Do i need a surgery with hemorrhoids?

Hemorrhoids—often referred to as "piles"—are one of the most common medical conditions worldwide, affecting up to 45% of adults at some point in their lives. Despite how common they are, finding straightforward, evidence-based advice can feel overwhelming.

To set the record straight, the European Society of ColoProctology (ESCP) brought together leading medical experts across Europe to publish comprehensive clinical guidelines. Here is what you need to know about why hemorrhoids happen, how doctors grade them, and what actually works to get relief.

1. What Are Hemorrhoids & How Are They Graded?

Hemorrhoids are simply swollen cushion-like blood vessels located in the lower rectum and anal canal. Everyone has these vascular cushions naturally; they only become a "disease" when they swell, bleed, itch, or slip out of place (prolapse).

Doctors classify internal hemorrhoids into four distinct grades (Goligher's classification) to decide the best treatment approach:

Hemorrhoid Severity Grading (Grades I to IV). Source: Astra Vein Treatment Center / Hemorrhoid Grading System | Vein & Endovascular Medical Care

Grade	What's Happening	Common Symptoms
Grade I	Swollen blood vessels inside the rectum that do not slip outside.	Painless rectal bleeding during bowel movements.
Grade II	Hemorrhoids slip out during straining but retract back inside automatically.	Bleeding, mild itching, feeling of pressure.
Grade III	Hemorrhoids slip out during bowel movements and must be pushed back in manually.	Soiling, discomfort, persistent prolapse.
Grade IV	Hemorrhoids stay permanently outside and cannot be pushed back in.	Constant discomfort, swelling, mucus secretion.

2. Basic Lifestyle Care & Over-the-Counter Products

For almost everyone—regardless of grade—the first line of defense is basic conservative treatment.

Healthy Habits (The Foundation)

• High-Fiber Diet & Hydration: Eating plenty of fiber (or using psyllium/ispaghula supplements) keeps stool soft and easy to pass.

• Toilet Habits Matter: Avoid sitting on the toilet for longer than 3–5 minutes (put away your phone!), and never force or strain.

• Gentle Hygiene: Always swap dry toilet paper for moist wet wipes (or a bidet). Dry toilet paper acts like sandpaper on swollen tissue, causing friction and micro-tears that worsen inflammation. Wet wipes clean gently without aggressive rubbing.

Smart Digital Tools (HEMM APP)

To make conservative management far easier to stick to, you can use advanced mobile applications designed specifically for hemorrhoid patients. HEMM is the most advanced application for patients with hemorrhoids (currently available exclusively on iOS).

Use it as a daily digital assistant:

• Personalized Goal Calculation: Calculates customized daily targets tailored to your body and condition.

• Triple Tracking: Helps you easily log and track your fiber intake(upload the photo of the food and explore amount of fiber, calories and if this food is bloating safe), hydration (water consumption), and daily physical activity.

• Digital Medical examination: As a helpful feature, the app offers a €19.90 remote diagnostic assessment with a medical specialist. This service allows a specialist to evaluate your anorectal health condition privately, using a targeted medical questionnaire alongside a photo upload of the anorectal area for examination.

The Truth About Creams and Wipes

When symptoms flare up, patients often turn to traditional over-the-counter options like Preparation H or modern skin-focused alternatives like Norms.

Medical Fact-Check:There is no scientific evidence showing that over-the-counter creams, ointments, or wipes can cure or eliminate hemorrhoids (they cannot reverse structural vascular damage).However, active soothing ingredients in quality creams and wet wipes are remarkably effective at reducing symptoms—calming active burning, itching, local swelling, and irritation so your tissue can rest and heal.

3. In-Office Medical Procedures (Grades I to III)

If basic lifestyle tweaks and topical treatments aren't providing enough relief, your doctor might recommend a quick, non-surgical office procedure.

• Rubber Band Ligation (RBL): According to ESCP guidelines, this is the gold-standard outpatient procedure for Grade I to Grade III hemorrhoids. A doctor places a small elastic rubber band around the base of the hemorrhoid to cut off its blood supply. Within a few days, it safely shrinks and falls off.

• Infrared Coagulation (IRC) & Sclerotherapy (SCL): IRC uses heat light to seal bleeding vessels (especially great for bleeding Grade I cases), while sclerotherapy involves injecting a solution to shrink the tissue.

4. When Is Surgery Necessary? (Grades III & IV)

Surgery is generally reserved for severe Grade IV cases, large circular prolapses, or when non-surgical treatments haven't worked.

• Haemorrhoidectomy (Surgical Removal): The complete surgical excision of the hemorrhoid remains the single most effective long-term treatment for severe Grade IV hemorrhoids.

• Less Invasive Surgical Alternatives: Procedures like Doppler-Guided Hemorrhoidal Artery Ligation (DG-HAL) or Stapled Hemorrhoidopexy (SH) may be offered based on individual patient preference and surgeon recommendation.

Summary Checklist for Patients

1. Don't wait: Have a doctor or gastroenterologist confirm your symptoms to rule out other digestive issues.

2. Upgrade your bathroom routine: Eat fiber, drink water, and stop straining.

3. Switch to wet wipes: Stop using dry toilet paper to protect delicate, inflamed skin.

4. Use topicals for relief: Reach for trusted products like Preparation H or Norms to soothe active itching and irritation, keeping in mind they manage symptoms rather than provide a permanent cure.

5. Explore outpatient options: If symptoms persist, ask your specialist about simple office procedures like Rubber Band Ligation.

6. Use HEMM application to have a better conservative results and fast medical support.

For full scientific guidelines and detailed patient documentation, visit the official European Society of ColoProctology (ESCP) portal.