bleeding is always from haemorrhoids; it should always be checked by a doctor to rule out other causes, including bowel cancer.
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're 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're bothering you. Smaller, milder haemorrhoids (Grade I–II) often respond well to increasing dietary fibre and fluids, along with topical creams for comfort. Rubber band ligation is the most effective 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. It has over 90% long-term success and is done in hospital under short sedation. When haemorrhoids are larger or haven't responded to simpler treatments, surgery may be needed. Options include haemorrhoidectomy (surgical removal), HALRAR (Haemorrhoidal Artery Ligation and Rectoanal Repair — a technique that ties off the blood supply and lifts the tissue back into place), and the Rafaelo procedure (which uses radiofrequency energy to shrink the haemorrhoid). The right technique for you will be discussed at your consultation.
Mr Nguyen always tries the gentlest, least invasive approach first. Rubber band ligation — the gold standard 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 needed, he offers haemorrhoidectomy, HALRAR, and the Rafaelo radiofrequency procedure — and he'll discuss which is best suited to your particular situation at your consultation, taking into account the grade, your anatomy, and what matters most to you.
Please don't ignore rectal bleeding, even if you've had haemorrhoids before — it's always worth getting it checked to make sure there's nothing else going on. Seek urgent review if you experience severe pain, if a prolapsed haemorrhoid won't go back in, or if you have heavy or persistent fresh bleeding.
Your GP will refer you to Mr Nguyen, and most patients are seen within one to two weeks. At the consultation, Mr Nguyen will take a history, examine the area, and discuss the most appropriate treatment — 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 don't. 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 haven't responded to other treatments.
They can return, particularly if you don't address the underlying causes — 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're worried, it's worth getting a specialist assessment — there's no need to just put up with it.
Mr Ba Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private Hospital and Epworth Eastern in Box Hill. To book an appointment, you'll need a referral from your GP or another specialist.