Bleeding and burst haemorrhoids

Haemorrhoids, also known as piles, are enlarged veins that develop inside your back passage (rectum) or around your bottom (anus). They can cause a burning sensation, bleeding, discomfort, itching and pain, especially when sitting down. However, for some people, haemorrhoids don’t cause any symptoms. 

When a haemorrhoid swells up with too much blood, it can burst, which can cause discomfort. Burst haemorrhoids can be treated at home but in rare cases, treatment in hospital is needed.

What are haemorrhoids?

Haemorrhoids are caused by enlarged veins, which can develop inside your rectum (internal haemorrhoids) or around the opening of your bottom (external haemorrhoids).

If a blood clot forms inside an internal or external haemorrhoid, it’s called a thrombosed haemorrhoid. This can cause severe pain and if it swells up with too much blood, it can burst. 

Haemorrhoids are often caused by changes in your bowel habits, including: 

• A diet lacking enough fibre
• Constipation 
• Diarrhoea
• Frequent straining when opening your bowels
• Sitting on the toilet for too long

Other causes of haemorrhoids include weakening of the tissues that support your anus and rectum due to ageing, pregnancy and lifting heavy objects.

Why can haemorrhoids burst?

Thrombosed haemorrhoids can burst if they swell up with too much blood. A burst haemorrhoid can bleed for a few seconds or minutes and may bleed again after opening your bowels. However, it shouldn’t bleed for longer than 10 minutes. On bursting, you may experience a sense of relief as the pressure caused by the build-up of blood is released. 

If you do not experience any relief after bleeding subsides, then it is unlikely that you had a burst haemorrhoid but instead have a bleeding haemorrhoid. 

Thrombosed haemorrhoids are not usually serious, despite causing severe pain and inflammation. In rare cases, a thrombosed haemorrhoid can cause severe bleeding from your rectum, which is a medical emergency. This is caused by the surrounding skin cells dying (necrosis) or ulcerating. 

Symptoms of bleeding haemorrhoids

Haemorrhoids often bleed after opening your bowels, producing bright red blood. If you notice blood after opening your bowels that is darker, see your GP as it may be caused by a problem further up your gut, instead of by haemorrhoids. Thrombosed haemorrhoids that burst also produce darker blood and you may sometimes notice a blood clot.

Other symptoms of haemorrhoids, aside from bleeding, include: 

• Difficulty properly cleaning your anus after opening your bowels
• Discharge from your anus similar to mucus
• Feeling pressure, or a lump or bulge around your anus 
• Feeling that a stool is stuck in your anus while or after opening your bowels
• Itchy anus or irritation around your anus

How to treat bleeding haemorrhoids at home

There are lots of things you can try at home to treat bleeding haemorrhoids. 

To prevent further bleeding, it is important not to strain when passing stools. As constipation makes it more likely you will strain, take steps to soften your stools. This may include: 

• Drinking lots of water during the day
• Eating a high fibre diet eg fresh fruit, vegetables and whole grains
• Opening your bowels when you feel the urge, rather than holding it in
• Performing regular physical exercise
• Taking an over-the-counter laxative — this may include: 
• A bulk-forming laxative that takes effect in one to three days eg methylcellulose or psyllium husk
• A stimulant laxative that takes effect in six to 12 hours eg senna — this may be in the form of a suppository ie a pellet that you insert into your rectum
• An osmotic laxative that takes effect in one to three days eg lactulose 

To reduce pain, burning and itching, you can apply an external haemorrhoid cream several times a day. You can also take a sitz bath, which involves soaking your anus in a bowl of warm water, with or without Epsom salts added. 

To reduce the chances of bleeding, avoid using dry toilet paper to wipe yourself after opening your bowels. Instead, use a moist, fragrance-free wipe or toilet paper containing witch hazel, which can reduce inflammation. 

During the day, if you’re uncomfortable, you can wrap an ice pack in a towel and sit on it for up to 20 minutes to reduce inflammation and pain. 

