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What is Hemorrhoids, What Causes Them, and How is Non-Surgical Treatment for Piles Conducted?

In this article, you can explore various topics related to hemorrhoids, such as what hemorrhoids are, their causes, symptoms, and non-surgical treatment for piles.

Commonly known as “basur” in Turkish, hemorrhoids are the most frequently encountered condition in the anal region. Hemorrhoids refer to the formation of protrusions, resembling finger-like projections, inside and outside the anus. They are classified into two types: internal and external.

Internal hemorrhoids are categorized into degrees 1 to 4. The classification includes the initial stage (1st degree) up to the most advanced stage (4th degree).

The classification for external hemorrhoids is different, ranging from large, medium, to small.

Why Do Hemorrhoids Occur?

When you search the internet for the causes of hemorrhoids, you can find dozens of reasons. Among these, the most significant cause is related to poor bowel habits, such as spending too much time in the bathroom and excessive straining. In fact, nearly 90% of patients spend minutes in the bathroom, straining intensively during this time.

Other reasons can be listed as follows:

Genetic Predisposition: Familial traits or genetic predisposition may arise from differences in the anatomy of the region.

Constipation: Straining is required when passing hard stool, and straining weakens the connective tissue in that area, leading to increased pressure in the blood vessels, causing them to expand.

Excessive Spice Consumption: While spice consumption does not have a direct effect, it can cause burning in the anus. The individual may strain more due to the burning sensation, spending more time in the bathroom.

Occupations Requiring Prolonged Standing: Having a profession that requires standing may increase pressure in the blood vessels of the region, although this is not entirely logical, as there is approximately the same pressure when sitting.

Pregnancy: As the baby grows, it puts pressure on the large veins behind the abdomen, and this pressure from the baby increases the pressure inside the lower veins.

Obesity: Similar to pregnancy, obesity increases pressure inside the abdomen, putting pressure on the major veins passing through the back wall.

Lifting Heavy Weight: Lifting weights is an action that causes straining.

Sedentary Lifestyle: A sedentary lifestyle can lead to constipation, which, in turn, can lead to hemorrhoids.

Advanced Age: With age, there is a loosening of the connective tissues in the anal region, and when the supportive connective tissue around the vessels weakens, the vessels can dilate.

Severe Diarrhea: Severe diarrhea can lead to straining.

Long-Term Use of Constipation Medication: Extended use of constipation medication.

Any one or a combination of these reasons can contribute to the development of hemorrhoids in an individual.

Whether there is a genetic predisposition or if it is learned in the family due to poor toilet habits is not entirely clear.”

Hemorrhoid Symptoms

There are different symptoms depending on the degree and type of hemorrhoids.

External Hemorrhoid Symptoms

Visible protrusions that can be seen and felt, varying in size depending on the degree.

Mild pain due to the compression of the protrusions.

Itching caused by friction on the protrusions.

Unpleasant odor due to natural secretions, moisture, and humidity in the protrusions.

No bleeding is observed; if bleeding occurs, it indicates the presence of internal hemorrhoids or another underlying condition.

Internal Hemorrhoid Symptoms

Bleeding can occur at all degrees, with the most common bleeding seen in the 2nd and 3rd degrees. Bleeding is less common in other degrees.

Other symptoms according to the degrees:

1st Degree Internal Hemorrhoid Symptoms:

  • Not considered a disease; it is evaluated as a hemorrhoidal condition rather than a disease.
  • No symptoms other than bleeding.
  • When irritated, a fresh drop of blood may be seen if straining occurs.
  • Usually stops spontaneously or with the use of hemorrhoid medications. If bleeding persists despite these measures, laser treatment may be applied.
  • The only condition requiring treatment in the 1st degree is persistent bleeding that cannot be stopped with other measures and medications.

2nd Degree Internal Hemorrhoid Symptoms:

  • Bleeding occurs when irritated, and there may be profuse bleeding during straining.
  • The protrusions come out during bowel movements and stay outside as long as the patient remains seated; they retract spontaneously when the patient stands up.
  • Infrequent itching due to the sensitivity caused by the protrusions can be observed. Contrary to common belief, there is usually no pain unless there is an additional problem.
  • Moisture may be present due to the protrusions staying outside.

3rd Degree Internal Hemorrhoid Symptoms:

  • All symptoms present in the second degree are also seen in the third degree, with the only difference being that the protrusions do not retract spontaneously; the patient needs to push them back in manually.
  • If left outside, the protrusions can cause pain by being compressed by the anal muscles. Bleeding is a common symptom.
  • In advanced stages of the 3rd degree, the patient cannot push the protrusions back inside manually. After a bowel movement, the patient may need to lie face down for 1-2 hours to allow the protrusions to go back inside.
  • Attempts to manually push them back can sometimes lead to serious bleeding.

