Haemorrhoids, also known as haemorrhoidal cushions, are a natural part of the anatomy of the anal canal. A problem appears when they become enlarged, bleed, prolapse, cause pain, itching or discomfort. It is important to remember, however, that not every episode of rectal bleeding is caused by haemorrhoids — this is why such symptoms are best assessed during a proctological consultation.
This article explains which symptoms may suggest haemorrhoidal disease, what haemorrhoids may be confused with, when not to delay a visit and what the first proctological assessment looks like. If you want to discuss your symptoms with a doctor, book a proctological consultation in Gdańsk.
Author: Sara Godyńska, MD, proctologist | Medical review: Justyna Szul, MD, proctologist | Publication date: 27.06.2026 | Last updated: 29.06.2026
What exactly are haemorrhoids?
People commonly use the word “haemorrhoids” or “anal varices”, but the more precise term is haemorrhoidal disease. Haemorrhoidal cushions themselves are a normal anatomical structure — they help seal the anal canal. The problem begins when they enlarge, move downward, bleed, prolapse or cause symptoms.
Important: the presence of haemorrhoidal cushions itself does not always mean disease. We treat symptoms and their cause, not the mere fact that a patient has haemorrhoidal cushions.
That is why good proctological care is not only about saying: “these are haemorrhoids”. It is about answering several important questions: where the bleeding comes from, how advanced the changes are, whether there are other diseases of the anus or rectum and which treatment method will be most reasonable.
“The most common mistake patients make is assuming that every rectal bleeding episode means haemorrhoids. Often it really is the case, but this should not be assumed without examination.”
— Sara Godyńska, MD, proctologist
Which symptoms may suggest haemorrhoidal disease?
The symptoms of haemorrhoids depend on whether the problem involves internal haemorrhoids, external haemorrhoids, thrombosis, inflammation or prolapse. In some patients bleeding is the main symptom, while in others itching, burning, moisture or discomfort while sitting dominate.
The most common symptoms include:
- fresh, bright red blood on toilet paper, in the toilet bowl or on the surface of the stool,
- itching and burning around the anus,
- a feeling of moisture, irritation or difficulty maintaining hygiene,
- pain or discomfort during bowel movements,
- a feeling of incomplete evacuation,
- prolapse of haemorrhoidal tissue outside the anus,
- a lump near the anus, especially painful in external thrombosis,
- mucous discharge or staining of underwear.
Symptoms may worsen after constipation, prolonged sitting on the toilet, intense straining, diarrhoea, pregnancy, childbirth, long periods of sitting or heavy physical effort.
Rectal bleeding — why should it not automatically be blamed on haemorrhoids?
Rectal bleeding is a common reason for visiting a proctologist. In many patients, haemorrhoids are indeed the cause, but a similar symptom may also occur in other diseases. That is why self-treatment with ointments or suppositories without a diagnosis may delay proper evaluation.
Rectal bleeding may occur, among other causes, in:
- haemorrhoidal disease,
- anal fissure,
- polyps of the rectum or large intestine,
- inflammation of the rectum,
- inflammatory bowel diseases,
- diverticular disease,
- cancerous lesions of the large intestine or rectum,
- injuries and irritation of the anal area.
The point is not to frighten every patient with cancer. The point is not to miss a situation in which “haemorrhoids” are only an assumption, while the real cause requires different treatment.
When should you see a proctologist more urgently?
| Symptom | Why is it important? |
|---|---|
| recurrent or increasing rectal bleeding | requires determining the source of bleeding |
| blood mixed with stool, clots or dark blood | may suggest a source of bleeding other than typical haemorrhoids |
| weight loss, weakness, anaemia | these symptoms should not be explained by haemorrhoids alone |
| change in bowel habits | new constipation, diarrhoea or change in stool shape requires assessment |
| severe pain, fever, increasing swelling | may suggest abscess, thrombosis or inflammation |
| first bleeding after the age of 40–50 | it is worth not automatically assuming that these are only haemorrhoids |
Why do haemorrhoids appear?
Haemorrhoidal disease usually does not have one single cause. It often results from several overlapping factors: chronic straining, constipation, diarrhoea, prolonged sitting on the toilet, low physical activity, a low-fibre diet, pregnancy, childbirth or anatomical predisposition.
Contributing factors include:
- constipation and prolonged straining during bowel movements,
- long sitting on the toilet,
- a diet low in fibre,
- insufficient hydration,
- low physical activity,
- overweight and obesity,
- pregnancy and childbirth,
- chronic diarrhoea,
- lifting heavy weights,
- age and weakening of supporting tissues.
In practice, treating haemorrhoids without improving bowel movements often gives only short-term results. If the patient continues to strain heavily, sit on the toilet for a long time and has hard stools, symptoms may return.
What does a proctological consultation look like?
A proctological visit begins with a conversation. The doctor asks about symptoms, how long they have lasted, bleeding, pain, bowel habits, constipation, diarrhoea, previous treatment, chronic diseases, medications and family history. This is important because similar symptoms may have different causes.
The doctor may then examine the anal area, perform a digital rectal examination and — if indicated — anoscopy. Anoscopy allows the doctor to examine the anal canal and the final part of the rectum. In many cases, it is this examination that helps assess haemorrhoids and distinguish them from other causes of symptoms.
For many patients, embarrassment is the biggest barrier. That is why discretion, calm explanation and the patient’s consent for each stage of the examination are so important in a good proctological consultation.
“Patients often come in afraid of the examination itself. After the visit, they say that the most stressful part was not pain, but embarrassment and the idea of what the examination would look like. That is why calm guidance through every stage of the consultation is so important.”
