The most commonly associated internal haemorrhoid symptom is painless fresh bleeding during bowel movements. A variable amount of fresh blood is often seen in the toilet bowl. Sometimes, blood is seen while wiping.

Haemorrhoids can also cause anal discomfort and itch. 

Sometimes there is an external anal lump, which may come and go or be permanently present.

Thrombosed external haemorrhoids often present with acute pain and a hard lump near the anus. This may sometimes require urgent surgery.

When a haemorrhoid causes significant symptoms as outlined above, you may visit a haemorrhoid doctor to confirm the diagnosis and institute effective treatment. 

You should see a haemorrhoid specialist if you have blood in your stool. The haemorrhoid specialist will determine your risk of having a more serious indication other than piles after screening and conducting a rectal examination. A referral to see a gastroenterologist will be needed, if bleeding is not from simple piles.

Gastroenterologists are piles specialists that help to manage gut symptoms. You should never ignore the blood in your stool. The piles specialist would likely carry out a colonoscopy to determine the exact cause of the bleeding.

Under increased pressure, the veins around the anus are prone to stretch and swell up, causing haemorrhoids.

Several common causes include

• Chronic diarrhoea or constipation
• Straining during bowel movements
• Pregnancy
• Obesity
• Anal intercourse
• Prolonged time spent sitting on the toilet

Patients with risk factors of colon cancer should undergo colonoscopy when they have bleeding during bowel movements.

Patient with risk factors for colon cancer includes:

1. Age>45
2. Family history of colon cancer and colon polyp
3. Family or personal history of another form of cancer
4. Diabetes
5. Obesity
6. Diet heavy in processed/preserved meat or red meat

Piles or haemorrhoids are diagnosed with direct visualisation with proctoscopy or colonoscopy. 

Haemorrhoid above the dentate line (found in the anal canal) is classified as an internal haemorrhoid.

Haemorrhoid below the dentate line is defined as an external haemorrhoid.

An internal haemorrhoid can also be classified according to how severe they are:

• Grade 1: enlarged haemorrhoid is always not visible from outside the anus
• Grade 2: Larger haemorrhoid that sometimes comes out of the anus but can return into the anus on its own
• Grade 3: Larger haemorrhoid that comes out of the anus that can be pushed back into the anus
• Grade 4: haemorrhoid that cannot be pushed back in

Bleeding from piles is often self-limiting. it will also often respond to simple medication available from family doctors. A Sitz bath can be helpful at times. Sometimes piles or haemorrhoid ligation can be done to treat it. The more severe cases may require more severe methods of hemorrhoids treatment such as surgery.

Bleeding from anal fissures would require medication to soothe the affected area. Stool softening often would help with reducing strain during a bowel movement.

Bleeding from the more serious causes would need proper treatment of the underlying cause. Polyps will be removed during colonoscopy using a snare. This procedure is called a polypectomy. 

Cancer of the colon would require surgery and in some cases, chemotherapy and radiotherapy.