Haemorrhoids, also known as piles, are enlarged veins that develop inside your back passage (rectum) or around your bottom (anus). They can cause a burning sensation, bleeding, discomfort, itching and pain, especially when sitting down. However, for some people, haemorrhoids don’t cause any symptoms.
When a haemorrhoid swells up with too much blood, it can burst, which can cause discomfort. Burst haemorrhoids can be treated at home but in rare cases, treatment in hospital is needed.
Haemorrhoids are caused by enlarged veins, which can develop inside your rectum (internal haemorrhoids) or around the opening of your bottom (external haemorrhoids).
If a blood clot forms inside an internal or external haemorrhoid, it’s called a thrombosed haemorrhoid. This can cause severe pain and if it swells up with too much blood, it can burst.
Haemorrhoids are often caused by changes in your bowel habits, including:
Other causes of haemorrhoids include weakening of the tissues that support your anus and rectum due to ageing, pregnancy and lifting heavy objects.
Thrombosed haemorrhoids can burst if they swell up with too much blood. A burst haemorrhoid can bleed for a few seconds or minutes and may bleed again after opening your bowels. However, it shouldn’t bleed for longer than 10 minutes. On bursting, you may experience a sense of relief as the pressure caused by the build-up of blood is released.
If you do not experience any relief after bleeding subsides, then it is unlikely that you had a burst haemorrhoid but instead have a bleeding haemorrhoid.
Thrombosed haemorrhoids are not usually serious, despite causing severe pain and inflammation. In rare cases, a thrombosed haemorrhoid can cause severe bleeding from your rectum, which is a medical emergency. This is caused by the surrounding skin cells dying (necrosis) or ulcerating.
Haemorrhoids often bleed after opening your bowels, producing bright red blood. If you notice blood after opening your bowels that is darker, see your GP as it may be caused by a problem further up your gut, instead of by haemorrhoids. Thrombosed haemorrhoids that burst also produce darker blood and you may sometimes notice a blood clot.
Other symptoms of haemorrhoids, aside from bleeding, include:
There are lots of things you can try at home to treat bleeding haemorrhoids.
To prevent further bleeding, it is important not to strain when passing stools. As constipation makes it more likely you will strain, take steps to soften your stools. This may include:
To reduce pain, burning and itching, you can apply an external haemorrhoid cream several times a day. You can also take a sitz bath, which involves soaking your anus in a bowl of warm water, with or without Epsom salts added.
To reduce the chances of bleeding, avoid using dry toilet paper to wipe yourself after opening your bowels. Instead, use a moist, fragrance-free wipe or toilet paper containing witch hazel, which can reduce inflammation.
During the day, if you’re uncomfortable, you can wrap an ice pack in a towel and sit on it for up to 20 minutes to reduce inflammation and pain.
If these home treatments aren’t effective after a week of trying them, see your GP for advice on further treatments.
If home treatments haven’t helped reduce your haemorrhoid symptoms, your doctor may recommend one of several medical treatments that don’t need general anaesthesia. This includes:
Rubber band ligation
This involves placing a tiny rubber band around the base of your haemorrhoid to cut off its blood supply. The haemorrhoid will shrivel up and fall off after three to 10 days.
This involves injecting a special chemical called phenol into the tissue around the base of your haemorrhoid. This causes scar tissue to form here, which cuts off the blood supply to your haemorrhoid. Your haemorrhoid will then shrivel up and fall off. You may need multiple injections over several weeks.
Bipolar, laser or infrared coagulation
This involves using infrared light, laser or bipolar electrical energy to cut off the blood supply to your haemorrhoid. Local anaesthesia will be applied before this procedure to numb the area and your haemorrhoid will fall off after one to two weeks.
For severe, bleeding haemorrhoids or internal haemorrhoids that are hanging out of your anus (prolapsed haemorrhoids), your doctor may recommend surgery performed under general anaesthesia, which will usually mean staying overnight in hospital. Options for haemorrhoid surgery include:
When to see a doctor
If you are bleeding from your anus, it is important to see your GP as you may not have haemorrhoids but another, potentially more serious condition affecting your gut, such as colorectal cancer.
Your GP will perform a physical examination, which may involve inserting a lubricated, gloved finger into your anus. This will help determine if there is a haemorrhoid present, however, not all haemorrhoids can be detected in this way.
If they can’t identify the source of your bleeding during your physical examination, they may recommend you have a colonoscopy. This involves inserting a thin, flexible telescope-like tube with a camera and a light at the end (a colonoscope) into your colon via your anus. You will be sedated during this procedure.
It is important to tell your doctor about any other symptoms you’re experiencing alongside bleeding. This may include abdominal pain or anal pain, as well as:
You should seek urgent medical attention if you notice that you have:
Burst haemorrhoids aren’t usually serious although the amount of blood released can cause alarm. Thrombosed haemorrhoids are usually intensely painful until they burst. If you don’t experience severe pain before bleeding, then it likely isn’t a thrombosed haemorrhoid that has burst but an irritated, inflamed haemorrhoid.
Preventing haemorrhoids involves making both dietary and lifestyle changes.
As constipation is a major risk factor for haemorrhoids, try to follow a diet rich in fibre ie eat fresh fruits, vegetables and whole grains. If you’re struggling to include enough fibre in your diet, you can also try taking daily fibre supplements. It is also important to stay hydrated by drinking eight to 10 glasses of water every day. Regular exercise reduces your risk of constipation too.
To avoid putting unnecessary strain on your anus when opening your bowels, don’t spend too long sitting on the toilet. Similarly, avoid lifting heavy objects as this also places extra strain on your lower abdomen.
Can haemorrhoids bleed without a bowel movement?
Yes, haemorrhoids can bleed even when you are not opening your bowels. Often the pressure applied when sitting down can cause bleeding. If you have a thrombosed haemorrhoid, it can burst at any time and cause bleeding.
How much haemorrhoid bleeding is normal?
If you have haemorrhoids, it is normal to notice a few drops of blood in the toilet when you open your bowels. This blood should be bright red. If you notice more blood than this or the blood is dark, you should see your GP as you may have another problem that needs treatment.
What should I do if my haemorrhoid is bleeding profusely?
You should call your GP urgently or NHS 111. You may have a thrombosed haemorrhoid and in rare cases, this may need medical attention.
When should I worry about a bleeding haemorrhoid?
If you’re bleeding more than a few drops of blood or if you are continuously bleeding, you should see a doctor.
Can you bleed to death from a ruptured haemorrhoid?
No, you can’t bleed to death from a ruptured haemorrhoid. However, in rare cases, you may need urgent medical treatment for a ruptured haemorrhoid where the surrounding skin cells are ulcerated or dying (necrosis).
How do you know if a haemorrhoid is thrombosed?
A thrombosed haemorrhoid causes extreme anal pain. You may also notice a blue-tinged lump in or around your anus.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.
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