Hemorrhoids: how do hemorrhoids occur, what are their symptoms and how can we reduce and treat them?

Hemorrhoids are not dangerous or life-threatening, but the symptoms they cause can be extremely uncomfortable. Sometimes our pains are reduced all by themselves, but in most cases, they reoccur in a similar or more extreme fashion if not treated adequately.

It is believed that 50% of people over the age of 50 have hemorrhoids, but not everyone has the same level of discomfort. Some have large hemorrhoids and a little discomfort, and others the opposite.

What are hemorrhoids?

Hemorrhoids are lowered anal cushions. We have anal cushions since birth They are located under the anal canal mucosa, two centimetres from the exit. In the cushions, there is a web of veins and arteries, which is connected to the anal canal wall with muscle and elastic tissue. There are more blood vessels than needed for supplying the tissue with food, which means that blood has another function here. This function consists of filling and increasing the anal cushions. The blood does not pass through the tissue, but directly from the arteries to the veins. Veins are uniquely built, with clustery openings. It was once believed that these clustery openings are responsible for the onset of hemorrhoids, so hemorrhoids were, quite wrongly, thought to be varicose veins.

That mistaken presumption dates right back to Hippocrates and has been retained until the present day, so it is still possible to find this idea in many books and on many internet sites. But today we know that these openings are a normal part of the anal cushions and that they are filled with blood and so increase the volume of the cushions.

Anal canal dissection

Over the course of our lives, these cushions begin to sink towards the exit to the anal canal, thereby forming hemorrhoids. Unfortunately for some, this begins when they are young, so they begin to have problems with hemorrhoids as early as their twenties.

Hemorrhoid severity: internal and external hemorrhoids

Internal hemorrhoids

The disease degree denotes the degree of anal cushion prolapse. The more the cushions are prolapsed, the greater the hemorrhoid degree is. Internal hemorrhoids rarely cause pain, because the anal mucosa where they occur is not sensitive to pain (it has no nerve endings).

Hemorrhoids - First Degree
Hemorrhoids - First Degree

Hemorrhoids – First Degree

Small, initial haemorrhoids that do not prolapse from the anal canal.

Symptoms: occasional bleeding after a bowel movement, itching

Hemorrhoids - Second Degree
Hemorrhoids - Second Degree

Hemorrhoids – Second Degree

Hemorrhoids protrude from the anus upon straining and after passing a stool, but they return inside spontaneously.
Symptoms: occasional bleeding after passing a stool, itching and burning, a feeling of fullness in the anus, patients may be able to feel a lump on the anus, which then withdraws.

Hemorrhoids - Third Degree
Hemorrhoids - Third Degree

Hemorrhoids – Third Degree

Protruding constantly, but can be returned inside the anal canal with the fingers.
Symptoms: like second degree; a brown or bloody discharge is noticed on the underwear.

Hemorrhoids - Fourth Degree
Hemorrhoids - Fourth Degree

Hemorrhoids – Fourth Degree

Constantly prolapsed hemorrhoids can no longer be returned inside the anal canal with the fingers.
Symptoms: constant discomfort, frequent bleeding unrelated to bowel movements, underwear soiling with brown or bloody discharge.

External hemorrhoids

These may appear in two forms.

Acute thrombosed hemorrhoids– some call this condition acute haemorrhoidal crisis.
A clot is formed in the hemorrhoidal veins, from several millimetres to
two to three centimetres in size. The ultra-sensitive skin around the anus stretches, causing acute pain which increases as the surrounding tissue swells even more. Having a bowel movement becomes an epic endeavour. Patients can usually feel a lump that has appeared around the anus.

Causes: lifting a heavy weight (spring cleaning, helping a bedridden patient), straining due to constipation, the habit of creating a library in the bathroom and frequently reading on the toilet, giving birth. People who sit a great deal at work are prone to thrombosed hemorrhoids (police officers, pilots, IT technicians), which suddenly activate doing heavy physical work.

