Haemorrhoids — Symptoms, Banding and When Rectal Bleeding Needs Investigation
TL;DR — Haemorrhoids are swollen blood vessels in or around the anus. They are very common — around half of all adults will have symptomatic haemorrhoids at some point — and almost never dangerous in themselves. The reason they matter clinically is that they cause rectal bleeding, and rectal bleeding always needs to be explained: the bleeding might be from the haemorrhoids, or it might be from something else further up the bowel (including a polyp or cancer) that has been wrongly blamed on them. Dr Goutham Sivasuthan performs rubber-band ligation (banding) of haemorrhoids — often during the same colonoscopy — across Brisbane, Redland and Logan.
What are haemorrhoids?
Haemorrhoids (sometimes called “piles”) are vascular cushions in the wall of the anal canal. Everyone has them — they are a normal part of anatomy and play a role in fine continence. They become a clinical problem when they enlarge, prolapse (drop down through the anus), bleed, thrombose (form a painful clot), or cause itching.
Haemorrhoids are classified as internal (above the dentate line — usually painless because the lining has no pain nerves) or external (below the dentate line — covered with skin and very sensitive to pain). Internal haemorrhoids are graded by how much they prolapse:
| Grade | Description | Typical management |
|---|---|---|
| Grade I | Bulge into the canal but do not prolapse through the anus | Conservative (fibre, fluids, topical treatment) |
| Grade II | Prolapse with straining but reduce spontaneously | Conservative or rubber-band ligation |
| Grade III | Prolapse with straining and require manual reduction | Rubber-band ligation (often during colonoscopy) |
| Grade IV | Permanently prolapsed and cannot be reduced | Surgical haemorrhoidectomy (referral) |
Symptoms
- Bright red rectal bleeding — usually painless, often noticed on toilet paper, in the bowl, or coating (rather than mixed into) the stool
- A lump or swelling at the anus, especially after a bowel motion
- A sense of incomplete emptying (tenesmus)
- Anal itching or irritation (pruritus ani)
- Mucus discharge or staining of underwear
- Severe localised anal pain — usually indicates a thrombosed external haemorrhoid (an acute blood clot) or an anal fissure rather than internal haemorrhoids
Important: rectal bleeding is never safe to attribute to haemorrhoids without investigation, particularly in anyone aged 45 or older, or anyone with a change in bowel habit, weight loss, iron-deficiency anaemia, or family history of bowel cancer. The most common avoidable diagnostic error in this area is to blame haemorrhoids without ruling out something more serious further up the bowel. See the bowel cancer screening page.
Causes and risk factors
- Chronic constipation and straining at stool
- Chronic diarrhoea
- Low-fibre diet, low fluid intake
- Pregnancy and childbirth
- Prolonged sitting (including long bathroom sessions with a phone)
- Heavy lifting
- Obesity
- Increasing age (vascular tissue weakens)
- Family history
How are haemorrhoids diagnosed?
Diagnosis is typically clinical — based on history, an external inspection of the anus, and a digital rectal examination. Anoscopy or proctoscopy (a short rigid scope inserted into the anal canal) directly visualises internal haemorrhoids and is the most useful office test. Where there is any concern that bleeding could be from higher up the bowel — or in anyone over 45 with new symptoms — colonoscopy is performed to exclude polyps, inflammation or cancer.
How are haemorrhoids treated?
Treatment is stepwise, escalating only if simpler measures don’t work.
- Conservative measures — 25–30 g of fibre per day, 2 litres of water, regular exercise, avoiding straining and prolonged sitting on the toilet. Topical treatments (e.g. Rectogesic, Proctosedyl, Anusol) for short-term symptom relief.
- Rubber-band ligation (banding) — the most effective office or endoscopic treatment for grade II and III internal haemorrhoids. A small elastic band is placed at the base of the haemorrhoid, cutting off its blood supply. The tissue shrinks and falls off over about a week, usually unnoticed. Around 70–80% of patients have lasting symptom relief from a single session. Often performed during the same colonoscopy — one procedure, both jobs done.
- Sclerotherapy or infrared coagulation — alternative office-based treatments for smaller haemorrhoids.
- Surgical haemorrhoidectomy — for grade IV, recurrent grade III, large external components, or banded haemorrhoids that have come back. Referred to a colorectal surgeon. More effective but more painful recovery than banding.
