Dr Devesh Kaushal


Haemorrhoids, also known as piles, are swollen veins in the lowest part of your rectum and anus. They’re similar to varicose veins and are a common condition.

Haemorrhoids can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids).

What Causes Haemorrhoids?

  • Increased Pressure: Straining during bowel movements, sitting for long periods of time on the toilet, or standing or lifting too much can cause increased pressure in the lower rectum.
  • Chronic Constipation or Diarrhea: Frequent straining during bowel movements can lead to haemorrhoids.
  • Pregnancy: Haemorrhoids are common during pregnancy, particularly in the third trimester and immediately after childbirth due to increased pressure on the veins.
  • Obesity: Being overweight can increase the likelihood of haemorrhoids.
  • Diet: A diet low in fibre can cause constipation, which can lead to haemorrhoids.
  • Aging: The tissues that support the veins in the rectum and anus can weaken and stretch with aging.
  • Genetics: There may be a hereditary component, as haemorrhoids can run in families.

Symptoms of haemorrhoids depend on the type and severity but may include:

  • Painless Bleeding: This might happen during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
  • Itching or Irritation: In the anal region.
  • Pain or Discomfort: Especially when sitting.
  • Swelling: Around the anus.
  • A Lump Near Your Anus: Which may be sensitive or painful (may indicate an external haemorrhoid).
  • Leakage of Faeces: Can occur with internal haemorrhoids.

A doctor can often diagnose haemorrhoids based on a physical examination. Visual inspection of the anus and surrounding area may diagnose external or prolapsed haemorrhoids. A rectal exam may be performed to detect possible rectal tumours, polyps, an enlarged prostate, or abscesses. To confirm the diagnosis of internal haemorrhoids, a doctor may perform an anoscopy, sigmoidoscopy, or colonoscopy.

Conservative Treatments:

For mild cases of haemorrhoids, several measures can be taken at home:

  • Dietary Changes: Increasing fibre intake can soften stools and reduce the strain that can cause haemorrhoids.
  • Topical Treatments: Over-the-counter creams, ointments, or suppositories for relief.
  • Sitz Baths: Sitting in warm water for about 15 minutes, several times a day, especially after bowel movements.
  • Good Hygiene: Keeping the anal area clean is important.
  • Pain Relievers: Medications such as acetaminophen, ibuprofen, or aspirin can help relieve pain.


Minimally Invasive Treatment Options:

If conservative treatments do not help or if haemorrhoids are particularly large, one of the following outpatient or in-office procedures may be considered:

  • Rubber Band Ligation: A band is placed around the base of a haemorrhoid to cut off blood supply, causing it to wither away.
  • Sclerotherapy: A chemical solution is injected into the haemorrhoid tissue to shrink it.
  • Infrared, Laser, or Bipolar Coagulation: Techniques that use heat or a laser to harden and shrivel small haemorrhoids.


Surgical Treatment Options:

For severe cases or those that do not respond to other treatments, surgery may be necessary:

  • Hemorrhoidectomy: The excess tissue causing bleeding is removed. This is the most effective and complete way to treat severe or recurring haemorrhoids.]
  • Haemorrhoid Stapling: This is used primarily to treat internal haemorrhoids by cutting off the blood flow to the haemorrhoid tissue.

Recovery time varies depending on the treatment. Simple dietary changes can provide relief within a few days, and most symptoms of mild haemorrhoids resolve without treatment. Surgical treatments can take a few weeks for full recovery, and pain management may be necessary. Following a high-fibre diet and taking sitz baths can help with the recovery process.

  • For Non-Surgical Treatments: There may be minor pain or discomfort, and a small risk of bleeding or infection.
  • For Surgical Treatments: These carry a higher risk of complications, including bleeding, infection, and reaction to anaesthesia. There can also be urinary retention problems post-surgery.

Most people get relief from haemorrhoids using home treatments and lifestyle changes. For persistent or severe cases, more advanced treatments and surgery can be effective. It is also important to note that while haemorrhoids are not life-threatening and often clear up on their own, any rectal bleeding should be evaluated by a doctor to rule out more serious conditions.

Dr Devesh Kaushal is a Specialist General Surgeon and a Fellow of the Royal Australian College of Surgeons (FRACS).

Dr Kaushal offers 15+ years of experience and holds a Master of Surgery Degree, as well as being fully certified in gastroscopy and colonoscopy by the Gastroenterology Society of Australia (GESA).

Dr Kaushal takes an empathetic, warm-hearted and friendly approach to patient care and is completely dedicated to patient outcomes.

He consults and operates across Souther-Western Sydney.