Health & Wellness Journal

🏥 Hemorrhoids: Causes, Stages, Symptoms, and Prevention

Hemorrhoids are one of the most common proctological conditions, affecting an estimated 30–50% of the adult population. Despite their prevalence, hemorrhoids remain a taboo subject: many people are embarrassed to see a doctor and try to treat themselves, which often leads to disease progression and complications. However, with timely medical attention and proper prevention, the condition can be successfully managed.

Anatomy and Development

Hemorrhoidal vascular plexuses are located in the lower rectum and around the anus. These specialized venous structures normally perform an important function: they help retain stool and gas by providing a tight seal for the anus. These plexuses are filled with blood and resemble cavernous tissue in structure.

Hemorrhoids develop when blood flow into the cavernous plexuses begins to exceed the outflow. The vessels become engorged, their walls stretch, and the supporting ligaments weaken, resulting in the formation of hemorrhoids. Depending on their location, hemorrhoids are classified as:

  • Internal hemorrhoids — located inside the rectum, above the dentate line; covered by mucous membrane and initially invisible and painless (the mucous membrane has no pain receptors)
  • External hemorrhoids — located beneath the skin around the anus; covered by skin containing sensitive nerve endings and therefore painful
  • Mixed hemorrhoids — a combination of both types

Causes and Risk Factors

Hemorrhoids are a multifactorial condition. The main causes and predisposing factors include:

  • Constipation and straining — prolonged and forceful straining sharply increases pressure in the hemorrhoidal plexuses; chronic constipation is the number one risk factor
  • Sedentary lifestyle — prolonged sitting, especially on a soft surface, impairs blood drainage from the pelvis; office workers, drivers, and programmers are at risk
  • Diet — insufficient fiber and water intake leads to hard stools and constipation; excessive consumption of spicy foods and alcohol increases blood flow to the rectal area
  • Pregnancy and childbirth — the growing uterus puts pressure on the pelvic blood vessels, while pushing during labor creates enormous pressure; hemorrhoids develop in 25–35% of pregnant women
  • Heavy lifting — excessive exertion, including heavy physical labor and strength sports, increases intra-abdominal pressure
  • Heredity — weakness of connective tissue and blood vessel walls may be inherited
  • Age — over time, connective tissue loses elasticity and blood vessel walls lose tone
  • Diarrhea — frequent loose stools irritate the mucous membrane and worsen inflammation
  • Prolonged sitting on the toilet — reading or using a phone in the bathroom leads to blood pooling in the pelvis

Stages of Internal Hemorrhoids

Stage I

The hemorrhoids are enlarged but do not protrude from the anal canal. The main symptom is painless discharge of bright red blood during bowel movements, visible on toilet paper, dripping into the toilet, or streaked on the stool. Discomfort is minimal and may include mild itching or a feeling of incomplete evacuation. Many people do not pay attention to this stage.

Stage II

The hemorrhoids prolapse from the anal canal during straining but retract on their own after a bowel movement. Bleeding may be accompanied by itching, a foreign-body sensation, mucous discharge, and moderate pain. Symptoms worsen after prolonged sitting, spicy foods, or alcohol consumption.

Stage III

The hemorrhoids prolapse during straining and physical exertion and do not retract on their own, so they must be pushed back manually. Bleeding may be heavy, pain intensifies, and persistent discomfort and hygiene difficulties develop.

Stage IV

The hemorrhoids remain permanently outside and cannot be pushed back in. Symptoms include severe pain, heavy bleeding that may lead to anemia, and difficulty with bowel movements and everyday activities. There is a high risk of thrombosis and strangulation.

