what is hemorrhoids

What are hemorrhoids?

The association with the word hemorrhoids is certainly an extremely unpleasant and often persistent health problem which is often so personal to patients that it is not uncommon to seek professional medical help even years after the onset of the first unpleasant symptoms.

This is one of those health problems that patients try to solve on their own at first with the help of various preparations that alleviate the first stages of hemorrhoids.

Hemorrhoids actually represent a normal anatomical vascular structure in the anal canal but under this name we mean hemorrhoidal disease that occurs when due to various causes hemorrhoids are enlarged, swollen and inflamed or blood vessels (veins) in the final part of the colon – anus and rectum.

The existence of hemorrhoids is not necessarily a disease. We can say that we have hemorrhoidal disease when the first  symptoms begin.

Under normal circumstances hemorrhoids are part of the basic structure of this part of our body whose basic function is to preserve continence ie. gas and liquid stool retention.

Another function is to protect the upper part of the anal canal from mechanical injuries.

However due to the circumstances of the modern way of life that include a lot of sitting, infrequent or no physical activity, inadequate diet and the like it most often happens that hemorrhoids react with enlargement, swelling and inflammation.

Then there are the problems which are known as hemorrhoids but it is actually a hemorrhoidal disease.

Hemorrhoids most often occur in the elderly but it is not uncommon in younger people and children if they have a problem with constipation.

Also hemorrhoidal disease often occurs during pregnancy and after childbirth.

Hemorrhoids can be internal (in the rectum) and external (on the skin around the anus) and also they can be distinguished by what stage they are in (there are four stages).


Hemorrhoidal disease can be manifested by symptoms that can be very similar to the symptoms of other diseases in the anal and perianal region.

The problem with hemorrhoids is manifested by symptoms such as pain in the anal region during an defecating, itching and swelling in the anal region, the appearance of blood on the toilet paper, thrombosis of hemorrhoids.

None of these symptoms should be ignored but it is necessary to contact a doctor for an examination and further treatment.

The symptoms of hemorrhoids deffer depending on the type of hemorrhoids and the stage in which they are located.

Internal hemorrhoids are less painful than external ones and in fact we can conclude that they are fresh bleeding from the anus without feeling any other discomfort.

Blood is noticed after the usual bowel movement, and what we see on the toilet paper after that, can be really experienced dramatically because blood in the stool and after bowel movement can indicate many other diseases of the digestive tract and for that reason any such phenomenon should be taken seriously and a doctor should be called immediately.

Of course this does not mean that internal hemorrhoids are something that necessarily points to e.g. malignant diseases but such conditions should never be ignored and you should contact a doctor in time.

Internal hemorrhoids appear inside the anal opening and when they are less pronounced they can neither be seen or felt outside.

In most cases internal hemorrhoids do not require surgical removal.

External hemorrhoids have symptoms that even if we want to we cannot ignore.

Unlike internal hemorrhoids which often cause bleeding external hemorrhoids often cause severe itching around the anus.

Primarily they appear under the skin at the very beginning of the anal canal and can be felt with hand.

External hemorrhoids can be extremely painful during defecation (bowel emptying) unlike internal ones.

The main symptom of external hemorrhoids is waking up and going to sleep with constant pulsating pain in the pelvic area as well as a daily feeling of pressure around the anal opening or canal which is accompanied by the appearance of hard lumps.

Hard lumps are inflamed and swollen veins that we actually call external hemorrhoids.


There are four stages of hemorrhoids.

In the first stage, the hemorrhoids bleed but do not fall out (prolapse) from the anal canal while in the second stage they prolapse during ejaculation but return spontaneously.

Both of these stages do not require surgery.

In the third stage, the hemorrhoids prolapse but it is possible to return them manually while in the fourth stage the hemorrhoids are constantly outside the anal canal and it is impossible to return them.

Last two stages usually require the necessary surgical treatment and are often a consequence of not reporting to the doctor on time and the timely start of treatment.


In addition to the hereditary factor the circumstances of the modern way of life play an important role in the development of hemorrhoidal disease.

This refers to a lot of sitting (behind the computer or the steering wheel), weaker or almost non-existent physical activity, a diet that is not rich in fiber (and usually not rich in any essential elements for our good health), obesity, irregular stools, pregnancy and even stress and similar life habits and circumstances.

Some of the causes are also frequent lifting of very heavy objects, long standing and sitting and accumulation of water in the stomach which creates additional pressure on the intestines.

Habits such as sitting on the toilet for a long time often can be the cause of hemorrhoids, ie their reaction to increased pressure in the colon (enlargement, swelling and inflammation) and then problems arise.

Also hemorrhoidal disease is a frequent companion of pregnancy (due to constant pressure on this part of the body during pregnancy but also as a consequence of childbirth itself, high stress and extremely high pressure on the anus and rectum) so it happens that mothers have a problem with hemorrhoids which after some time can be completely resolved.


Hemorrhoids can be external or internal.

What separates them in medicine is known as the toothed line which is located 1.5cm to 2 cm from the anal edge.

Internal hemorrhoids are located above this line.

External hemorrhoids are located below the dentate line in the anal canal and under the thin anal skin which is rich in nerve endings (which is why external hemorrhoids are often characterized by strong and persistent pain).

In addition hemorrhoidal disease is distinguished by the stage in which they are (from the first to the fourth stage).

Internal hemorrhoids

Internal hemorrhoids are usually not visible and their presence is determined by a medical examination.

They most often appear in the form of pale bleeding from the rectum or blood on the stool.

It is safe to say that internal hemorrhoids are the most common cause of fresh bleeding from the anus but this important symptom should never be taken lightly and based on it doctors will consider other diseases that manifest this way.

