Hemorrhoids: symptoms, causes and when to see a specialist

A large share of the adult population experiences them at least once in a lifetime; yet they are rarely talked about, and many people only see a doctor once the problem has become hard to ignore. Hemorrhoids — or, more precisely, hemorrhoidal disease — are a common, well-understood condition that can now be treated with increasingly less invasive techniques. In this guide we look at how to recognize the symptoms, what the most common causes are, and when it is the right time to see a specialist.

What hemorrhoids are (and why they are not all the same)

Contrary to popular belief, hemorrhoids are not a disease in themselves: they are normal vascular cushions present in everyone’s anal canal, where they contribute to continence. We speak of hemorrhoidal disease when these cushions become enlarged and congested, or slide outwards (prolapse), giving rise to the typical complaints. Hemorrhoids are classified as internal or external and, for internal ones, into four grades of severity: from simple bleeding without prolapse (grade I) up to a permanent prolapse that cannot be pushed back (grade IV). Establishing the correct grade is essential, because it determines the most appropriate treatment.

The symptoms to recognize

The most common sign is bleeding during or after a bowel movement: bright red blood, visible on the paper or in the toilet bowl. Other frequent complaints include a sensation of heaviness or of a foreign body, itching and irritation of the anal area, and tissue protruding during straining — which in the early grades goes back in on its own, while in advanced grades it needs to be repositioned manually or remains outside. Severe pain, on the other hand, is not typical of uncomplicated hemorrhoidal disease: when it appears suddenly, it may point to a hemorrhoidal thrombosis or to another condition, such as an anal fissure.

One important word of caution: bleeding should never be attributed to hemorrhoids on your own. Similar symptoms can also be caused by other conditions of the colon and rectum, and only a medical assessment can rule them out with confidence.

Causes and contributing factors

Hemorrhoidal disease usually arises from a combination of individual predisposition and factors that increase pressure in the anal region. The most common are chronic constipation and prolonged straining, a low-fiber diet and poor hydration, a sedentary lifestyle but also many consecutive hours spent sitting or standing, repeated heavy lifting, and pregnancy and childbirth. With age, moreover, the supporting tissues physiologically tend to lose tone, making prolapse more likely.

What can be done: from daily habits to minimally invasive treatments

Good daily habits

For mild complaints, and to prevent recurrences, the basic measures remain essential: a fiber-rich diet, adequate hydration, regular physical activity, taking care not to postpone the urge or prolong straining, and gentle local hygiene. Your doctor may also recommend topical treatments or supplements during flare-ups.

Minimally invasive outpatient treatments

When conservative measures are not enough, in the early and intermediate grades it is now often possible to avoid traditional surgery. The minimally invasive options available include foam endosclerosis and radiofrequency: outpatient procedures, generally well tolerated, that aim to reduce congestion and bleeding of the hemorrhoidal cushions with limited recovery times. The indication is assessed case by case by the specialist, based on the grade of the disease and the patient’s characteristics.

Surgery for advanced cases

In the more advanced grades, with significant prolapse or persistent symptoms, surgical techniques remain the reference solution. Here too the options have evolved: after a complete assessment, the specialist will propose the most suitable procedure and explain its benefits, limits and post-operative course.

When to see a specialist

A specialist consultation is advisable when bleeding recurs, when prolapse, pain or discomfort start interfering with daily activities, or when symptoms keep flaring up despite good habits. The proctological examination is simple and quick, and in most cases is completed in the clinic with anoscopy. Seeing a specialist early has a concrete advantage: in the initial grades, the treatment options are more numerous and less invasive.

Frequently asked questions

Do hemorrhoids go away on their own?

Mild episodes can improve with conservative measures — fiber, hydration, hygiene and, when indicated, topical treatments. If symptoms keep coming back or a prolapse has appeared, however, the condition tends to be recurrent and a specialist assessment is advisable.

Is bleeding always caused by hemorrhoids?

No, and it should never be taken for granted: rectal bleeding can also be caused by other conditions of the colon and rectum. This is why it always deserves a medical assessment, especially if it is recurrent or accompanied by other symptoms.

Do minimally invasive treatments require hospitalization?

Generally not: techniques such as foam endosclerosis and radiofrequency are performed on an outpatient basis, with a quick return to normal activities. It is in any case the specialist who confirms whether the procedure is suitable and provides guidance for the recovery period.

At the Vascular Surgery and Phlebology department of the Istituto Chirurgico Palazzo Manzoni in Brescia, hemorrhoidal disease is assessed and treated within a dedicated pathway, from minimally invasive outpatient techniques through to surgery: you can learn more on our hemorrhoid treatment page and book a consultation by calling 030 294 2437.