Acute hemorrhoids thrombosis
Acute hemorrhoids thrombosis

Another form of external hemorrhoids is skin folds (anal pendants) around the anus. They remain after acute thrombosed hemorrhoids, which severely stretched the skin around the anus.

Women often say that their external hemorrhoids appeared during pregnancy and giving birth. They are not painful, but they cause problems with maintaining anal hygiene, and if they bother the patient greatly, they require surgical treatment.

External hemorrhoids - skin folds
External hemorrhoids - skin folds

Why do hemorrhoids occur?

Both men and women are equally susceptible to hemorrhoids, which indicates that the muscles and elastic threads are equally strong in both sexes. The incidence of hemorrhoids increases with the years, probably as the supporting muscles and elastic threads weaken.
Although no hemorrhoid gene has yet been discovered, we know that hemorrhoids are more frequent in some families. But we don’t know if this is because of a hemorrhoid gene, a similar diet, or a way of life that fosters the occurrence of hemorrhoids.


It is estimated that during pregnancy 40% of women have problems with hemorrhoids, and there are many reasons for this.
Estrogen receptors have been discovered in hemorrhoids, which are just as densely distributed as in breast tissue. Estrogen causes tissue to become stretchy, so the belief is that this contributes to the problems because the weakening of the supporting threads that hold the hemorrhoids to the large intestine wall occurs more easily. During pregnancy, as a result of taking iron supplements and higher levels of estrogen and progesterone, women frequently suffer from constipation (slow digestion). Also, the increased pressure in the pelvic veins due to the baby’s weight and the increased blood volume (up to 40%) means that symptomatic hemorrhoids have almost become a normal part of pregnancy.

Hard Stool

A hard stool damages the anal cushions.
Straining due to constipation will cause snapping of the supporting threads holding the hemorrhoid cushions in the anal canal if we allow this situation to continue for a long time. Straining when having a bowel movement due to constipation is seen as one of the most important factors in the occurrence of hemorrhoids.


Hemorrhoids love it when you drink red wine.
All food that causes constipation leads to straining when having a bowel movement, encourages the occurrence of hemorrhoids.

There is no scientific evidence that drinking coffee or alcohol can favour the occurrence of hemorrhoids, although you will find recommendations on many internet sites that you should not drink these beverages. We would only recommend that you avoid red wine and strong spices because they increase skin irritation around the anus.

Hemorrhoids love it when you drink wine
Hemorrhoids love it when you drink wine

Work and recreation

It has been known since ancient times that hard physical labour makes problems with hemorrhoids worse. You can read about St. Fiacre, who got hemorrhoids after digging, on our web pages. Tensing the stomach muscles leads to an increase in pressure in the abdomen, and pressure in the hemorrhoidal veins also increases, which leads to the snapping of the supporting threads of the anal cushions. Contemporary science has only recently found proof for this claim. Physical work, as well as occupations that require us to sit or stand for long periods of time, are related to hemorrhoids occurring more frequently.
One study mentions that men have hemorrhoids more often after working in the garden in spring, or from doing too much exercise on their holidays. In women, however, they occur after the spring cleaning, or after caring for their bed-ridden husband or relative.

Hemorrhoids and activity
"I will get up myself so you don't get hemorrhoids"

Sitting on the toilet

Sitting on the toilet for a long period of time with a relaxed perineum favours the development of hemorrhoids. The pressure in the veins in the hemorrhoids increases, which may lead to damaging the supporting apparatus of the anal cushions. According to the research conducted by the American magazine Reader’s Digest, the bathroom is the place where American people read the most. From personal experience, we can say that this is also the case in Croatia. However, reading on the toilet while constipated is a winning combination for getting hemorrhoids. That is why the American Society of Colon and Rectal Surgeons advises avoiding sitting on the toilet for a long time if you want to avoid hemorrhoids. We would recommend the libraries that want to attract readers to cover their walls with ceramic tiles, and to install toilet bowls instead of chairs.

