Health condition · Clinically reviewed
Haemorrhoids, common, treatable — but always investigate red flags first.
Very common and usually benign — but rectal bleeding always warrants a proper exam to exclude cancer. Modern office-based procedures work well for most patients.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced from guidance
Checked against NICE, ACPGBI and peer-reviewed sources you can see at the end.
- 03
Current for 2026
Reflects current UK guidance on haemorrhoid grading, office-based procedures and red-flag screening.
Key facts
Haemorrhoids at a glance.
The essentials, in plain English — what they are, how they are graded, and how they are treated in the UK today.
-
What they are
Vascular cushions in the anal canal — pathological only when symptomatic (bleeding, prolapse, pain).
-
Grading
Goligher grades I–IV, based on prolapse and whether it reduces spontaneously or manually.
-
How common
Very common in adults — most people experience symptoms at some point.
-
A crucial caveat
Never assume rectal bleeding is “just piles” — proper examination is essential to exclude cancer.
-
Treatment today
Office-based procedures (banding, sclerotherapy, infrared coagulation) now cover most cases.
-
Prevention
A high-fibre diet, adequate hydration and avoiding prolonged straining prevent recurrence.
Why this guide matters
Common, but never assumed.
Haemorrhoids are the commonest cause of rectal bleeding — but never the only one. The three points below shape everything else on this page.
-
Always examine, never assume
Bright red bleeding is usually piles — but a DRE and, if needed, endoscopy is what rules out cancer.
-
Grading guides the treatment
Goligher grade I–IV determines whether you need cream, banding, or surgery — not guesswork.
-
Office procedures are the mainstay
For most patients, a short clinic visit — banding, sclerotherapy or coagulation — is enough.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP or colorectal team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History, red-flag screen and examination
Phase 2 · Confirming
Proctoscopy and, if needed, endoscopy to exclude other causes
Phase 3 · Managing
Surgical referral and grade-matched treatment
- 01
Recognising
History + red-flag screen
Bleeding pattern, bowel habit, weight change, family history and age — before assuming benign disease.
- 02
Recognising
Digital rectal examination
A careful DRE assesses tone, tenderness and any palpable mass — the essential first exam.
- 03
Confirming
Proctoscopy
A short rigid scope visualises the anal canal and confirms internal haemorrhoids and their grade.
- 04
Confirming
Sigmoidoscopy if red flags
Flexible sigmoidoscopy examines the rectum and lower colon when the picture is not straightforward.
- 05
Confirming
Colonoscopy if age >45 or FH
A full colonoscopy when age, family history or bleeding pattern raises the suspicion of colorectal cancer.
- 06
Managing
Colorectal surgery consultation
Referred for grade III–IV disease, recurrent bleeding, or when office-based procedures are not enough.
- 07
Managing
FIT test if any doubt
A faecal immunochemical test detects hidden blood and helps triage — used when the clinical picture is unclear.
Typical timeline: 2–6 weeks from first appointment to a settled plan.
Symptoms
What haemorrhoids actually feel like.
Bleeding, itching, prolapse or sudden pain — a spectrum of symptoms that ebbs and flows. Here is the shape of it.
-
Bright red bleeding on paper
Painless bright red blood on the paper or in the pan — the classic first symptom.
-
Anal itch
Persistent itching and irritation around the anus, worse at night or after opening bowels.
-
Prolapse on straining
A soft lump that appears with straining — reducing spontaneously (grade II) or needing to be pushed back (grade III).
-
Painful thrombosis
A sudden, exquisitely tender purple lump at the anal margin — a thrombosed external haemorrhoid.
-
Mucus discharge
A small amount of clear mucus staining underwear, often with prolapsing haemorrhoids.
-
Faecal soiling
Minor leakage or difficulty keeping the area clean when larger haemorrhoids prevent a full seal.
-
Anaemia
Chronic blood loss can, rarely, cause iron-deficiency anaemia — always deserves further investigation.
-
Red flag
Dark blood, weight loss or a change in bowel habit — 2-week-wait cancer pathway, not a haemorrhoid clinic.
Treatment
How haemorrhoids are treated in the UK.
A layered, grade-matched plan — from diet and topical treatment to office procedures and, for the few who need it, day-case surgery.
-
High-fibre diet + hydration
Softer stool and less straining — the foundation of every treatment plan and the best prevention.
-
Topical steroid / anaesthetic
Short courses of a topical cream ease itch, inflammation and discomfort during flares.
