Ep 93 – Haemorrhoids

Haemorrhoids are a very common finding in the Western world and are often seen in our surgeries. They are frequently under-reported so their exact incidence can be difficult to quantify; however, estimates are that 50% of the population experience them by the age of 50. Because many people attribute symptoms of more serious pathology to haemorrhoids, careful evaluation is always very important. Fortunately, most cases are simple to treat and often resolve very quickly, although up to 10% of sufferers may require surgery to fully alleviate their symptoms. In this episode, Dr Roger Henderson looks at the classification of haemorrhoids, their predisposing factors, symptoms — including red flag symptoms — and treatments.

Key references

1. NICE. Treatment summaries. Haemorrhoids. Accessed 20 February 2024.
2. Mott T, et al.Am Fam Physician. 2018;97(3):172-179.
3. Thaha MA and Steele RJC. BMJ Best Practice. 6 May 2022.

Key take-home points

• Haemorrhoids are extremely common and often under-reported, affecting 50% of the general population by the age of 50.
• They are particularly common during pregnancy and from middle age onwards.
• They have multiple predisposing factors including pregnancy, constipation or chronic diarrhoea, straining, a low-fibre diet and obesity.
• Haemorrhoids may be external or internal, and may present differently, but are caused by increased pressure within the anal submucosal blood vessels and laxity of supporting connective tissue.
• Many people with haemorrhoids do not seek professional help because of embarrassment or fear.
• Always check for the presence of red flag symptoms in someone with haemorrhoids – symptoms of more serious pathology may be dismissed as being due to them.
• Mild to moderate cases usually respond well to lifestyle changes and topical treatments. Good anal hygiene is also crucial.
• Topical treatments typically contain a number of ingredients to provide symptom relief.
• Prolonged use of creams containing topical steroids can lead to skin sensitisation, dermatitis and skin atrophy.
• There are no topical haemorrhoid preparations licensed for use during pregnancy or breastfeeding. However, NICE guidance says that any potential risk is lowest with simple, soothing products.
• Always avoid opioid painkillers, as they may cause constipation, and non-steroidal anti-inflammatory drugs if there is active bleeding from haemorrhoids.
• Approximately 1 in 10 people with haemorrhoids may require surgical treatment at some point.