Hemorrhoids love it when you read on the toilet
Hemorrhoids love it when you read on the toilet

Associated diseases
Reliable data exists showing that hemorrhoids are more frequent in patients with a hernia or a prolapsed uterus because their connective tissues are weaker. The supporting muscles and elastic threads that hold the anal cushions are also connective tissue. Smoking activates certain enzymes that lead to the weakening of connective tissue, which means it may also favour the hemorrhoids. Men with enlarged prostates or narrowed urinal tracts also have hemorrhoids more often, but the reason is tensing the abdomen due to difficulties passing urine.
There are many myths about patients, allegedly related to the increased incidence of hemorrhoids, such as varicose veins in the legs, vascular diseases, high blood pressure and liver cirrhosis. But they are all false. People with these ailments do not suffer from hemorrhoids more often. Patients with cirrhosis may develop larger collateral veins around the anus, but these are not hemorrhoids.

Problems Caused by Hemorrhoids

  • PAIN
tegobe koje uzrokuju hemoroidi

Itching, burning and discomfort in the anal area are the most frequent problems related to hemorrhoids. We feel as though we have an infection, although there is none. These problems are the result of skin irritation. They occur because mucus and pieces of stool get out onto the skin around the anus. Brown stains begin to appear on underwear. There are bile salts in the stool that help to break down fats. Bile salts are actually an excellent detergent. When they come into contact with skin, they break down the skin’s protective lipid layer and cause severe irritation. It is like a burn caused by strong sunlight. The skin that is constantly exposed to detergents reacts by thickening its surface layer and increasing the number of nerve endings. Then it begins to itch, although we do not know exactly how an increase in the number of nerve endings causes itching. When the itch appears, we instinctively increase our anal hygiene, using intimate soaps and shampoo. All soaps and shampoos contain detergents that act like bile salts and make the problems worse. So we have a vicious circle: itching – more shampoo washing – worse itching. I am frequently asked why intimate shampoos cause irritation if they are pH neutral. It is not the pH that causes irritation, but the detergents in the products.

Itching, burning and discomfort are often intensified after eating spicy food. That is why we often hear people complaining about getting hemorrhoids after eating a “hot” stew or barbecue. This is not a case of hemorrhoids, though, but rather a more severe irritation because of the extra bile salts in the stool due to the spicy food. Some say that red wine is worse than a spicy stew.

Bile salts and detergents damage the skin, a bit like the Sun. They cause irritation and redness, which we experience as similar to an infection.

The skin becomes thicker after long-term irritation by bile salts or detergents, and then it begins to itch.

People describe a feeling of fullness, as though something was left behind in the anus after having a stool, which can’t come out. Since hemorrhoids are enlarged and prolapsed anal cushions, it is normal for them to cause a feeling as though there is something in the anus. The anus is actually a very sensitive body area, which has more nerve endings than our fingertips. After passing a stool, the hemorrhoid tissue fills with blood and increases in size, which causes this feeling of fullness. Later, the blood in the hemorrhoid gradually empties and it shrinks, which causes the feeling of fullness to disappear.

Hemorrhoids are in fact prolapsed anal cushions, which are normally found in the anal canal and help to retain gases and stools. When the connections that hold the anal cushions to the anal canal wall are severed, they begin to prolapse. At first, they only prolapse after a bowel movement and return spontaneously into the anal canal. Later hemorrhoids protrude all the time and can no longer be returned into the anal canal.

Bleeding is not such a frequent symptom of hemorrhoids as people think. But it is the most frequent symptom that causes people to see a doctor because they fear it might be something worse. This fear is justified because a colon tumour can bleed just like a hemorrhoid. Blood from hemorrhoids is bright red and is noticed as a red stain on paper or in the form of drops on the toilet bowl after defecation. Dark red blood with clots indicates something more dangerous than hemorrhoids.

