By Kage Team | 29 June 2026
Reviewed by the Gastroenterology Team, KIMS KAGE — KIMS Hospitals, Secunderabad
Piles — or hemorrhoids — are one of the most common reasons adults visit a gastroenterologist. They're also one of the most over-self-treated conditions in India.
The pattern is familiar: discomfort or bleeding during bowel movements, a trip to the pharmacist, a cream or suppository, some temporary relief, and then the symptoms come back. This cycle can go on for months or years. And while hemorrhoids are often manageable with lifestyle changes, prolonged self-treatment without a proper diagnosis carries real risks.
Here's what you need to know — including the signs that it's time to stop managing this yourself.
What Are Hemorrhoids?
Hemorrhoids are cushions of tissue containing blood vessels, muscle, and connective tissue that exist naturally in the anal canal. Everyone has them. The problem arises when these cushions swell, enlarge, or slide down — causing symptoms.
There are two types:
- Internal hemorrhoids sit inside the rectum. They aren't usually painful because the rectum has fewer pain-sensitive nerves, but they can bleed. In more advanced cases, they prolapse — protrude out through the anus.
- External hemorrhoids develop under the skin around the anus and can be painful, itchy, and may swell. When a blood clot forms inside an external hemorrhoid (thrombosed hemorrhoid), the pain can be sudden and severe.
What Causes Hemorrhoids?
The most common contributing factors are:
- Chronic constipation and straining during bowel movements — this is the leading cause in most Indian patients
- Prolonged sitting on the toilet — a habit made worse by smartphones
- Low-fibre diet — common in urban Hyderabad with increasing processed food consumption
- Pregnancy — increased pressure in the pelvis
- Heavy lifting
- Obesity
- A sedentary lifestyle
In many patients, a combination of a low-fibre diet, dehydration, and sedentary habits creates a perfect environment for hemorrhoids to develop and persist.
Symptoms — and What Each One Means
Bright red blood on toilet paper or in the toilet bowl
This is the most common symptom of internal hemorrhoids. Blood from hemorrhoids is typically bright red (not dark) because it comes from blood vessels near the surface. While usually not dangerous, rectal bleeding should never simply be assumed to be hemorrhoids without a proper examination — colon cancer and other conditions can also cause similar bleeding.
Itching or irritation around the anus
Often caused by mucus or stool residue that irritates the surrounding skin. Usually associated with internal hemorrhoids that are partially prolapsed.
Pain or discomfort
External hemorrhoids and thrombosed hemorrhoids can cause significant pain. Internal hemorrhoids are usually painless unless they prolapse and get trapped outside.
A lump or protrusion near the anus
Prolapsed internal hemorrhoids may be felt as a soft lump outside the anus, particularly during or after a bowel movement. Some can be gently pushed back in; others cannot.
A feeling of incomplete emptying
Larger internal hemorrhoids may create a sensation that the bowel hasn't emptied fully after a motion.
When Home Management Is Reasonable
Mild hemorrhoid symptoms — occasional discomfort, minor bleeding after straining, mild itching — often respond well to:
- Increasing dietary fibre: more fruits, vegetables, lentils, oats
- Drinking adequate water throughout the day
- Not straining during bowel movements and not sitting on the toilet for extended periods
- Warm sitz baths (sitting in warm water for 10–15 minutes after bowel movements)
- Over-the-counter topical creams for temporary relief of itching or discomfort
These measures can significantly improve mild symptoms within one to two weeks. If they don't, it's time to see a doctor.
When to Stop Self-Treating and See a Doctor
Consult a gastroenterologist if:
- You have rectal bleeding that has lasted more than a week, is heavy, or is increasing
- Your symptoms haven't improved after two weeks of home management
- You have significant pain — especially sudden, severe pain (which may indicate a thrombosed hemorrhoid)
- You notice dark or tarry stools — this is different from bright red blood and may indicate bleeding higher in the GI tract
- You're losing weight without trying
- You're over 45 and this is your first episode of rectal bleeding
- You have a family history of colorectal cancer
This last point matters. Rectal bleeding is one of the earlier symptoms of colorectal cancer. Most of the time it is hemorrhoids — but a proper examination is what confirms that, not an assumption.
How Hemorrhoids Are Diagnosed
Diagnosis is clinical — a gastroenterologist takes your history and performs a physical examination. This includes a digital rectal examination and, when needed, an anoscopy (viewing the anal canal with a small scope).
If there is any doubt about the source of bleeding, or if you are above 45 years of age and have risk factors, a colonoscopy will be recommended to rule out other causes.
Treatment Options
Dietary and lifestyle changes — often the foundation of management for grades 1 and 2 internal hemorrhoids.
Rubber band ligation
A small rubber band is placed at the base of an internal hemorrhoid, cutting off its blood supply. It shrinks and falls off within a week or two. Effective, quick, done without general anaesthesia.
Sclerotherapy
A chemical is injected into the hemorrhoid to shrink it. Used for smaller internal hemorrhoids.
Haemorrhoidectomy
Surgical removal of hemorrhoids. Reserved for large, prolapsed, or thrombosed hemorrhoids that haven't responded to less invasive measures. Laser haemorrhoidectomy is now also available and offers reduced post-operative discomfort.
Stapler haemorrhoidopexy
A procedure that repositions prolapsed internal hemorrhoids rather than removing them. Suitable for certain prolapsed grades.
A Note on Misconceptions in Hyderabad
There's a persistent hesitation in India — particularly around rectal symptoms — to seek medical care due to embarrassment. Patients routinely describe waiting 6 to 12 months before consulting a doctor. During this time, symptoms worsen, and in some cases, a potentially treatable early cancer is delayed.
Hemorrhoids are extremely common. A gastroenterologist sees them daily. There is nothing unusual or embarrassing about seeking an evaluation. What would be genuinely concerning is waiting until a manageable problem becomes a complicated one.
Hemorrhoid Care at KIMS KAGE
At KIMS KAGE, Secunderabad, the gastroenterology team evaluates and manages hemorrhoids at all grades — from dietary and lifestyle counselling for mild cases to rubber band ligation, sclerotherapy, and surgical referral for more advanced presentations.
If bleeding or discomfort has been going on for more than two weeks, please don't wait longer.
Book a consultation at KIMS KAGE, KIMS Hospitals, Secunderabad — call +91-7288842255 or visit kimskage.com.
Frequently Asked Questions
Hemorrhoids themselves are rarely dangerous, but they should be evaluated by a doctor to confirm the diagnosis and rule out other conditions — particularly colorectal cancer, which can present with similar symptoms.
Small hemorrhoids can improve with dietary and lifestyle changes. Larger ones, prolapsed hemorrhoids, or thrombosed hemorrhoids typically require treatment.
No. Many hemorrhoids are managed non-surgically with rubber band ligation, sclerotherapy, or dietary changes. Surgery is reserved for severe or recurrent cases.
Yes. Hemorrhoids do not prevent a colonoscopy. In fact, if you have rectal bleeding, a colonoscopy is often recommended alongside examination of the anal region to confirm the bleeding source.
The main factors are a high-fibre diet, adequate water intake, not straining during bowel movements, regular physical activity, and avoiding prolonged sitting on the toilet. These reduce the conditions that cause hemorrhoids to develop or recur.