Hemorrhoids (hemorrhoidal disease)

Realizing something is wrong

I woke up with a lump that bothers me. Yesterday I was fine, nothing was wrong. What happened? Is it something serious? I can’t even sit down. I tried to go to the toilet, but it hurts even more. I got scared when I saw blood on the paper, and it even dripped into the toilet bowl. It must be something serious…
I’ll go to the doctor. But what if they tell me I need surgery? How do I explain what happened to me? How can I show that area?… Better to get a cream from the pharmacy, maybe it will go away. I’ve already used several creams. It keeps getting worse. It stings, my skin itches. I don’t think I have a choice anymore.

In the doctor’s office

Patient: Doctor… I’m a bit embarrassed. I think I have hemorrhoids. It hurts a lot and there was bleeding.
Doctor: First of all, please don’t worry. This is one of the most common conditions we treat. You are neither the first nor the last patient in this situation.
Patient: But it came on suddenly. Yesterday I was fine.
Doctor: Most likely it is a blood clot in an external hemorrhoid (a thrombosed external hemorrhoid) or an inflamed internal hemorrhoid. It can come on suddenly, especially after constipation, straining, sitting for a long time or stress.
Patient: The blood scared me the most.
Doctor: Bleeding from hemorrhoids is usually bright red and happens when you have a bowel movement. What matters is to confirm the diagnosis and rule out other causes. That is why the examination is essential.
Patient: Will the examination hurt?
Doctor: The examination is short and gentle. We do it carefully. The discomfort is minimal compared with the pain you already have.

What exactly are hemorrhoids?

Doctor: Hemorrhoids are dilations of normal veins in the anal canal. Everyone has these structures; they help with continence. They become a problem when they get inflamed or dilate too much.

There are:

• Internal hemorrhoids: they can bleed or prolapse (come out).
• External hemorrhoids: they can become painful, especially if a clot forms in them (thrombosis).

Patient: So it’s not cancer?

Doctor: No. Hemorrhoids do not turn into cancer. But any bleeding should be checked, to be safe.

About creams and tablets

Patient: I used creams from the pharmacy, but it didn’t go away. Why?
Doctor: Creams help with the symptoms: they ease pain, stinging and itching. But they don’t “cure” hemorrhoids. If the problem is more advanced, they are not enough on their own.
Patient: Can I use them for as long as I want?
Doctor: No. Creams with cortisone should be used only for a few days. Used for too long, they can irritate the skin and make the problem worse.
Patient: Do hemorrhoid tablets help?
Doctor: Yes, they can help during a flare-up:
• they can reduce bleeding
• they can ease itching
• they can improve symptoms overall (their effect on pain is less clear)
They do not make hemorrhoids go away, and they should be taken on a doctor’s advice.

Patient: Then what is important to do?
Doctor: Three clear things:
• Calm the flare-up: the right cream, plus tablets if needed.
• Regulate your bowel movements: fiber and water every day.
• Avoid straining on the toilet.

Treatment

Patient: Will I need surgery?
Doctor: In most cases, no. The treatment depends on the grade and the symptoms. If it is a mild form:
we regulate your bowel movements (fiber, fluids), use the right local treatment and, if needed, venoactive medication.

If the symptoms persist:
minimally invasive procedures (rubber band ligation, sclerotherapy).
Surgery is reserved for advanced or recurring hemorrhoids.
Patient: So not every hemorrhoid needs surgery?
Doctor: Exactly. Surgery is the last option, not the first.

Fear and embarrassment

Patient: I was embarrassed to come…
Doctor: Embarrassment delays treatment and prolongs suffering. For us, this is a common, treatable condition. For the patient, it is a problem that affects quality of life. Our role is to solve the problem, discreetly and professionally.

Foods rich in dietary fiber

Legumes
Lentils, chickpeas

Fruit
Apples, pears, raspberries, plums

Whole grains
Oats, whole-wheat bread, brown rice

Nuts and seeds
Almonds, chia seeds, flax seeds

Recommended daily intake:
25-35 g of fiber a day

PRACTICAL GUIDE: preventing and controlling hemorrhoids

Keep your bowel movements regular
✔ Eat vegetables, fruit and whole grains every day
✔ 25-35 g of fiber a day
✔ 1.5-2 liters of water a day
✔ Don’t put off going to the toilet
Stools should be soft and pass without straining.

Good toilet habits
✔ Don’t sit on the toilet for more than 3-5 minutes
✔ Don’t strain
✔ Avoid using your phone on the toilet
✔ Lean slightly forward (you can use a small footstool)
Repeated straining makes hemorrhoids worse.

Move every day
✔ 20-30 minutes of walking
✔ Get up every hour if you work at a desk
✔ Avoid long periods of inactivity
Movement improves venous circulation.

Gentle local hygiene
After each bowel movement:
✔ Wash with lukewarm water
✔ Mild, unscented soap (if needed)
✔ Pat dry, don’t rub
✔ Soft, unscented toilet paper

AVOID:

• Wipes with alcohol or perfume
• Menthol gels or irritating products
• Long-term use of cortisone creams without medical advice
• Rubbing the area hard

End of the consultation

Doctor: The good news is that your problem is treatable. We will start with conservative treatment and then reassess.
Patient: I already feel calmer.
Doctor: That is the first step. The right information reduces anxiety, and the right treatment can solve the problem.

Message for patients

Hemorrhoidal disease is common, treatable and rarely serious.
These measures can greatly reduce the risk of it coming back:
✔ Regular bowel movements
✔ No straining on the toilet
✔ Drinking enough fluids
✔ Movement
Good hygiene means being gentle, simple and consistent.
Too many products often do more harm than good.
Creams and tablets help, but they do not replace a medical examination.

If you have a lot of pain, the bleeding continues or the problem keeps coming back, you need a medical assessment. Go to the emergency department or call 112 if you are in severe pain, the bleeding does not stop or there is a lot of blood (the toilet water turns red or you see large clots). Get medical help the same day if you have a high temperature or feel hot, cold or shivery and generally unwell, if you have painless bleeding from your bottom, or if pus is leaking from the area.

Don’t put off seeing a doctor out of embarrassment or fear!
The sooner we act, the simpler the treatment.

If you are in Constanța, see our page on hemorrhoid treatment: grades, rubber band ligation, prices and booking.

Medical sources

• NHS: Piles (haemorrhoids)
• Perera N et al. Phlebotonics for haemorrhoids. Cochrane Database of Systematic Reviews, 2012;(8):CD004322