-
Rubber-band ligation (RBL)
The most widely used office procedure for grade I–III — a small band cuts off the blood supply.
-
Sclerotherapy
An injection shrinks and scars smaller internal haemorrhoids — quick, well tolerated.
-
Infrared coagulation
A brief burst of infrared light coagulates the base — good for smaller bleeding piles.
-
Haemorrhoidal artery ligation
A Doppler-guided day-case procedure that ties off feeding arteries — less painful than excision.
-
Stapled haemorrhoidopexy
A circular stapler lifts and refixes prolapsing tissue — for larger internal disease.
-
Excisional haemorrhoidectomy
Traditional surgical removal — reserved for severe (grade IV) or refractory disease.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or colorectal surgeon knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.
-
NICE. Haemorrhoids — Clinical Knowledge Summary (CKS).
-
Association of Coloproctology of Great Britain and Ireland (ACPGBI). Commissioning guidance.
-
Royal College of Surgeons of England. Patient information on haemorrhoids.
-
Bowel Research UK. Patient information on rectal bleeding.
Red flags
When it is not just piles.
Most rectal bleeding is benign. These are the patterns that need urgent assessment — do not push through them.
-
Dark red or mixed blood
Darker blood mixed with stool suggests a higher source — needs urgent investigation.
-
Unexplained weight loss
With any bowel symptoms — trigger for the 2-week-wait cancer pathway.
-
Change in bowel habit
A persistent shift in frequency, consistency or urgency — especially over 50.
-
Iron-deficiency anaemia
Chronic blood loss confirmed on blood tests — always investigate the source.
-
Age over 50 with new bleeding
New rectal bleeding after 50 warrants prompt lower GI investigation.
-
Family history of bowel cancer
Lowers the threshold for colonoscopy — discuss with your GP.
-
Persistent pain despite Rx
Ongoing pain after appropriate treatment needs re-assessment — consider fissure, abscess or fistula.
-
Prolapse that will not reduce
An irreducible or strangulated prolapse is a surgical emergency.
-
Post-operative complications
Heavy bleeding, fever or urinary retention after any procedure — contact the surgical team.
Living with it
Manage the daily basics, and most people stay well.
Four things that make the biggest difference day to day — fibre, toilet habits, gentle hygiene and knowing when to come back.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Fibre
Build fibre slowly
Aim for 30 g of fibre a day, added gradually with plenty of water — sudden jumps cause bloating.
- 02 Toilet
Do not linger, do not strain
Answer the call promptly, keep visits short, and avoid reading on the loo — prolonged straining is the main driver.
- 03 Hygiene
Gentle and dry
Rinse rather than scrub, pat dry, and avoid perfumed wipes — friction and fragrance both worsen symptoms.
- 04 Reviews
Return if the pattern changes
Any new red flag — darker blood, weight loss, change in habit — needs another look, not more cream.
Frequently asked
Everything we get asked about haemorrhoids.
Quick answers on grading, banding, when a colonoscopy is needed, and how to prevent recurrence.
-
What are haemorrhoids?
Vascular cushions in the anal canal that become symptomatic — bleeding, prolapsing, itching or occasionally painful. They are extremely common and, in most cases, benign.
-
Is rectal bleeding always haemorrhoids?
No. Bright red bleeding on the paper is often haemorrhoids, but darker blood, mixed blood, weight loss or a change in bowel habit can point to something more serious — always get it checked.
-
What is Goligher grading?
A four-point system based on prolapse: I (no prolapse), II (prolapses on straining, reduces spontaneously), III (needs manual reduction), IV (irreducible). It guides treatment.
-
What is rubber-band ligation?
A small elastic band placed at the base of an internal haemorrhoid in the clinic — it cuts off the blood supply and the pile drops off within a week. Well tolerated and highly effective for grade I–III.
-
Do I need a colonoscopy?
Not for every haemorrhoid — but yes if you are over 45, have a family history of bowel cancer, or your bleeding pattern is atypical. Your GP or surgeon will decide.
-
Can haemorrhoids be prevented?
Largely, yes — a high-fibre diet, plenty of fluid, exercise and avoiding prolonged straining or long toilet sits all reduce the risk of new or recurrent symptoms.
Related content
Keep reading.
-
Colonoscopy
The definitive test if red flags are present.
Learn more -
Sigmoidoscopy
A shorter scope for the rectum and lower colon.
Learn more -
FIT bowel screen
Faecal immunochemical test to detect hidden blood.
Learn more -
All conditions
Browse the full library of clinically reviewed guides.
Learn more