Hemorrhoids: A Complete Guide for International Patients in Shanghai

Introduction

Hemorrhoids — also known as piles — are one of the most common anorectal conditions in the world, affecting an estimated 75% of people at some point in their lives. Despite being so prevalent, hemorrhoids are often a source of embarrassment, leading many people to suffer in silence rather than seek the straightforward medical care that can resolve their symptoms.

The reassuring truth is that hemorrhoids are highly treatable. The vast majority of cases respond well to simple lifestyle changes and conservative measures, while those that do not can be effectively managed with minimally invasive office procedures or, when necessary, surgery.

For international patients and expatriates in Shanghai, this guide provides a clear, practical overview of hemorrhoids — from understanding the condition and recognizing symptoms to treatment options and accessing specialist colorectal care in Shanghai.

What Are Hemorrhoids?

Hemorrhoids are cushions of vascular tissue, smooth muscle, and connective tissue located in the anal canal and lower rectum. They are a normal part of human anatomy — everyone has them. The term “hemorrhoids” as a medical condition refers to the pathological enlargement, prolapse, or inflammation of these cushions, causing symptoms.

There are two main types, defined by their location relative to the dentate line — the anatomical boundary between the upper and lower anal canal:

• Internal hemorrhoids: Located above the dentate line, inside the rectum. The lining above the dentate line lacks pain-sensitive nerve fibers, so internal hemorrhoids are typically painless. They most commonly present with bright red rectal bleeding during bowel movements and, in more advanced cases, prolapse (protrusion through the anus).
• External hemorrhoids: Located below the dentate line, under the skin around the anus. This area is richly innervated, so external hemorrhoids can be painful, particularly when thrombosed (containing a blood clot). They may present as a tender lump at the anal margin.
• Mixed hemorrhoids: Both internal and external components are present.

Grading of Internal Hemorrhoids

Internal hemorrhoids are classified into four grades based on the degree of prolapse:

• Grade I: Hemorrhoids bulge into the anal canal but do not prolapse. Bleeding may occur.
• Grade II: Hemorrhoids prolapse during straining but reduce spontaneously.
• Grade III: Hemorrhoids prolapse and require manual reduction (pushing back in with a finger).
• Grade IV: Hemorrhoids are permanently prolapsed and cannot be reduced. May include thrombosed or strangulated hemorrhoids.

Causes & Risk Factors

Hemorrhoids develop when increased pressure in the lower rectum causes the vascular cushions to engorge and the supporting connective tissue to weaken. Common contributing factors include:

• Straining during bowel movements: The most important risk factor. Often caused by constipation or hard stools.
• Chronic constipation or diarrhea
• Low-fiber diet: Leads to hard stools and straining
• Prolonged sitting on the toilet: Increases pressure on the anal veins
• Pregnancy: Increased intra-abdominal pressure and hormonal changes cause hemorrhoids in up to 35% of pregnant women
• Obesity
• Heavy lifting
• Aging: Supporting tissues weaken with age
• Low physical activity
• Shanghai context: Sedentary office work, low-fiber diets, and inadequate hydration are common contributors among expats in Shanghai

Symptoms

Symptoms vary depending on the type and severity of hemorrhoids:

Internal Hemorrhoids

• Bright red blood on toilet paper, in the toilet bowl, or coating the stool after a bowel movement — typically painless
• A feeling of incomplete evacuation
• Mucus discharge
• Prolapse: a soft lump protruding from the anus during or after bowel movements (Grades II–IV)
• Anal itching or irritation (from mucus discharge)

External Hemorrhoids

• Pain or discomfort around the anus, particularly when sitting
• Swelling around the anus
• Itching or irritation
• A tender lump at the anal margin

Thrombosed External Hemorrhoid

When a blood clot forms inside an external hemorrhoid, it causes sudden, severe anal pain and a firm, tender lump. This is one of the most acutely painful anorectal conditions. If treated within 72 hours of onset, surgical excision of the clot provides rapid relief.