4th Degree Internal Hemorrhoid Symptoms:

  • Internally and externally, they are intertwined; some of the internal hemorrhoids are now outside.
  • The largest form of hemorrhoids. Since the protrusions are outside, sitting may cause pain due to compression.
  • Continuous wetness, resembling a persistent discharge, can be observed.
  • Foul odor in the anus is one of the reasons.
  • The only treatment method is surgery.

How to Get Rid of Hemorrhoids?

There is no chance of it resolving on its own. If the correct diagnosis is made, it does not resolve spontaneously or with medications, and its degree may not even regress.

Hemorrhoids are a structural deterioration similar to tooth decay. Just as tooth decay does not go away with brushing or chewing gum, it is a similar situation.

If constipation is prevented, excessive straining during bowel movements is avoided, and medications such as Daflon Tablet, Proctologist Cream, Proctoglivenol Cream, Kortos suppositories are used, the symptoms caused by the disease may decrease, but the degree does not change.

Does Hemorrhoid Cream Provide Healing?

Hemorrhoid cream can provide relief by reducing the pain and swelling that occurs during acute flare-ups. However, this is not a true recovery; it is more like relieving the pain of a decayed tooth with a pain reliever.

Some individuals may share that they used creams or herbal products and improved. Since the patient makes their own diagnosis, it can lead to a situation where a wrong diagnosis is made. An anal hematoma, which is very similar to hemorrhoids and almost certainly resolves on its own, occurs.

In anal hematoma, the pain rapidly decreases on the 3rd-4th day, even without using anything. The disease progresses like this, and the patient tolerates the pain for a few days. Eventually, unable to bear it any longer, they start a herbal or pharmaceutical medication on someone’s suggestion. The next day after taking the medication, the pain decreases, and the patient attributes it to the product they used. However, even without using any medication, it would have improved on the 4th day, but they may not be aware of this.

Which Doctor/Department to Consult for Hemorrhoids?

The specialty that deals specifically with the diagnosis and treatment of anal diseases, or more precisely, diseases related solely to this area, is the proctology department. The specialist who deals with these conditions is referred to as a proctologist or proctology specialist. Therefore, it is advisable to consult the proctology department for examination.

Proctologists typically work in private practice. In government hospitals, one should visit the general surgery clinics for consultation. Although not as specialized as proctology specialists, general surgeons can also diagnose and treat hemorrhoids.

How Is Hemorrhoid Treatment Performed?

Medication can alleviate symptoms to a certain extent, but the disease persists. The true treatment comes from the intervention of a specialized doctor using various methods.

Treatment methods can be classified into non-surgical and surgical procedures.

Non-Surgical Hemorrhoid Treatments

Common Features:

Easy to apply Minimal pain No side effects like gas leakage No difficulty in holding stool No development of anal stenosis

Medication to Dry Hemorrhoids (Hemorrhoid Sclerotherapy)

A chemically caustic medication is injected into the hemorrhoid tissue. The medication burns the tissue, causing it to shrink and heal.

Due to the risk of excessive bleeding and severe infections leading to patient deaths, this method is almost obsolete. Even if occasionally used, the fear of giving too little medication results in inadequate outcomes.

Rubber Band Ligation (RBL) for Hemorrhoids

Also known as rubber band ligation, this method involves placing a tight rubber band around the base of the hemorrhoid. The vacuum device pulls the hemorrhoid into a ligator, which then places a tight rubber band around its base. The band cuts off the blood supply, causing the hemorrhoid to shrink and disappear.

This is the most practical and successful method, suitable for second and third-degree hemorrhoids. The procedure takes 4-6 minutes, and the patient can resume normal activities afterward. It is used for the treatment of first, second, and third-degree hemorrhoids (1).

There are rarely any side effects apart from minimal bleeding.

Infrared Coagulation (IRC) for Hemorrhoids

Also known as laser treatment, infrared coagulation is a method where light is used to cook the hemorrhoid tissue. The light, when applied to the hemorrhoid, heats up to 130 degrees, causing coagulation or denaturation.

The damaged area heals with new, healthy tissue. It is applied for first and second-degree hemorrhoids (2).

The procedure takes 5-7 minutes, and the patient may feel mild discomfort. Mild pain may occur after the procedure, and the patient can return to regular activities.

