It starts with a sting or a little swelling. Then a bit of bleeding that's easy to brush off—until it becomes a weekly ordeal. Yet many men stay silent, sitting uncomfortably at their desks or shifting awkwardly in traffic, unsure whether to call it pain or just "discomfort."
Dr Mark Siboe, a general and laparoscopic surgeon, sees this all too often. "In my practice, I get at least three consultations per week for possible haemorrhoids," he says.
"Haemorrhoids, also known as piles, are vascular structures in the anal canal that aid in maintaining continence," explains Dr Siboe. "Think of haemorrhoids as natural 'cushions' of blood vessels in your bottom that help control bowel movements."
They only become a problem when these cushions swell, become inflamed, or prolapse—then it becomes what doctors call haemorrhoidal disease, which affects up to 40 percent of adults, particularly those over 50.
While haemorrhoids affect both men and women equally, Dr Siboe says more women are likely to report symptoms and seek treatment.
"This is because of social stigma or discomfort discussing anorectal issues," he explains.
But left untreated, haemorrhoids can become more than just a nuisance. They can lead to chronic blood loss and anaemia, strangulated haemorrhoids where blood flow is cut off, thrombosis, or even severe prolapse that impacts hygiene and day-to-day comfort.
What causes haemorrhoids?
The condition is often triggered by venous hypertension—that is, prolonged straining, constipation, or pregnancy, which leads to venous distension.
Another major cause? Mechanical stress. "Shearing forces and straining weaken the anchoring tissue," Dr Siboe says. This includes poor bathroom habits like straining or scrolling your phone while on the toilet.
Connective tissue degeneration is another culprit. Think of it like your favourite old sofa.
"Age-related or genetic degradation of collagen/elastin fibres—like your favourite old sofa when it sags and no longer cushions you. Your tissues naturally weaken with age when you are about 40–60 years," he explains.
Inflammation and angiogenesis (formation of new blood vessels) also play a key role. "The former plays a pivotal role in the pathogenesis and symptomatology of haemorrhoidal disease," he says.
"The engorgement and prolapse of haemorrhoidal cushions lead to vascular stasis, which in turn triggers an inflammatory response. This inflammation results in symptoms such as pain, swelling, and bleeding."
Common symptoms
According to Dr Siboe, these are the top signs that should prompt medical review: Bright red rectal bleeding, mucous discharge, perianal itching, swelling around the anus and pain—especially with thrombosed external haemorrhoids.
And here's a key warning: "For patients with bleeding, it's important to perform colonoscopy or sigmoidoscopy to exclude growths that may have the potential to be cancerous—that is, polyps or adenomas."
What makes it worse?
Office jobs. Truck driving. Construction work. These aren't just tough on your back. "Sedentary work—sitting for more than six hours a day—doubles pressure," says Dr Siboe.
Jobs involving heavy lifting, like movers and gym trainers, also increase risk.
"Holding your breath and straining during lifts increases intra-abdominal pressure, which can lead to haemorrhoids. Holding your breath while lifting (Valsalva manoeuvre) can spike pressure to three times normal—like overinflating a balloon."
A smart fix? Exhale during lifts of above 25 kilogrammes and avoid max lifts if you are prone to flare-ups.
Do over-the-counter (OTC) creams and home remedies work?
They help, but only for mild symptoms. Dr Siboe says most OTC treatments provide temporary relief, and persistent or worsening symptoms should be reviewed by a doctor.
"Proven home relief: warm sitz baths (2–3 times a day for 10 minutes)," he says. "Skip unproven remedies like tea tree oil, aloe vera, and crushed ginger or garlic, among others."
Dr Siboe says treatment depends on the grade and symptoms. For patients presenting with Grade I or II haemorrhoids, where there is no prolapse or only mild prolapse during straining that resolves on its own—treatment is generally conservative.
"You are advised to eat foods that are rich in high fibre of about 25–35g a day to reduce bleeding and recurrence. Secondly, you should drink between 1.5–2L of water every day," says Dr Siboe.
Doctors may also recommend stool softeners like Castocap or Laxilac, along with topical corticosteroids, anaesthetics, and flavonoids such as Caldoberg and Daflon.
In cases where the condition has progressed to Grade III—where the prolapse requires manual reduction—or where conservative measures fail, minimally invasive procedures may be necessary.
If the condition worsens to Grade IV or becomes recurrent and irreducible, surgery becomes the next step.
"It could be an excisional haemorrhoidectomy, which is highly effective but more painful and has a longer recovery time. You could undergo a stapled haemorrhoidopexy (PPH), which has a faster recovery, is minimally invasive and less painful, or the Doppler-guided haemorrhoidal artery ligation (DG-HAL), which targets arterial inflow using ultrasound guidance."
Can it affect your sex life?
Not directly, but it can impact confidence and intimacy. "Pain during certain activities may also lead to avoidance, impacting relationships," shares Dr Siboe.