If these home treatments aren’t effective after a week of trying them, see your GP for advice on further treatments. 

Medical treatments for bleeding haemorrhoids

If home treatments haven’t helped reduce your haemorrhoid symptoms, your doctor may recommend one of several medical treatments that don’t need general anaesthesia. This includes:

Rubber band ligation

This involves placing a tiny rubber band around the base of your haemorrhoid to cut off its blood supply. The haemorrhoid will shrivel up and fall off after three to 10 days.

Sclerotherapy

This involves injecting a special chemical called phenol into the tissue around the base of your haemorrhoid. This causes scar tissue to form here, which cuts off the blood supply to your haemorrhoid. Your haemorrhoid will then shrivel up and fall off. You may need multiple injections over several weeks.

Bipolar, laser or infrared coagulation

This involves using infrared light, laser or bipolar electrical energy to cut off the blood supply to your haemorrhoid. Local anaesthesia will be applied before this procedure to numb the area and your haemorrhoid will fall off after one to two weeks.

For severe, bleeding haemorrhoids or internal haemorrhoids that are hanging out of your anus (prolapsed haemorrhoids), your doctor may recommend surgery performed under general anaesthesia, which will usually mean staying overnight in hospital. Options for haemorrhoid surgery include: 

• Doppler-guided haemorrhoid artery ligation (DG-HAL) to tie off the small blood vessels supplying your haemorrhoid using ultrasound energy, so that your haemorrhoid shrinks and falls off — if you have severe haemorrhoids, they are likely to return even after having this procedure
• Haemorrhoidectomy to remove a prolapsed haemorrhoid or complex external haemorrhoid
• Haemorrhoidopexy to pull a prolapsed haemorrhoid back up into your rectum and staple it there, while also reducing its blood supply, so that it shrinks and eventually falls off

When to see a doctor

If you are bleeding from your anus, it is important to see your GP as you may not have haemorrhoids but another, potentially more serious condition affecting your gut, such as colorectal cancer. 

Your GP will perform a physical examination, which may involve inserting a lubricated, gloved finger into your anus. This will help determine if there is a haemorrhoid present, however, not all haemorrhoids can be detected in this way. 

If they can’t identify the source of your bleeding during your physical examination, they may recommend you have a colonoscopy. This involves inserting a thin, flexible telescope-like tube with a camera and a light at the end (a colonoscope) into your colon via your anus. You will be sedated during this procedure. 

It is important to tell your doctor about any other symptoms you’re experiencing alongside bleeding. This may include abdominal pain or anal pain, as well as: 

• Changes in your bowel movements
• Changes in the colour or consistency of your stools
• Fever
• Lightheadedness or dizziness
• Nausea or vomiting
• Unintentional weight loss

You should seek urgent medical attention if you notice that you have: 

• A blue-tinged lump in or around your anus — this is a sign of a thrombosed haemorrhoid
• Constant anal bleeding
• Constant anal pain
• More than a few drops of blood in the toilet when opening your bowels

What is the outlook for burst haemorrhoids?

Burst haemorrhoids aren’t usually serious although the amount of blood released can cause alarm. Thrombosed haemorrhoids are usually intensely painful until they burst. If you don’t experience severe pain before bleeding, then it likely isn’t a thrombosed haemorrhoid that has burst but an irritated, inflamed haemorrhoid.

How to prevent haemorrhoids

Preventing haemorrhoids involves making both dietary and lifestyle changes.

As constipation is a major risk factor for haemorrhoids, try to follow a diet rich in fibre ie eat fresh fruits, vegetables and whole grains. If you’re struggling to include enough fibre in your diet, you can also try taking daily fibre supplements. It is also important to stay hydrated by drinking eight to 10 glasses of water every day. Regular exercise reduces your risk of constipation too.

To avoid putting unnecessary strain on your anus when opening your bowels, don’t spend too long sitting on the toilet. Similarly, avoid lifting heavy objects as this also places extra strain on your lower abdomen.