- Thrombosed external haemorrhoid — if seen within 48–72 hours of onset, the clot can be excised under local anaesthetic for rapid relief. After 72 hours, conservative management (warm baths, analgesia) is usually better.
Banding during colonoscopy — one procedure, both done
If you are having a colonoscopy and known internal haemorrhoids are confirmed during the procedure, Dr Goutham can perform rubber-band ligation in the same session under the same sedation. This avoids a separate appointment and is one of the most efficient uses of a single endoscopy slot. The banding adds no significant time to the procedure and recovery is the same as a standard colonoscopy.
When to see a specialist
- Any rectal bleeding — especially if you are 45 or older, or have any change in bowel habit, weight loss, iron-deficiency anaemia, or family history of bowel cancer
- Haemorrhoid symptoms not settling with 4–6 weeks of fibre, fluid and topical treatment
- Recurrent prolapse or troublesome itching
- A persistent painful lump at the anus
- Iron-deficiency anaemia of unclear cause
- If you’ve had banding before and symptoms have come back
What to expect at your appointment with Dr Goutham
At consultation Dr Goutham will take a focused history (bleeding pattern, bowel habit, prior treatment, family history) and perform an external examination, digital rectal examination, and usually anoscopy. If colonoscopy is appropriate — either because of the patient’s age, the bleeding pattern, or to rule out a more proximal cause — it will be arranged, and banding can be performed during the same procedure where indicated. For grade IV or extensive disease, referral to a colorectal surgeon may be the more appropriate route.
Frequently asked questions
Is rectal bleeding always from haemorrhoids?
No. Haemorrhoids are the most common cause but not the only one. Fissures, polyps, inflammatory bowel disease, diverticular bleeding and bowel cancer can all cause rectal bleeding. The pattern of the bleeding can give clues, but the only way to be sure is to examine the area — and if there is any doubt, examine the rest of the bowel as well. Painless bright red bleeding is classic for haemorrhoids, but it’s not specific.
Does banding hurt?
Banding is generally well tolerated. Internal haemorrhoids sit above the part of the anal canal that has pain nerves, so the banding itself is usually not felt or felt as mild pressure. Most patients have some discomfort or a sense of fullness for 24–48 hours after the procedure, manageable with paracetamol and warm baths. Significant pain is unusual and usually indicates the band has been placed too close to the dentate line — treatable by removing the band.
How long does banding take to work?
The banded tissue typically shrinks and sloughs off over 5–10 days — often without you noticing. Symptom improvement is usually obvious within 2–4 weeks. Some patients need a second banding session for additional haemorrhoid columns; this can be scheduled 4–6 weeks after the first.
Will banding fix my haemorrhoids forever?
About 70–80% of patients have lasting relief from a single banding session at 1–2 years. Some patients have recurrence over time, particularly if the underlying causes (low fibre, straining, constipation) are not addressed. Repeat banding can usually be performed if needed.
Can I prevent haemorrhoids?
Largely yes. The most effective measures are: a high-fibre diet (25–30 g/day), 2 litres of water a day, regular physical activity, not straining at stool, not sitting on the toilet for prolonged periods, and avoiding heavy lifting where possible. These don’t eliminate risk but substantially reduce it.
I have a sudden painful lump at the anus — is this haemorrhoids?
Probably a thrombosed external haemorrhoid — an acute clot in an external haemorrhoid. It is dramatic and painful but not dangerous. If seen within 48–72 hours of onset, the clot can be excised under local anaesthetic for rapid relief. After 72 hours, conservative measures (warm baths, paracetamol, topical analgesic) are usually a better choice as the clot is starting to resolve. See your GP or the practice promptly if symptoms are severe.
Are haemorrhoids dangerous?
Not in themselves. The clinical danger of haemorrhoids is not the haemorrhoids — it is the risk that another source of bleeding gets wrongly attributed to them and missed. That is why every episode of new or persistent rectal bleeding should be properly assessed.
Book a consultation
Phone 07 3733 1551 or send a referral via the contact form. No-gap colonoscopy and banding for insured patients across Brisbane, Redland and Logan. See about Dr Goutham, the bowel cancer screening guide, or the cost page.