Important: Rectal bleeding should never be automatically attributed to hemorrhoids without appropriate evaluation, particularly in patients over 40 or those with risk factors for colorectal cancer. A colonoscopy may be recommended to exclude other causes.

Diagnosis

Hemorrhoids are diagnosed through clinical history and physical examination:

• History: Symptom duration, bleeding pattern, bowel habits, diet, and relevant risk factors
• External inspection: Examination of the perianal area for external hemorrhoids, skin tags, fissures, or fistulas
• Digital rectal examination (DRE): Manual examination of the lower rectum
• Anoscopy: A short, rigid scope inserted into the anal canal to directly visualize internal hemorrhoids — the most reliable method for diagnosing and grading internal hemorrhoids
• Proctoscopy / flexible sigmoidoscopy / colonoscopy: Recommended when rectal bleeding is present, particularly in patients over 40, to exclude colorectal cancer, polyps, or inflammatory bowel disease as alternative or concurrent diagnoses

Treatment

Conservative Management (Grade I–II, and initial treatment for all grades)

The majority of hemorrhoid symptoms can be significantly improved with lifestyle and dietary modifications:

• High-fiber diet: Aim for 25–35 g of dietary fiber per day. Increase intake of vegetables, fruits, whole grains, and legumes. Fiber softens stools and reduces straining.
• Adequate hydration: Drink at least 2 liters of water per day to support stool softening.
• Fiber supplements: Psyllium husk (ispaghula) or methylcellulose supplements can be helpful if dietary fiber is insufficient. Available at pharmacies in Shanghai.
• Sitz baths: Soaking the anal area in warm water for 10–15 minutes, 2–3 times daily, relieves discomfort and reduces swelling.
• Avoid prolonged sitting on the toilet: Do not read or use your phone on the toilet. Limit time to what is necessary.
• Avoid straining: Do not force bowel movements.
• Topical treatments: Over-the-counter creams and suppositories containing local anesthetics (lidocaine), corticosteroids, or astringents (witch hazel) can provide temporary symptom relief. Available at Chinese pharmacies.
• Stool softeners: Lactulose or macrogol (polyethylene glycol) can help if constipation is contributing.

Office-Based Procedures (Grade I–III)

When conservative measures fail, several minimally invasive procedures can be performed in an outpatient setting:

• Rubber band ligation (RBL): The most widely used and effective office procedure for Grade I–III internal hemorrhoids. A small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within 1–2 weeks. Highly effective with low recurrence rates. Available at colorectal surgery departments in Shanghai.
• Sclerotherapy: Injection of a sclerosing agent into the hemorrhoid tissue, causing it to shrink. Effective for Grade I–II hemorrhoids. Commonly used in China.
• Infrared coagulation (IRC): Uses infrared light to coagulate the blood vessels supplying the hemorrhoid. Effective for Grade I–II hemorrhoids.
• Hemorrhoidal artery ligation (HAL) / Transanal hemorrhoidal dearterialization (THD): A minimally invasive procedure using Doppler ultrasound to identify and ligate the arteries supplying the hemorrhoids, reducing their blood supply and causing them to shrink. Suitable for Grade II–III hemorrhoids. Available at leading Shanghai hospitals.

Surgical Treatment (Grade III–IV, or failed office procedures)

• Hemorrhoidectomy: Surgical removal of hemorrhoidal tissue. The most effective treatment for Grade III–IV hemorrhoids and those that have failed other treatments. Can be performed as open (Milligan-Morgan) or closed (Ferguson) hemorrhoidectomy. Requires general or regional anesthesia. Recovery involves 2–4 weeks of discomfort.
• Stapled hemorrhoidopexy (PPH — Procedure for Prolapse and Hemorrhoids): A circular stapling device repositions and reduces the blood supply to prolapsing hemorrhoids. Less painful than conventional hemorrhoidectomy with faster recovery, but higher recurrence rates. Suitable for Grade III–IV prolapsing hemorrhoids.
• Excision of thrombosed external hemorrhoid: For acutely thrombosed external hemorrhoids presenting within 72 hours, surgical excision under local anesthesia provides rapid, definitive relief.

