Causes of Hemorrhoids

Treatment for Hemorrhoids

Signs & Symptoms of Hemorrhoids

Prevention of Hemorrhoids


Hemorrhoids: 10 Most Common Questions Answered

Hemorrhoids are considered to be one of the most common anorectal diseases, for which it is estimated that nearly half of those aged over 50 have received treatment.1 However, hemorrhoidal disease can occur independently of age and sex, and at any stage of life.

It is important to really understand what causes hemorrhoids, together with the factors that can make the condition worse, as well as how best to treat them. In this article, we’ve compiled a list with the most commonly asked questions about hemorrhoids to provide you with all the answers you need.

what are hemorrhoids

What are hemorrhoids?

Hemorrhoids are enlarged veins inside the rectum (internal hemorrhoids) and on the outside of the anus (external hemorrhoids) that have widened as a result of having been put under extra pressure.2

These 2 common types of hemorrhoids have quite noticeable differences. Internal hemorrhoids3 can sometimes be asymptomatic and are therefore often harder to detect, while external hemorrhoids, due to their location tend to cause more pain, swelling, and can lead to rectal bleeding.4


The most common symptoms of hemorrhoids are4:

  • Itching, aching, and discomfort
  • Inflammation or swelling
  • A burning sensation around the anus
  • Difficult bowel movements, also known as dyschezia
  • Bleeding (typically of a bright red color when passing a stool)


causes of hemorrhoids 

What are the main causes of hemorrhoids?

 The main causes of hemorrhoids are related to the following risk factors:

  • Pregnancy increases intra-abdominal pressure leading to hemorrhoids. It is considered that up to 35% of pregnant women suffer from hemorrhoids.5  
  • Constipation and excess straining when going to the bathroom. One of the main causes of hemorrhoids is constipation which causes us to strain harder, which can irritate the veins located in the anal area.
  • Increased intra-abdominal pressure together with venous congestion and chronic inflammation caused by obesity seem to be among the main culprits in the development of hemorrhoids.6
  • Sedentary lifestyle or sitting for long periods of time. A general lack of exercise has a direct effect on the development of hemorrhoids. It has been noted in studies that regular exercise is a great way of managing chronic constipation, one of the leading causes of hemorrhoids.7 Check out how sport and physical activity can help treat hemorrhoids.
  • Stress and depression. Since stress is connected to gastrointestinal distress,8 it can easily lead to straining with bowel movements, among other things, and a higher risk of suffering from hemorrhoids. You can read here about how stress can cause hemorrhoids and how to prevent it.

 can hemorrhoids symptoms disappear

Can the symptoms of hemorrhoids disappear?

The symptoms due to hemorrhoids can typically go away on their own after a few days, however, depending on the type of hemorrhoid and its size, you may experience symptoms like itchiness, pain, and bleeding for more than a week. If hemorrhoids don’t go away after a few days, it’s a definite sign to visit a doctor and ask about the best treatment for your case.


How long do hemorrhoid symptoms last?

Hemorrhoids are veins in the rectum and anus that have become swollen and inflamed and can be very painful. That’s why, depending on the level of the swelling, hemorrhoids can last for a few days to more than a week, typically.

Read more about how long hemorrhoids last in this article.

anal bleeding with hemorrhoids

Is anal bleeding a sign of hemorrhoids?

One of the most common symptoms of hemorrhoids is rectal bleeding associated with bowel movements.2 This happens because hemorrhoids, enlarged veins in the anal canal, become full of blood. When strain and pressure in the area are increased, the tiny capillaries can burst and provoke a brief period of bleeding. Find out more about how to treat bleeding hemorrhoids.

How do you know if you have hemorrhoids?

Hemorrhoids can be internal or external. Due to their location, external hemorrhoids are easier to visually recognize, since they tend to be located around the anal opening or close to it, often causing a great deal more pain and discomfort.

Internal hemorrhoids, however, develop inside the rectum and can be more difficult to identify.

Both types of hemorrhoids, depending on their severity and size, can cause discomfort, rectal bleeding, pain, itchiness, and swelling.9

Learn how to reduce the swelling of hemorrhoids.

hemorrhoids treatment

How to treat hemorrhoids

There are some tips to alleviate the painful symptoms of hemorrhoids, such as maintaining a healthy diet high in fiber, being active, and practicing certain types of exercise especially beneficial for hemorrhoids, among other things.

However, if you want to make sure you treat the problem and not only alleviate its symptoms, oral venotonic medications are a highly recommended treatment. They work fast to reduce the symptoms of hemorrhoids and may even prevent their recurrence.10

flavonoids for hemorrhoids


Are flavonoids good for hemorrhoids?

Flavonoids are one of the most common agents used in venoactive drugs, also known as phlebotonics, a treatment for both hemorrhoidal disease and chronic venous disease.11 In the treatment of hemorrhoids, flavonoids have been linked to a significant reduction with the risk of bleeding, persistent pain, itching.2

Are piles and hemorrhoids the same thing?

Yes, hemorrhoids and piles are the same thing. Piles refers to hemorrhoids, whether they are external, internal, prolapsed, or thrombosed hemorrhoids.