This primarily refers to malignant diseases of the anorectum (the final part of the colon).

This is why it is important to perform a series of diagnostic tests on all people who suffer from hemorrhoids or have problems that indicate this disease.

These are primarily digital rectal examination and rectoscopy (endoscopic examination) and in people older than 50 years colonoscopy (endoscopic examination of the colon with an apparatus with optics).

External hemorrhoids

External hemorrhoids are located on the edge and around the anus.

They appear as swellings and are mostly red in color.

Although more painful for the patient and in every sense more unpleasant external hemorrhoids are less important than internal ones precisely because they are an obvious problem that can be solved and which does not lead us to suspect that it can be some other disease.

External hemorrhoids are a more common cause of problems than internal ones.

They most often occur during pregnancy then long-term chronic constipation, long sitting or standing in place or due to inadequate nutrition.

The most common symptom of external hemorrhoids is their thrombosis which is a type of complication of hemorrhoidal disease.

Hemorrhoids are painful and tense and bluish nodules of various sizes can be seen under the skin of the anoderm.

Thrombosis most often occurs as a consequence of lifting a heavy load, coughing, straining when defecating, during childbirth and etc.

External hemorrhoids can exist independently of internal hemorrhoids.


Hemorrhoids are usually a long-term health problem.

One of the reasons is the delay in seeing a doctor. It happens that patients treat some form of hemorrhoidal disease on their own for years avoiding seeing a doctor.

The fact is that the diagnosis implies examinations that no one likes but the problems with hemorrhoids should not last longer than the period needed for their treatment and yet they last because people are usually embarrassed or ashamed to see a doctor.

People often neglect hemorrhoids and tolerate them, often do not believe that anything can be changed with treatment so only after the increase of problem they decide to treat hemorrhoids.

Here is important to emphasize that the best results in treatment are possible if we call the doctor on time and any delay worsens the problem sometimes irreversibly.

Depending on the stage and progression hemorrhoids can last for a very long time even up to several decades.


The very fact that irregular stools and frequent constipation above all can be one of the important causes of hemorrhoidal disease suggests that nutrition is very important both in the prevention of hemorrhoids and in the treatment process.

Finally the problem with hemorrhoids occurs in the final part of the digestive tract so it is certainly important what we take into our bodies, how we digest that food and in what condition and how often the products of digestion come out of our body.

Hemorrhoids are more common in obese and less active people or those who do not get enough fiber in their diet and eat foods that are too refined.

The recommendation both in prevention and treatment is to bring body weight within a healthy framework.

It is important to have a balanced diet with a lot of fiber so that our bodies receive sufficient amounts of nutrients and so that our blood vessels remain strong and healthy.

Dietary fiber is very important for regular bowel movements and preventing constipation.

It is also important how much fluid we take into the body.

When we have a problem with hemorrhoids it is good to drink an additional amount of water over the usual ones (it is recommended to drink up to one liter over daily doses) in order to make our stools softer.

It is recommended to eat a lot of fresh fruits and vegetables, whole grains, nuts and seeds.

These foods help treating constipation.

Vitamin C is also very useful as it is found in fruits, broccoli and peppers, as well as foods rich in flavonoids that give mobility to blood vessels (lighter-colored fruits and vegetables, berries, buckwheat, cherries, whole grains).

We suggest you take a look at other topics related to nutrition in hemorrhoids:


When treating hemorrhoids it is very important to take care of hygiene of the anal region which should be washed every time after emptying the intestines and only with water without the use of strong hygiene products such as soaps and washing baths.

Washing baths and soaps especially when used frequently can damage the skin’s natural hydro-lipid protective layer after which the skin is more prone to irritation and itching.

This means that itching as one of the most unpleasant symptoms can only intensify.

Hemorrhoids can be treated non-surgically and surgically depending on the stage of the disease.

The fastest and most effective way to solve the problems of hemorrhoids that are in the third or fourth stage is through surgery which achieves an almost immediate long-term solution.

There are different methods here.

The classic surgical methods of removing hemorrhoids include the removal of hemorrhoidal nodules and their ligation in typical places.

With this method there is a risk of certain complications such as difficult and prolonged recovery, pain after the operation, which can last for days or even weeks, damage to the sphincter, narrowing of the anus and other problems.

Modern surgical methods of treatment are minimally painful which implies a quick recovery so patients can usually return to their daily activities after one or at most two days.

One of the modern methods of treatment is the “Ligasure” method, which performs radiofrequency coagulation of dilated blood vessels with the help of a “Ligasure” device.

The advantages of the “Ligasure” method are less postoperative pain, shorter hospital stay, faster return to normal activities.

The most modern method of treating hemorrhoidal disease is THD – Transanal hemorrhoidal dearterialization.

This operation without an incision directly affects the very cause of hemorrhoids and is thus permanently resolved.

Not all hemorrhoids are treated surgically.

Non-surgical treatment of hemorrhoids means first of all a change in life habits but also the introduction of specific therapy.

This therapy can eliminate the need for surgical treatment in the early stages of the disease.

This treatment involves the use of local region creams and ointments for hemorrhoids, certain medications that reduce blood flow through the hemorrhoids as well as changes in diet – with much more fluids and foods rich in fiber.

Prevention of hemorrhoids

Physical activity, a diet rich in fiber (banana helps in the treatment of hemorrhoids), avoiding excessive sitting, standing, regular monitoring and taking care of our own health are also important in the treatment and prevention of hemorrhoids.

Most important of all is not ignoring the symptoms that may indicate hemorrhoidal disease.