Hemorrhoids rarely cause pain. But when they do hurt, they make it difficult to sit normally or walk, because the pain is intense. The reason for this is a thrombosis inside the hemorrhoid that creates high pressure, which in turn stretches the sensitive skin around the anus. The stretched skin around the anus is the reason for the pain. The thrombosis in the hemorrhoid can be felt as a painful lump the size of a pea, but it may grow to the size of a walnut.

How to ease itching and burning

Two steps you must take in order to relieve itching and burning:

1.Change your anal hygiene
2.Start using a protective ointment

The occurrence of itching and burning around the anus is not a hemorrhoid infection, but a sign of severe irritation and redness of the skin, caused by damage to the skin’s fat barrier. The skin barrier is damaged by bile salts which leak from the anal canal with a small quantity of stool. The stool leaks because the hemorrhoids disturb the tight seal of the anal sphincter, and a stain appears on the underwear.

It usually goes like this: you wash up after defecating and everything is great for a few hours, and then at work, you feel an itch and burning around your anus. When you get home, there are usually a few brown stains on your underwear. Another possible scenario is this: you wash in the evening and go to bed, and then you are woken up in the night by an unbearable itch around your anus. When you go to sleep, all sphincters relax, so a little piece of stool comes out onto the skin around your anus. Thus the irritation begins. You wake up.

anal hygieneAfter wiping yourself with dry toilet paper, you wash in plain water. It may be lukewarm or cold. Stop using intimate soaps, shampoos and moist wipes which contain detergents. Detergents make it easier to clean a soiled surface, but unfortunately, they damage the protective layer of skin and make your problems worse.

Detergents are present in intimate soaps and shampoos. They make the itching and burning worse. Avoid them.

You want to know how our products can improve your anal hygiene?

Use ointment to prevent hemorrhoids after washing the anal region. The ointment must create a film that replaces the damaged skin barrier, and so reduces the itching and burning.

A good ointment for hemorrhoids relieves the itching and burning, causes no irritation and is very thick.

Hemorrhoids have troubled people since the beginning of time. People looked for solutions to their problems on their own. They noticed that thick, fatty substances help with hemorrhoidal problems. They did not conclude this on the basis of research, but experience. They tried all kinds of things and found something that relieved their problems. So in Dalmatia today people still use olive oil to help with hemorrhoids. In northwest Croatia, olives do not do as well when compared to pigs. In that region, people have used pig fat for centuries to spread on their hemorrhoids.

Today we have proof of what people have known for so long. And that proof is that fatty substances help restore the damaged skin barrier in case of hemorrhoids.

In the USA, the regulatory body (the Food and Drug Administration) issued a monograph about protective substances for the skin which have been proved to be effective, and how much of these substances ointments should contain. Most of these protective substances are fatty substances and replace the damaged skin barrier.


Protective substance How much is needed in the ointment
Vaseline 30-100 %
Fish oil 5-13 %
Dimethicone 1-30 %
Lanolin 12,5-50 %
Paraffin 50-100 %
Cocoa butter 50-100%
Starch 10-98 %
Zinc oxide 1.25 %


The recommendations of the American Food and Drugs Agency regarding good protective substances for the skin, and how much of each should be included in ointments
Do you want to know why our Prokten ointment is better than olive oil or pig fat?

What should you do if hemorrhoids prolapse or bleed?

The only thing that has proven to reduce prolapsed hemorrhoids and bleeding is fiber. You have to take 5 to 7 grams of fiber a day over several weeks. We recommend psyllium for fiber.

These are the guidelines of the American Gastroenterological Association based on research into how to reduce prolapsed or bleeding hemorrhoids.

How do dietary fibers do that?

Fiber gives volume to stools and makes them softer. The more fiber in food, the fatter and softer the stools will be. The fatter the stool, the more it stretches the anal sphincter. When the anal muscle (sphincter) is stretched, blood drains out of the hemorrhoids and they shrink. While the anal muscle is contracted, blood cannot come out of hemorrhoids that are enlarged, prolapsed and bleeding.

