Normally, there is a vascular net in the spongy structure in the last part of the large intestine that opens out in humans. Hemorrhoidal disease occurs with the expansion of these structures called hemorrhoidal vessels.

Hemorrhoidal vessels have important functions in the body:

  • Normally, blood that accumulates in these vessel nets ensures that the anus is completely closed. Thus, hemorrhoidal vessels help for defecation control, even if the person does not voluntarily contract the muscles which control the anus.
  • They act as a protective cushion layer over the muscle ring with the name of the sphincter surrounding the anus.
  • They prevent the feces from leaking out by completely closing the anus at resting and sleeping state.

Hemorrhoidal vessels are classified as external (external) and internal (internal) depending on the location. The external hemorrhoids are located around the anus and are covered with thin skin.


It is called “hemorrhoidal disease” when the spongiform hemorrhoidal vessels in the anus and rectum are extensively enlarged and sometimes effused. There may be hemorrhoidal disease separately in the external and internal hemorrhoids. If the clot (thrombosis) occurs in external hemorrhoids, the patient feels a lot of pain. Internal hemorrhoids are more pronounced with bleeding.


One of the main causes of the illness is the strain. Strain causes blood filling with high pressure in this region. Other factors that increase intraabdominal pressure other than strain may also cause hemorrhoidal disease, for example:

  • Constipation
  • Chronic cough
  • Pregnancy
  • Obesity
  • Heavy lifting
  • Prostate disease
  • Bleeding during defecation

It is the most common symptom. It typically has fresh bright red color with drop-like structure. Blood can be noticed on feces and during cleaning.

  • Protruding of the anus, palpable swelling

The patient complains about a soft swelling protruding from the anus. Some patients may push this swelling back into the anus.

  • Anal itching

The hygiene of the anal region is also impaired by the inability of the hemorrhoidal vessels to perform their normal functions. Leakage of feces and discharge occur due to not full closure of the anus. Itching occurs because of this.

  • Pain

Patients cannot fully express these complaints. They may describe as a sensation in the form of pain, swelling, or burning. In particular, thrombosis of external hemorrhoids (Blood clot formation in the vein) causes severe pain.

  • Swellings that are constantly outside the anal channel and painful when touched

This may occur as a result of internal hemorrhoids hanging out from the anus, as well as thrombosis of external hemorrhoids.


1.Stage: Bleeding occurs

2.Stage: In addition to bleeding, internal hemorrhoids come out after defecation and after a while they enter inside by themselves

3.Stage: In addition to bleeding, the internal hemorrhoids come out after defecation and need to be pushed in by hand.

4.Stage: In addition to bleeding, internal hemorrhoids are always outside



The doctor visually examines the patient’s anus area first in the bend down position or in the side position, then the finger is inserted into the anus and the examination is completed. This examination is usually sufficient to diagnose hemorrhoidal disease. However, since hemorrhoid-like complaints can also be seen in diseases such as colon cancer and there are other diseases that cannot be detected with hemorrhoids in the examination, sigmoidoscopy or colonoscopy is also necessary.

Many disorders may occur with bleeding during defecation as the first symptom. Colorectal cancer (colon and rectum cancer), intestinal polyps, anal fissure, inflammation (abscess), fistula formation, inflammatory bowel disease (ulcerative colitis and Crohn’s Disease), prolapse, incontinence, anal itching disease, irritable bowel syndrome, sexually transmitted diseases and many other conditions can affect this region. Therefore differential diagnosis is very important and should be done by a specialist.


The treatment of hemorrhoidal disease varies according to the complaints of the patient and the condition of the disease. There are many alternatives to treatment. However, the ideal is to choose the appropriate method for the patient. First of all, defecation should be regulated by eating habits.

– Regulation of defecation habits

Regular defecation habits are important for the treatment. The long time sitting on the toilet (cigarette smoking, reading the newspaper etc.) and avoiding excessive strain reduce tension and pressure in the hemorrhoidal veins so that hemorrhoids can be prevented from going out the anus.

– Regulation of diet

It may be helpful to increase the fibrous food ratios in the meals and to get regular stool habits. Another important issue is drinking enough water. It is required to drink at least 10-12 large glasses of water a day. Fruit juice, coffee, tea does not replace water.

Medical Treatments

  1. Sitz bath

Staying 10 minutes in warm water several times a day reduces symptoms (symptoms, complaints). After the sitz bath, the anus area should not be left wet and it should be kept dry. With this treatment, even in the most severe hemorrhoids, the pain is reduced within 2-7 days and the hard palpable swelling around the anus regresses within 4-6 weeks.

  1. Cream-Pomade applications

There are many types of pomade used in the treatment of hemorrhoidal disease. Your doctor can recommend pomade to you depending on the condition of your disease.

  1. Medications

There are medications controlling the blood flow of the veins in the anus region and preventing excessive swelling, making it easier for the hemorrhoidal disease to return to normal in a short time. These medications should be used with the control of the doctor.

Surgical Treatment

  1. Laser method

It is an increasingly used method in recent years. Very good results are obtained when appropriately applied by an experienced team in appropriate patients. There is little pain after the procedure. You get up immediately, do not need hospitalization.

  1. Hemorrhoidectomy – Classical surgical method

It is a process for the removal of hemorrhoid piles. This process can be done by conventional methods, or by using tools such as ligasure, cautery and ultrasonic bisturis. The healing period can last up to three weeks depending on the size of the surgical process performed.

  1. Stapler (Longo) method (Stapled hemorrhoidopexy, stapled hemorrhoid surgery)

It is a developing method in recent years. It is a less painful, effective method, healing and returning to daily life is quicker. They are the surgeries using disposable instruments called stapler.