Prof. Dr. Emre Sivrikoz

Area of Expertise

Hemorrhoids (Piles)

Hemorrhoids are a common anorectal condition that occurs when the vascular cushions in the anal canal enlarge, swell, and may gradually protrude. The most common symptom is bright red rectal bleeding.

Information

What are hemorrhoids (piles)?

Hemorrhoids are enlarged and sometimes prolapsing vascular cushions in the anal canal that normally contribute to continence. Internal hemorrhoids are located inside the anal canal, while external hemorrhoids are located under the skin around the anus.

A clear definition becomes meaningful with the right evaluation.

Who gets hemorrhoids?

Hemorrhoids can occur at any age, but they are more common with:

Chronic constipation and straining
Prolonged sitting
Pregnancy and postpartum period
Obesity
Older age
Symptom duration and severity help shape the treatment plan.

Why do hemorrhoids occur?

Hemorrhoids most often develop due to increased pressure in the anal/rectal venous cushions:

Constipation and strainingRaises pressure and stresses the cushions.
Long toilet sittingMay increase vascular load over time.
PregnancyHigher intra-abdominal pressure and circulation changes.
ObesityCan increase pelvic pressure.
Low-fiber dietMakes constipation more likely.
Genetic predispositionVascular/connective tissue factors may contribute.

Symptoms of hemorrhoids

Most common symptoms

  • Bright red rectal bleeding
  • A lump/swelling around the anus
  • Itching or discharge
  • A feeling of incomplete emptying after bowel movements
  • Pain in advanced cases (especially with a thrombosed external hemorrhoid)
Not all bleeding is due to hemorrhoids. Evaluation matters.

Can hemorrhoids be confused with other conditions?

Yes. Hemorrhoids may be confused with anal fissure, anal fistula, or rectal prolapse. For this reason, treatment should not be delayed with the assumption that it is “just hemorrhoids”.

How are hemorrhoids diagnosed?

Diagnosis is often made with a clinical examination. When needed, anoscopy, rectoscopy, or colonoscopy may be used to evaluate whether bleeding has another cause.

1 Examination

A brief assessment usually clarifies the findings.

2 Additional evaluation if needed

Anoscopy/rectoscopy may be used to assess the area.

3 Ruling out other causes

If appropriate, colonoscopy may be planned.

When should I see a doctor?

  • Bleeding that recurs or increases
  • Bleeding with dizziness, weakness, or anemia
  • Severe, persistent anal pain
  • A lump that becomes hard and very painful (possible thrombosis)
  • First-time rectal bleeding after age 40
  • Symptoms not improving despite hemorrhoid treatment
Rectal bleeding is not always caused by hemorrhoids. A specialist evaluation is important to rule out serious conditions, especially Colon Cancer and Rectal Cancer.

Treatment of hemorrhoids

Treatment is planned according to the stage (grade) and symptoms.

Non-surgicalFiber intake, constipation management, topical creams/suppositories.
Office proceduresRubber band ligation, sclerotherapy, and similar methods.
SurgeryConventional hemorrhoidectomy, stapled hemorrhoidopexy, laser/energy ablation, Doppler-guided techniques.
The goal is durable relief with the option that best fits the stage and expectations.

After-treatment period

  • Return to daily activities is often quick.
  • Avoiding constipation is essential.
  • Healthy bowel habits should be established.
FAQ

Frequently asked questions about hemorrhoids

Some early-stage hemorrhoids may improve with lifestyle measures. If bleeding, pain, or swelling persists or recurs, an examination is recommended. Delaying care can make treatment more difficult.
Bright red bleeding is often due to hemorrhoids, but not always. A specialist evaluation is important to exclude polyps and other causes of bleeding.
The examination is brief and is generally well tolerated by most patients.
Yes. Many patients can be treated without surgery using medications, lifestyle changes, and office procedures. Surgery is considered mainly for advanced or recurrent cases.
With modern techniques, hemorrhoid surgery can be performed in a controlled and safe manner. However, surgery is usually evaluated as a last option.
Warm sitz baths, a fiber-rich diet, and adequate water intake may reduce symptoms. If bleeding, swelling, or pain continues, you should see a specialist.
Recurrent/heavy bleeding, severe pain, a prolapsing lump that cannot be reduced, or lack of response to home care are reasons to seek evaluation promptly.
Yes, especially if bowel habits and lifestyle factors are not addressed. With proper treatment and healthier routines, the risk can be reduced.
It is recommended to consult a general surgeon, preferably one experienced in colorectal surgery and proctology.
You can book via phone, WhatsApp, or the contact form. Early evaluation often makes treatment easier.
Real Reviews

Information Note

This content is for general informational purposes only and does not replace medical diagnosis or treatment. For symptoms such as rectal bleeding or severe pain, please consult a general surgeon.

Author

Prof. Dr. Emre Sivrikoz, Specialist in General Surgery
Clinical experience in colorectal surgery and proctology

Medical Review

Last updated: 02 / 2026

Sources

  • American Society of Colon and Rectal Surgeons (ASCRS)
  • UpToDate – Hemorrhoidal Disease
  • National Institute for Health and Care Excellence (NICE)

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