The haemorrhoidal cushions are blood vessels located in the so-called submucosa of the anal canal. These are normal structures that are held in position by fine muscle strands. They engorge with increased pressure (such as when straining to carry a heavy weight) which is one of the body’s mechanisms for continence.

With repeated straining and pushing, these fine strands of muscle fibres are torn. The haemorrhoidal cushions then drop down in an abnormally low position producing what we call “haemorrhoids” or “piles”.

In this abnormally low position, they can bleed without producing a lump (grade 1), they can start protruding out of the anus but come back spontaneously (grade 2), they can protrude and have to be pushed back in (grade 3) or they can protrude and not be able to be pushed back in (grade 4). Grade 4 haemorrhoids may be associated with clotting inside the haemorrhoid which can be very painful (prolapsed thrombosed haemorrhoids).

Haemorrhoids are usually painless. Only prolapsed thrombosed haemorrhoids produce pain.

Often patients may have a concurrent anal fissure which causes pain and is mistaken for pain from haemorrhoids.

Small rubber bands can be applied to the base of the haemorrhoid to stop bleeding from grade one haemorrhoids or deal with minor prolapse from grade two haemorrhoids.

This can be done following a colonoscopy under sedation or in the consulting rooms without any anaesthesia with the aid of a proctoscope (a short cylindrical tube which is inserted into the anus).

The base of the haemorrhoid is usually above the area of sensation in the anus and should therefore be painless. If pain is experienced after band ligation, the band is usually removed on the same day. It is normal, however, to feel like needing to open your bowels as the banded haemorrhoids may feel like anal content. It is important to resist any temptation to strain following banding.

The bands will fall off after 3-10 days and this may be associated with some bleeding. Significant bleeding is rare.

Other complications including infection are rare following banding.

Most haemorrhoids will settle down spontaneously by improving bowel function (see treatment of constipation) and avoiding straining.

Bleeding haemorrhoids can be treated by haemorrhoid banding, haemorrhoid artery ligation or haemorrhoidectomy.

Prolapsing haemorrhoids usually require either haemorrhoid artery ligation or haemorrhoidectomy. They are not well managed with banding alone.