It is often used in conjunction with rubber band ligation. There are rarely any significant side effects apart from mild bleeding.

Laser Treatment for Hemorrhoids from Inside

Unlike IRC, the hemorrhoidal tissue is punctured from one point, a laser probe is inserted through this hole, and the tissue is burned from the inside. It does not have superiority over other non-surgical methods, and there is a risk of infection due to tissue puncture in the dirty area. Occasionally, bleeding may occur.

It is applied at the third degree and should not be applied at the fourth degree; if laser is applied at the fourth degree, it results in failure, and it is unnecessary for the first and second degrees.

THD Hemorrhoid Treatment

Also known as HAL (Hemorrhoidal Artery Ligation), it involves tying off the feeder arteries to the hemorrhoidal tissue at their roots. When blood no longer reaches the hemorrhoid due to the tied-off artery, the tissue shrinks and disappears.

In fact, it is as effective as surgical methods and as easy as non-surgical methods. Since there is no cutting involved, it is not classified as surgery. It should not be applied to the fourth degree because it becomes an unnecessarily large procedure. The most successful among these surgeries is the Milligan Morgan surgery.

Hemorrhoid Surgery: What Is It, and How Is It Performed?

The primary goal is to remove the hemorrhoid by cutting it surgically. Various surgical techniques, such as Milligan Morgan, Reclus, Whitehead, Ligasure, De Longo, Plication, and Radiofrequency Ablation, are applied. It is performed in very advanced cases. It should preferably not be applied to those below the fourth degree because it becomes an unnecessarily large procedure. The most successful among these surgeries is the Milligan Morgan surgery.

Despite small details, it can be generalized as follows: both internal and external hemorrhoids are surgically cut as a whole, and the resulting open wound may be left open or closed. Closing the wound may cause anal stenosis, so it is preferably left open.

What Should You Avoid Eating If You Have Hemorrhoids?

Actually, you can eat anything; consuming any food does not directly affect existing hemorrhoids. The only food that is said to be avoided for those with hemorrhoids is spicy food. However, just like spicy food does not cause disease in the mouth, it does not cause disease in the anus either. But if spicy food is consumed, and there is prolonged sitting on the toilet and excessive straining during this time, it can lead to exacerbation of hemorrhoids and existing hemorrhoids.

Foods such as sour or pickled items are also blamed, but these are unjustly accused.

What Should You Eat If You Have Hemorrhoids?

Those without hemorrhoids can eat anything, but in addition, it is good to eat foods that prevent constipation and ensure easy defecation.

To prevent constipation:

  • Whole grain bread should be consumed.
  • Vegetables and fruits should be consumed more than usual.
  • Normal amounts of water should be consumed.
  • Apricots, dried apricots, or a similar amount of apricot juice should be consumed every night before going to bed.

If these are not sufficient to solve the constipation problem, in addition to these, bran should be consumed directly. Wheat bran or oat bran should be purchased from a herbalist or online. Every night, 1–2 hours before going to bed, a glass of bran mixed with milk, yogurt, buttermilk, or soup should be eaten. If one glass is not enough, the amount of bran can be gradually increased.

Bran with large particles is more effective. The biggest advantage of consuming bran over other foods is that it trains the intestines over time. If bran consumption is continued continuously for 2 months, even if bran is not consumed in the following period, the constipation problem is likely to be permanently resolved.


1- Çay, F., Kanat, B. H., & Girgin, M. (2017).

2- Singal, R., Gupta, S., Dalal, A. K., Dalal, U., & Attri, A. K. (2013). An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital. Journal of Medicine and Life, 6(3), 302.

3- Ratto, C., Donisi, L., Parello, A., Litta, F., & Doglietto, G. B. (2010). Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Diseases of the colon & rectum, 53(5), 803-811.

4- Gupta, P. J. (2004). A comparative study between radiofrequency ablation with plication and Milligan-Morgan hemorrhoidectomy for grade III hemorrhoids. Techniques in coloproctology, 8(3), 163-168.

About Op. Dr. Canan ERDEM

Merhabalar, ben Op. Dr. Canan ERDEM, 1967 doğumluyum 1984 yılında Etiler Anadolu Lisesinden mezun olduktan sonra Cerrahpaşa Tıp Fakültesi’ne girdim ve 1990 yılında mezun oldum. 1991 yılında Erzurum’da mecburi hizmetimi tamamlayarak 2000 yılında Kartal Eğitim Araştırma Hastanesinde Genel Cerrahi Uzmanlığı İhtisasımı tamamladım.