Complications of Hemorrhoids

  • Hemorrhoidal thrombosis — formation of a blood clot inside a hemorrhoid; causes sudden, intense pain, swelling, and bluish discoloration of the hemorrhoid; it is an urgent condition
  • Strangulation — prolapsed hemorrhoids are compressed by the sphincter, disrupting their blood supply; accompanied by extremely severe pain and swelling
  • Bleeding — frequent or heavy bleeding can cause chronic anemia, or low hemoglobin, which manifests as weakness, paleness, and shortness of breath
  • Anal fissure — often occurs alongside hemorrhoids; a linear tear in the lining of the anal canal that causes sharp pain during bowel movements
  • Paraproctitis — a purulent infection of the tissues around the rectum; a rare but serious complication

When to See a Proctologist

You should see a doctor if you experience any rectal symptoms:

  • Blood during bowel movements or on toilet paper—it is important to rule out other conditions, including polyps and tumors
  • Prolapsed hemorrhoids
  • Pain around the anus
  • Itching, burning, or mucous discharge
  • A foreign-body sensation

Diagnosis includes a visual examination, digital rectal examination, and anoscopy, in which the anal canal is examined using a special instrument. If necessary, sigmoidoscopy or colonoscopy may be performed to rule out other conditions. The examination is brief and generally painless.

Dietary Recommendations

Normalizing bowel movements is a key part of preventing and treating hemorrhoids. Stools should be soft, formed, and passed daily without straining.

  • Fiber — 25–35 grams per day from vegetables, fruit, whole grains, legumes, and bran; increase intake gradually to avoid bloating
  • Water — 1.5–2 liters per day; fiber without sufficient water worsens constipation
  • Fermented dairy products — kefir, yogurt, and cultured milk stimulate intestinal motility
  • Limit — hot spices and alcohol, which increase blood flow, as well as strong tea, coffee, rice, and white bread, which contribute to constipation
  • Prunes, dried apricots, beets, and flaxseed — natural remedies for constipation

Bathroom Habits and Physical Activity

Proper bathroom habits significantly affect the condition of hemorrhoids:

  • Do not strain—if stool does not pass easily, it is better to stop and wait for a stronger urge
  • Do not sit on the toilet for more than five minutes—put away your phone and books
  • Use the toilet at the first urge—do not hold it in
  • After a bowel movement, use moist toilet paper or wash with cool water

Physical activity improves blood circulation in the pelvis and promotes intestinal motility. Beneficial activities include brisk walking, swimming, yoga, and light exercise. Avoid weightlifting, heavy squats, and cycling during a flare-up. If you have a sedentary job, stand up every 30–45 minutes and do a brief warm-up. You can also discreetly contract and relax the anal sphincter muscles as a Kegel exercise.

Hemorrhoids During Pregnancy

Pregnancy is one of the main contributing factors. Preventive measures for expectant mothers include:

  • Drink enough fluids and eat fiber-rich foods
  • Walk daily for at least 30 minutes
  • Do not lift heavy objects
  • Do not strain during bowel movements
  • Do Kegel exercises to strengthen the pelvic floor muscles
  • See a doctor at the first symptoms; many treatments are safe to use during pregnancy

After childbirth, hemorrhoids often shrink on their own within several weeks if dietary and lifestyle recommendations are followed.

Conservative Measures and Myths

In the early stages (I–II), hemorrhoids respond well to conservative treatment: normalizing bowel movements, topical medications such as suppositories and ointments with pain-relieving, anti-inflammatory, and venotonic effects, warm sitz baths, and phlebotonics, which are medications that improve venous tone. Stages III–IV generally require minimally invasive procedures such as ligation, sclerotherapy, or laser treatment, or surgery.

Common misconceptions:

  • “Only older people get hemorrhoids” — the condition can occur at any age; it is most common between the ages of 45 and 65 but frequently affects young adults aged 20–30
  • “They will go away on their own” — without changes in lifestyle and diet, hemorrhoids progress; seeing a doctor early allows them to be managed with minimal measures
  • “Surgery is inevitable” — most cases can be successfully managed conservatively; surgery is required only in advanced stages
  • “The examination is painful and embarrassing” — modern proctology offers comfortable diagnostic methods, and proctologists see patients with these problems every day

Hemorrhoids are nothing to be embarrassed about. A balanced diet with sufficient fiber, an active lifestyle, regular bowel movements without straining, and a timely visit to a proctologist at the first symptoms are reliable tools for prevention and management. The earlier treatment begins, the simpler and more effective it will be.

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