Medical content by Elias Tsiolis, Director Surgeon · Last updated: 11 May 2026
Although they can lead to anemia in some cases, they usually cause significant discomfort, pain, bleeding and problems in everyday life and quality of life.
Everything You Need to Know About Hemorrhoids
What are hemorrhoids?
Everyone naturally has hemorrhoidal veins. But when they swell excessively because of pressure, they lose their elasticity and bulge outwards — this is called hemorrhoidal disease.
There are two main types:
- Internal hemorrhoids: located inside the rectum; they usually cause bleeding, and also pain if they become thrombosed.
- External hemorrhoids: located around and inside the anus; they cause severe pain, bleeding, itching or swelling in the anal area.
Causes and Risk Factors
Hemorrhoidal disease is caused by factors that increase pressure on the blood vessels in the area:
- Chronic constipation or diarrhea
- Prolonged sitting
- Pregnancy
- Obesity
- Heavy lifting or intense physical effort
- Poor diet (low in fiber)
- Hereditary predisposition
Symptoms
- Bleeding (usually at the end of a bowel movement)
- Pain or burning in the anus
- A feeling of “pressure” or incomplete emptying
- Itching or irritation
- A swelling or lump that protrudes outside
Diagnosis
Diagnosis is made by clinical examination and proctoscopy. The doctor assesses the grade of the hemorrhoids:
- Grade 1: internal only, without prolapse
- Grade 2: protrude but go back by themselves
- Grade 3: protrude and need to be pushed back manually
- Grade 4: permanently prolapsed, often painful
Treatment
Treatment depends on the grade and the symptoms.
Conservative Treatment
- A diet rich in fiber and fluids
- Avoiding constipation and prolonged sitting
- Topical ointments or suppositories
Surgical Treatment
Minimally invasive methods
For grade 2–3 hemorrhoids, the following are used:
- Rubber band ligation: a small band is placed that cuts off the blood supply
- Thermal or laser method: precise intraluminal coagulation or removal with fast healing
Surgical Treatment
For grade 3–4 hemorrhoids:
- Milligan–Morgan or Ferguson hemorrhoidectomy, a proven technique with very good results in grade 4 cases and when skin tags are also present.
- Laser hemorrhoidectomy: a modern, bloodless technique with excellent results
Aftercare
- All patients:
- Go home the same day
- Resume their normal activities in 1–7 days
Discomfort settles gradually and the results are long-lasting and stable.
Frequently Asked Questions
Are hemorrhoids dangerous?
No, but if neglected they can cause anemia, thrombosis or severe pain that requires surgery.
Do I definitely need surgery?
Not always. Mild cases are treated conservatively, and in many cases rubber band ligation in the clinic is enough, without an operation. Surgery is indicated in advanced stages, repeated episodes of thrombosis or persistent bleeding.
Is the procedure painful?
With modern methods pain is minimal and patients return to everyday life very quickly.
What should I eat?
- Foods rich in fiber (vegetables, fruit, whole grains)
- Plenty of fluids
- Avoid spicy food, alcohol and processed foods
What should I avoid?
- Prolonged sitting
- Constipation or straining on the toilet
- Lifting or intense exercise immediately afterwards
Are they hereditary?
There is a genetic predisposition, but lifestyle is the main factor.
Can they come back?
Rarely, if the instructions are followed, eating habits change and constipation is treated.
When can I go back to work?
Usually in 1–7 days, depending on the type of work, the method and the extent of the operation.
What is a thrombosed hemorrhoid?
It is a hemorrhoid that has filled with a blood clot and causes severe pain.
Are there complications after surgery?
Practically none in the hands of the experienced surgeon at Athens Surgery.
Rectal Mucosal Prolapse
Mucosal prolapse is a condition in which the inner lining of the bowel or the anal canal “slips” outwards through the anus, partly or completely.
It is more common in women, especially after several childbirths, chronic constipation or weakening of the pelvic floor, but it can also occur in young women and in men. Although it is not a dangerous disease, it can cause significant discomfort, bleeding, a feeling of “protrusion” and difficulty with bowel movements.
Early diagnosis and the right treatment lead to full recovery and better quality of life.
Everything You Need to Know About Rectal Mucosal Prolapse
What is mucosal prolapse? Normally the rectum and anal canal are supported by muscles and ligaments. When these become lax or weak, the lining “slides” outwards, usually when straining to pass stool.
There are three main forms:
- Rectal mucosal prolapse: only the inner lining of the bowel protrudes.
- Complete rectal prolapse: all layers of the rectal wall protrude.
- Anal mucosal prolapse: a limited form involving only the lining of the anal canal.
This last form is very common, more so in older women or those with a history of hemorrhoids or mild fissures, and it is treated without surgery, using simple, minimally invasive methods.
Causes and Risk Factors
Prolapse is caused by a combination of mechanical pressure and weakening of the supporting structures of the pelvic floor:
- Chronic constipation and heavy straining
- Multiple pregnancies and births
- Obesity
- Chronic cough
- Previous operations in the area
- Neurological or muscular disorders
- Age-related tissue laxity
Symptoms
- A feeling of a lump or “protrusion” at the anus
- Bleeding or mucus discharge
- A feeling of incomplete emptying or pressure
- Irritation and itching
- In more advanced cases: leakage of gas or stool
Diagnosis
Diagnosis is made by:
- Clinical examination, during which the prolapse is seen when the patient strains
- Proctoscopy and/or rectoscopy
- Depending on the case, defecography or pelvic MRI may be needed to assess the pelvic floor
Distinguishing between partial and complete prolapse is crucial, because it determines the treatment method.
Treatment
Treatment depends on the type and severity of the prolapse.
Conservative Treatment
- A high-fiber diet
- Adequate fluid intake
- Kegel exercises to strengthen the pelvic floor
- Treating constipation and chronic cough
Surgical Treatment
Minimally Invasive Treatment
In cases of anal mucosal prolapse (not complete rectal prolapse), rubber band ligation gives excellent results.
This method:
- Is performed painlessly in the clinic
- Takes a few minutes
- Tightens and stabilizes the lining
- Requires no anesthesia or hospital stay
- Allows an immediate return to activities
- Ideal for women with mild to moderate prolapse and preserved muscle tone.
Surgical Treatment
- In extensive cases or complete prolapse:
- Transanal techniques (Delorme, STARR)
- Laparoscopic rectopexy, lifting and fixing the rectum to the pelvic wall. These restore anatomy and improve function.
Aftercare
- Light diet for 3–5 days
- Good hydration
- Light activities after 48 hours
- Avoid heavy strain for 2 weeks
- Good hygiene of the area
Recovery is quick and complete, and the results are stable and long-lasting.
Frequently Asked Questions
Is prolapse dangerous?
No, but it needs follow-up and timely treatment so that it does not get worse.
What is the difference between mucosal prolapse and hemorrhoids?
Hemorrhoids are swollen veins, whereas prolapse involves the bowel wall itself slipping. However, the two can occur together.
When are “rubber bands” enough?
When there is limited prolapse of the anal canal lining, without involvement of the deeper layers of the rectum. The method has success rates of over 90%.
Is the treatment painful?
Ligation is done without anesthesia and is almost painless. Any mild pain or pressure settles within a few hours.
Is a hospital stay needed?
No, all modern techniques are performed as outpatient procedures, with an immediate return home and to daily activities.
When can I go back to work?
From the next day in most cases.
Can it happen again?
Rarely, as long as the causes are treated (constipation, straining, cough).
How does it affect quality of life?
The right treatment restores comfort, self-confidence and normal bowel function.