Hemorrhoidal disease is typically described in the 4 following stages:

  • Grade I (mild): these are visible, yet they do not run the risk of prolapse.
  • Grade II (moderate): when hemorrhoids prolapse but also return at once.
  • Grade III (severe): hemorrhoids at this grade do prolapse but they are unable to shrink on their own and must be manually returned.
  • Grade IV (most severe): these are hemorrhoids that often require surgery to be removed.10

chronic hemorhhoids

Can hemorrhoids become chronic?

Hemorrhoidal disease can indeed become chronic. Since hemorrhoids can be caused by several different risk factors such as pregnancy, constipation, stress, obesity, and a sedentary lifestyle, hemorrhoids can easily reoccur.

In fact, according to recent studies, the recurrence rate with conservative medical management is considered to be somewhere between 10% and 50% over 5 years.12 Taking into account that hemorrhoids are a leading cause of rectal bleeding with a high impact on the person’s quality of life, prevention and treatment is key to avoid developing chronic hemorrhoidal disease.13

How can I prevent hemorrhoids?

The prevention of hemorrhoids with venotonic medications together with a few lifestyle changes are the most effective ways to help prevent the added pressure that causes veins to enlarge resulting in hemorrhoids.2

The recommended lifestyle changes include:


  • Following a balanced diet including high fiber foods such as vegetables, fruits, and whole meal pasta and bread. Fiber helps keep stools soft in order to avoid straining from constipation. 14, 15
  • Physical activity. Exercise is associated with an increased blood flow in the body and a higher relaxation of the muscles which help avoid the development of hemorrhoids.9
  • Drinking lots of fluids to avoid dehydration. Dehydration is a leading cause in the suffering of constipation. The hot summer months can have a direct link on the development of hemorrhoids, since heat increases dehydration within the body.16

If you take on board all the suggestions discussed in the FAQs above, including stress management, and the symptoms of your hemorrhoids refuse to go away for more than a week, we strongly recommend that you should visit your doctor immediately. Don’t forget to ask them about all of the available treatments mentioned above, especially since the oral venoactive medications have proven themselves time and again, not only with greatly reducing symptoms, but also  in helping to increase the blood flow and improve the tone of the veins themselves.17

They have also been recognized as an effective preventative treatment greatly reducing the risks of hemorrhoids coming back again to ruin our future happiness.


  1. Song SG, Kim SH. Optimal treatment of symptomatic hemorrhoids. J Korean Soc Coloproctol. 2011 Dec;27(6):277-81. doi: 10.3393/jksc.2011.27.6.277. Epub 2011 Dec 31, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259422/#:~:text=Hemorrhoids%20are%20one%20of%20the,hemorrhoids%20once%20in%20their%20lifetimes
  2. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 May 7;18(17):2009-17, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598/
  3. Courtney M. Townsend JR., MD, in Sabiston Textbook of Surgery, 2022, from  https://www.sciencedirect.com/topics/medicine-and-dentistry/internal-hemorrhoids
  4. Sandler RS, Peery AF. Rethinking What We Know About Hemorrhoids. Clin Gastroenterol Hepatol. 2019 Jan;17(1):8-15, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075634/  
  5. Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G. Hemorrhoids in pregnancy. Can Fam Physician. 2008 Feb;54(2):189-90, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278306/ 
  6. Lee JH, Kim HE, Kang JH, Shin JY, Song YM. Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey. Korean J Fam Med. 2014 Sep;35(5):227-36, from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192796/
  7. Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson A. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci. 1998 Nov;43(11):2379-83, from https://pubmed.ncbi.nlm.nih.gov/9824122/  
  8. Harvard Health. (2019, August 21). Stress and the sensitive gut. Retrieved October 5, 2022, from https://www.health.harvard.edu/newsletter_article/stress-and-the-sensitive-gut
  9. Harvard Health. (2021c, November 16). Hemorrhoids and what to do about them. Retrieved October 5, 2022, from https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
  10. Godeberge P. Daflon 500mg is significantly more effective than placebo in the treatment of hemorrhoids. Phlebology. 1992;7(suppl 2):61-63.
  11. Sheikh P, Lohsiriwat V, Shelygin Y. Micronized Purified Flavonoid Fraction in Hemorrhoid Disease: A Systematic Review and Meta-Analysis. Adv Ther. 2020 Jun;37(6):2792-2812. doi: 10.1007/s12325-020-01353-7. Epub 2020 May 12. PMID: 32399811; PMCID: PMC7467450, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467450/
  12. NCBI - Internal Hemorrhoid. Retrieved October 5, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK537182/
  13. Ray-Offor E, Amadi S. Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment. Ann Afr Med. 2019 Jan-Mar;18(1):12-16, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380113/  
  14. Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q, Johanson JF, Guyatt G. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006 Jan;101(1):181-8, from https://pubmed.ncbi.nlm.nih.gov/16405552/  
  15. Eating, Diet, & Nutrition for Hemorrhoids. (2022, July 23). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved October 5, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/eating-diet-nutrition
  16. Heat stress. Hydration. Department of health and human services. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health, from https://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2017-126.pdf?sort=new?utm_source=post&utm_medium=blog
  17. Shelygin Y, Krivokapic Z, Frolov SA, et al. Clinical acceptability study of micronized purified flavonoid fraction 1000 mg tablets versus 500 mg tablets in patients suffering acute hemorrhoidal disease. Curr Med Res Opin. 2016;32(11):1821-1826.