Piles / Haemorrhoids

Haemorrhoids (also known as piles) are swollen veins in the lower part of the rectum or anus. They are similar to varicose veins and can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids).

Causes

Straining during bowel movements

Sitting for long periods

Especially on the toilet

Chronic constipation or diarrhoea

Obesity

Pregnancy

Low-fibre diet

Symptoms

Itching or irritation around the anus

Pain or discomfort

Swelling around the anus

Bleeding

Bright red blood, often noticed on toilet paper or in the toilet bowl

A lump near the anus, which may be sensitive or painful

In case of thrombosed haemorrhoids

Treatment

Self-care / At-home Remedies

  • Increase fibre intake (fruits, vegetables, whole grains)
  • Drink plenty of water
  • Use over-the-counter creams or suppositories (e.g., hydrocortisone, witch hazel)
  • Take sitz baths (warm water baths for the buttocks)
  • Avoid straining during bowel movements

Medical Treatments

  • Rubber band ligation (cutting off blood flow to the haemorrhoid)
  • Sclerotherapy (injecting a solution to shrink it)
  • Coagulation therapy (laser or infrared light)
  • Surgical removal (hemorrhoidectomy) – for large or persistent haemorrhoids

When to See a Doctor

  • Bleeding during bowel movements
  • Persistent pain or haemorrhoids that don’t improve with home treatment
  • Suspected thrombosed haemorrhoid (very painful with a hard lump)

Anal Fissure

An anal fissure is a small tear or cut in the lining of the anal canal, which can cause pain and bleeding during or after bowel movements. It’s a relatively common condition and can affect people of all ages.

Types

Acute

Recent and typically heals within a few weeks.

Chronic

Persists for more than 6–8 weeks and may require more intensive treatment.

Causes

Passing large or hard stools

Chronic constipation or straining

Chronic diarrhea

Anal intercourse

Childbirth (in women)

Inflammatory bowel diseases

Like Crohn's disease

Symptoms

Sharp pain during and after bowel movements

Bright red blood on toilet paper or in the toilet bowl

A visible crack or tear around the anus

A small lump or skin tag near the fissure

Itching or irritation

Treatment

Home Remedies

  • Increase fiber intake (fruits, vegetables, whole grains)
  • Drink plenty of water
  • Take sitz baths (sitting in warm water for 10–20 minutes several times a day)
  • Use stool softeners or mild laxatives
  • Apply topical anesthetics or over-the-counter ointments

Medical Treatment

  • Prescription nitrate or calcium channel blocker ointments to relax anal muscles and increase blood flow
  • Botox injections to relax the sphincter muscle
  • Topical nitroglycerin to promote healing (can cause headaches as a side effect)
Surgical Treatment (for chronic or unresponsive cases)
Lateral internal sphincterotomy

A small portion of the anal sphincter muscle is cut to reduce spasm and promote healing. It’s highly effective but may carry a small risk of incontinence.

When to See a Doctor

  • If symptoms persist longer than a few weeks
  • Severe pain or bleeding
  • Suspected underlying conditions (like Crohn’s disease or cancer)

Anal Fistula

An anal fistula is an abnormal, tunnel-like connection between the inside of the anal canal and the skin near the anus. It usually develops as a result of an infection in an anal gland that spreads to the skin surface after forming an abscess. Once the abscess drains (naturally or surgically), a fistula may remain.

Causes

Perianal abscess

Most common cause

Crohn’s disease

Inflammatory bowel disease

Tuberculosis

Radiation therapy

Cancer

Rare

STIs

Sexually transmitted infections

Symptoms

Persistent pain or swelling near the anus

Discharge of pus or blood from a small opening near the anus

Irritation or itching in the perianal area

Fever or chills

If infection is present

Pain during bowel movements

Diagnosis

Physical exam

Often enough

Anoscopy

To view inside the anus

MRI or endorectal ultrasound

To map complex fistulas

Fistulography

Less commonly used

Treatment

Treatment almost always involves surgery, as fistulas do not typically heal on their own.

Common Procedures:

Fistulotomy

Cutting open the fistula tract; preferred for simple, superficial fistulas.

Seton placement

A thread is placed through the fistula to allow drainage and gradual healing (used in complex cases or those involving sphincter muscle).

Advancement flap

Closing the internal opening using a flap of rectal tissue.

LIFT procedure
Ligation of intersphincteric fistula tract – for fistulas that pass through the anal sphincter.
Fibrin glue or plug

Less invasive options with lower success rates.

Prognosis

  • With proper surgical treatment, healing rates are high.
  • Recurrence is possible, especially in people with Crohn’s disease or complex fistulas.
  • Continence usually preserved if managed correctly.