— Justyna Szul, MD, proctologist
Treatment of haemorrhoids — where does it usually begin?
Treatment depends on symptoms, disease stage, examination findings and the patient’s expectations. A procedure is not always the first step. In some patients, the basis is bowel regulation, dietary changes, increased fibre and fluid intake and avoiding long sitting on the toilet.
In symptomatic treatment, the doctor may consider:
- increasing fibre intake,
- proper hydration,
- treatment of constipation or diarrhoea,
- reducing straining and time spent on the toilet,
- topical preparations relieving itching, pain or inflammation,
- oral medications used in selected situations,
- office-based methods for persistent symptoms.
Probiotics and the gut microbiota are an interesting area of research, but probiotics should not be presented as a standard, independent treatment for haemorrhoids. In patients with constipation or diarrhoea, the most important step is to identify the cause of bowel movement problems and match treatment to the actual issue.
When is procedural treatment considered?
If symptoms persist despite conservative treatment, or if haemorrhoids prolapse, bleed or significantly interfere with daily functioning, the doctor may discuss office-based or procedural treatment. The choice of method depends on the type of haemorrhoids, disease stage and examination findings.
Methods used in the treatment of haemorrhoidal disease include, among others, rubber band ligation using the Barron method, sclerotherapy, laser methods and surgery in selected, more advanced cases.
In this blog, however, the most important point is not comparing techniques, but the principle: treatment is chosen after examination. Details of methods, indications and treatment organisation are described on the page: treatment of anal varices and haemorrhoids in Gdańsk.
Preventing recurrence — what can the patient do?
Haemorrhoids tend to recur, especially if the factors that worsen them persist. Prevention is therefore not just about using ointments, but about improving daily habits.
The most important rules are:
- increasing dietary fibre, preferably gradually,
- drinking enough fluids,
- avoiding long sitting on the toilet,
- not delaying bowel movements when the urge appears,
- treating constipation and chronic diarrhoea,
- regular physical activity,
- maintaining a healthy body weight,
- avoiding excessive straining,
- gentle hygiene of the anal area without irritating rubbing.
If symptoms return despite changes in habits, it is worth not treating yourself blindly, but reassessing the situation with a proctologist.
Key conclusions
| Is every rectal bleeding episode caused by haemorrhoids? | No. Haemorrhoids are a common cause, but bleeding requires assessment, especially if it recurs or is accompanied by other symptoms. |
| Is a proctological examination necessary? | Yes, if symptoms persist, bleed, hurt or return. Examination helps choose treatment and rule out other causes. |
| Is a procedure always necessary? | No. Treatment often begins with bowel regulation, diet, hydration and symptomatic treatment. |
| When are procedural methods considered? | When symptoms are persistent, recurrent, haemorrhoids prolapse or bleeding and discomfort affect everyday life. |
| Where to start? | With a proctological consultation and determining the true cause of symptoms. |
Frequently asked questions
Can haemorrhoids go away on their own?
Mild symptoms may decrease after improving bowel movements, adding more fibre to the diet, proper hydration and reducing straining. However, if bleeding, pain, itching or prolapse persists or recurs, a proctological consultation is needed.
Does blood on toilet paper always mean haemorrhoids?
No. Bright red blood may occur with haemorrhoids, but also with anal fissure, inflammation, polyps and other diseases. Rectal bleeding should be consulted, especially if it recurs.
Does a proctological examination hurt?
The examination is usually short and performed with respect for the patient’s privacy. It may be uncomfortable, but it should not be forced. If the patient has severe pain, the doctor adjusts the examination to the situation.
When is anoscopy needed?
Anoscopy helps assess the anal canal and the final part of the rectum. It is especially useful in bleeding, suspected internal haemorrhoids, pain, itching, prolapse or unclear symptoms.
Can haemorrhoids be treated without surgery?
Yes. In many patients, treatment begins with conservative and office-based methods. Surgery is reserved for selected, more advanced or treatment-resistant cases.
Who should I see if I suspect haemorrhoids?
A proctologist is the best choice. At Wyspa Medycyny Przyjaznej, proctological consultations are provided, among others, by Sara Godyńska, MD, Justyna Szul, MD and Dr Kamil Smok.
Do you have bleeding, itching, pain or a lump near the anus?
Do not automatically assume it is “only haemorrhoids”. Start with a calm proctological consultation and examination.
Book a proctological consultation →Summary
Haemorrhoids are a common cause of itching, burning, pain, bleeding and discomfort around the anus. This does not mean, however, that every such symptom can be safely attributed to haemorrhoidal disease. Rectal bleeding in particular requires sensible diagnostics.
The best starting point is a proctological consultation, examination and — if indicated — anoscopy. Only after assessment can the doctor decide whether conservative treatment, dietary and habit changes, symptomatic treatment, an office-based method or a procedure is needed.
If you want to check available treatment methods after a diagnosis of haemorrhoidal disease, see the page: treatment of anal varices and haemorrhoids in Gdańsk. If, however, you only have symptoms and do not know what is causing them, start with a proctological consultation.
Sources and medical context:
- ASCRS — Hemorrhoids Expanded Information
- NIDDK — Symptoms & Causes of Hemorrhoids
- NIDDK — Eating, Diet & Nutrition for Hemorrhoids
- NICE NG12 — Suspected cancer: recognition and referral
- ASCRS — Management of Hemorrhoids, 2024 Clinical Practice Guidelines
This article is for informational purposes only and does not replace medical consultation. Rectal bleeding, severe pain, fever, increasing swelling, weight loss, anaemia, change in bowel habits or symptoms persisting despite treatment require medical assessment.