If I take enough fiber one day, will I get better immediately?

No. Hemorrhoids do not grow in a single day, and they won’t shrink in a single day. They can only be reduced in a single day by surgery. Fiber must be taken for at least a week to have results. It is recommended to take fiber for several months to achieve the best results.


Fibers Stool weight Transit time
12g 69g 70h
25g 130g 60h
45g 180g 45h

The more fiber in your food, the larger and softer your stools will be And the faster it will pass through the intestines

“The dry twig effect” – the stool is narrow and hard due to a lack of fiber

The result is hemorrhoids, which bleed and are prolapsed.

“The sausage effect” – the stool is soft and fat like a sausage when we eat enough fiber. Hemorrhoids shrink and bleed less

Several decades ago, a surgeon called Parks discovered a good method for treating hemorrhoids, by stretching the anal sphincter using four fingers. Although it was not pleasant, the method gave good results, and hemorrhoids shrank when the anal muscle was stretched. Fibers can do the same as Dr. Parks but in a less painful way.

How much fiber in a day is enough to make stools fat and soft? About 25 grams of fiber is needed. People today eat about 16 to 18 grams of fiber a day. This means that it is usually necessary to add 5 to 7 grams of fiber to our diet to achieve the “sausage effect”, that is, soft, fat stools that easily slide out.

Are fruit and vegetables rich in fiber? No. Fruit and vegetables contain a lot of water, but relatively little fiber. If you want to supplement 7 grams of fiber by eating lettuce or cucumbers, you need to eat 1 kilo of lettuce or cucumbers. Apples and pears are slightly richer in fiber, so you need to eat 200 to 400 grams of those fruits to achieve the “sausage effect”

What contains a lot of fiber? Whole-grain foods such as oats, barley, wheat, rye, as well as dried fruit are excellent sources of fiber. It is nice to know that popcorn is also a whole-grain food that contains a lot of fiber.

How can we easily increase our fiber intake through food, while keeping in mind to consume only natural products? Take bran or psyllium. They are both natural fibers. The only difference is that bran comes from wheat, and psylliumfrom desert Indianwheat. Psyllium has two advantages:

  • it is water-soluble so it can be prepared as a drink
  • it expands in the intestines so it produces the best “sausage effect”

4. What to do when hemorrhoids become painful?

Pain around the anus is almost always the result of two things:

  • thrombosed hemorrhoids which can be felt as painful lumps
  • anal fissures, that is , wounds on the anus, which cannot be felt but are painful as hell

In both cases, the pain is very intense and makes normal sitting and other everyday activities difficult. Both conditions are treated in the same way.


Three things you can do to ease the pain:


1. Take painkillers.

Paracetamol is recommended, in a large dose, 3 x 2 500 mg tablets. Do not take other pain killers as they may cause bleeding. Paracetamol does not cause bleeding. It is known as Lupocet or Plicet in pharmacies.

I have noticed that regardless of how painful hemorrhoids may be, people do not take anything for the pain, nor do doctors or pharmacists recommend it. I don’t know why we put up with the pain of hemorrhoids, but we take tablets for headaches. If we have rheumatism, we take pain-relieving tablets. It seems that the problem is the absence of tablets for our bottoms! That is why I suggest that paracetamol becomes the tablet for hemorrhoids.

If your hemorrhoids cause you pain, take some paracetamol.


2. Take psyllium fiber to soften your stools and they will hurt less.

Go on taking psylliumfor a few weeks after the pain recedes.


3. Take the thickest hemorrhoid ointment there is, and spread a thick layer on your anal region several times a day.

Creams and ointments that contain normal local anesthetics will not help you much because local anesthetics cannot be absorbed through the skin. If you don’t believe me, try spreading it on your finger and then pricking yourself with a pin.

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