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How to stop active piles bleeding

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hemorrhoids AND bleeding

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NHS rectal bleeding haemorrhoids urgent advice bleeding piles

If bleeding is heavy, continuous, passing clots, causing dizziness/fainting, weakness, shortness of breath, or black/tarry stool, seek emergency care now. Rectal bleeding should not automatically be assumed to be piles.
For mild bright-red bleeding that seems to be from known haemorrhoids:
  • Do not strain or sit on the toilet for long.
  • After a bowel movement, gently rinse with water or use unscented moist tissue. Do not rub.
  • Use a cold pack wrapped in cloth against the outside of the anus for 10 to 15 minutes to reduce swelling and oozing.
  • Take a warm sitz bath for comfort, then pat dry.
  • Keep stools soft: drink fluids, eat fibre, and consider a bulk-forming fibre supplement or stool softener after asking a pharmacist.
  • Use paracetamol/acetaminophen if needed. Avoid ibuprofen or aspirin for pain while actively bleeding unless a clinician has specifically told you to take them.
  • Do not insert creams, suppositories, or anything into the anus during brisk active bleeding without medical advice.
  • Do not stop prescribed blood thinners such as warfarin, apixaban, rivaroxaban, clopidogrel, or aspirin without urgent advice from the prescriber. Contact them or urgent care today.
Arrange a clinician review today or within 24-48 hours if bleeding is recurrent, more than a few streaks on paper, you have pain, a new lump, altered bowel habits, weight loss, or fatigue. Persistent bleeding can cause anaemia and may need treatment such as rubber-band ligation or another procedure. Painless bright-red bleeding is typical of internal haemorrhoids, but other causes must still be excluded. Bailey and Love's Short Practice of Surgery, 28th ed., clinical features section; NHS hospital guidance also describes the characteristic bleeding pattern.

What treatments can a clinician use for bleeding haemorrhoids?

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ASCRS 2024 clinical practice guideline hemorrhoids office based treatment rubber band ligation sclerotherapy infrared coagulation

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A clinician will first confirm that the bleeding is actually from haemorrhoids. Bright-red blood on paper or dripping after a bowel movement is typical, but persistent or substantial rectal bleeding may need anoscopy, sigmoidoscopy, or colonoscopy to exclude fissure, inflammatory bowel disease, polyps, cancer, or another source.
Treatment depends on whether the haemorrhoids are internal or external, the degree of prolapse, bleeding severity, anaemia, and whether you take anticoagulants.
  1. Conservative treatment
    • Fibre supplement, adequate fluids, and stool-softening treatment to prevent straining.
    • Toilet-habit advice: avoid prolonged sitting and straining.
    • Short-term topical anaesthetic or anti-inflammatory preparations for symptoms, not as a permanent treatment.
    • Treat diarrhoea or constipation that is aggravating the bleeding.
  2. Office procedures for bleeding internal haemorrhoids These are usually used when bleeding continues despite conservative measures.
    • Rubber-band ligation: a small band is placed around the internal haemorrhoid above the pain-sensitive area. It cuts off its blood supply; the tissue falls off later. This is commonly the preferred office treatment for grade 1-2 and selected grade 3 internal haemorrhoids.
    • Injection sclerotherapy: an injected agent scars and shrinks the bleeding haemorrhoid. It may be useful when banding is unsuitable, including in some people with higher bleeding risk.
    • Infrared coagulation: heat energy coagulates tissue and reduces blood flow. It is generally most useful for smaller, early internal haemorrhoids.
    • Some centres use electrocoagulation or other coagulation techniques.
    These treatments are for internal haemorrhoids. They are not normally used for external piles because that area is pain-sensitive.
  3. Surgical treatment
    • Excisional haemorrhoidectomy: removal of the haemorrhoid. It is more definitive but has more postoperative pain and recovery time. It is considered for large grade 3-4 haemorrhoids, combined internal-external disease, recurrent bleeding after office procedures, or bleeding causing iron-deficiency anaemia.
    • Haemorrhoidal artery ligation with mucopexy: Doppler-guided suturing of feeding arteries, often combined with lifting prolapsing tissue. It can be an option in selected cases.
    • Stapled haemorrhoidopexy: repositions prolapsing internal tissue. It is not suitable for every type of haemorrhoid and is selected by a colorectal surgeon.
    • Emergency surgery is uncommon but may be needed for strangulated, gangrenous, or severely thrombosed prolapsed internal haemorrhoids.
  4. Thrombosed external haemorrhoid If there is a very painful bluish external lump, a clinician may offer local anaesthetic excision/evacuation early after onset, often within about 48-72 hours. Otherwise, conservative care is usually preferred.
Tell the clinician if you take aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, or another blood thinner. Do not stop these medicines yourself. Seek urgent care for heavy ongoing bleeding, clots, dizziness, fainting, breathlessness, black stool, or marked weakness.
Internal haemorrhoids most often cause painless bright-red bleeding, while ongoing bleeding or anaemia requires more active treatment and assessment for other causes. Yamada’s Textbook of Gastroenterology, 7th ed., p. 1532.
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