Hemorrhoids

Haemorrhoids (piles) are swollen vascular cushions in the anal canal — a normal part of anatomy that becomes a problem when the tissue engorges, prolapses or thromboses. They cause painless bright-red bleeding on the paper or in the pan, itching, and lumps at the anal verge; a thrombosed external pile causes a sudden, exquisitely painful lump. They are extraordinarily common, heavily associated with straining and constipation, and — importantly — a diagnosis that should not be self-assumed for every episode of rectal bleeding.

• •Bright red blood on the paper, in the pan or coating the stool — usually painless
• •Itching and irritation around the anus
• •A lump at the anal verge, sometimes reducible
• •Mucus discharge and a feeling of incomplete emptying
• •Sudden severe pain with a firm bluish lump — thrombosed external haemorrhoid
• •Dull ache or heaviness after standing or sitting for long periods

• •Straining at stool and chronic constipation — the central drivers
• •Prolonged sitting on the toilet — phone-scrolling piles are real
• •Low-fibre diet producing small, hard stools
• •Pregnancy — pressure, hormones and the strain of delivery
• •Chronic diarrhoea — repeated irritation and frequency
• •Ageing — the supporting tissue weakens over time
• •Obesity and heavy lifting — raised abdominal pressure
• •Family tendency

The anal cushions are normal vascular structures that assist continence. Raised pressure in the anal canal — from straining, hard stools, pregnancy or prolonged sitting — engorges these cushions and stretches their supporting connective tissue. Over time they enlarge, descend and bleed; internal cushions prolapse through the anal canal, while external ones can thrombose, producing sudden severe pain. Constipation is the hub of the wheel: it drives straining, prolongs toilet time and hardens stool, which is why virtually all effective non-surgical management routes through stool softening.