Traditional Chinese Medicine (TCM) Approaches

TCM has a long history of treating hemorrhoids in China. Approaches include herbal medicine (oral and topical), acupuncture, and medicated baths. Some patients find symptomatic relief with TCM approaches. However, TCM should be used as a complement to, not a replacement for, evidence-based medical evaluation and treatment — particularly when rectal bleeding is present. Always inform your doctor of any TCM treatments you are using.

Hemorrhoids in Pregnancy

Hemorrhoids are extremely common during pregnancy and the postpartum period. Management focuses on conservative measures: high-fiber diet, adequate hydration, sitz baths, and topical treatments safe for use in pregnancy. Most pregnancy-related hemorrhoids improve significantly after delivery. Invasive procedures are generally deferred until after delivery unless symptoms are severe.

Prevention

The most effective prevention strategies are also the first-line treatments:

• Maintain a high-fiber diet with adequate hydration
• Avoid straining and prolonged toilet sitting
• Stay physically active — regular exercise promotes healthy bowel function
• Respond promptly to the urge to defecate — delaying increases stool hardness
• Maintain a healthy weight

Managing Hemorrhoids in Shanghai

Practical considerations for international patients:

• Medications and supplies: Fiber supplements (psyllium husk), stool softeners, and topical hemorrhoid creams are widely available at Chinese pharmacies (Watson’s, Guoda, hospital pharmacies). International brands such as Preparation H may be available at international pharmacies.
• Specialist care: Colorectal surgery departments at Zhongshan Hospital, Ruijin Hospital, and Renji Hospital have extensive experience with hemorrhoid management, including rubber band ligation and hemorrhoidectomy.
• Diet in Shanghai: Chinese cuisine can be low in fiber. Actively seek out high-fiber foods: whole grain options, vegetables, legumes, and fruits. Supplement with psyllium husk if needed.
• Colonoscopy: If you have rectal bleeding and are over 40 or have not had a recent colonoscopy, CMCS can coordinate a screening colonoscopy to exclude colorectal cancer.

How China Medical Concierge Shanghai (CMCS) Can Help

While hemorrhoids may seem like a minor condition, they can significantly impact quality of life — and rectal bleeding always warrants proper evaluation. CMCS provides:

• Specialist matching: Connecting you with experienced colorectal surgeons at Shanghai’s leading hospitals for diagnosis and treatment
• Appointment booking: Prompt scheduling to minimize waiting time
• Medical interpretation: Professional interpreters for consultations and procedures
• Colonoscopy coordination: Arranging colonoscopy to exclude colorectal cancer when indicated
• Insurance coordination: Liaising with your international health insurer for office procedures and surgical treatment

📩 Contact CMCS today for a free initial consultation.

Frequently Asked Questions

Are hemorrhoids dangerous?
Hemorrhoids themselves are not dangerous, but they can cause significant discomfort and, in rare cases, significant bleeding leading to anemia. More importantly, rectal bleeding should always be evaluated by a doctor to exclude more serious conditions such as colorectal cancer, particularly in patients over 40.

Will hemorrhoids go away on their own?
Mild hemorrhoid symptoms often improve with dietary and lifestyle changes. However, Grade III–IV hemorrhoids and thrombosed external hemorrhoids typically require medical or surgical treatment. Without addressing the underlying causes (low fiber, straining), hemorrhoids tend to recur.

Is rubber band ligation painful?
Rubber band ligation of internal hemorrhoids is generally well-tolerated as internal hemorrhoids are above the pain-sensitive dentate line. Some patients experience a feeling of pressure or mild discomfort for 24–48 hours after the procedure. It is performed as an outpatient procedure without anesthesia.

How long is recovery after hemorrhoidectomy?
Recovery from conventional hemorrhoidectomy typically involves 2–4 weeks of discomfort, with most patients returning to desk work within 1–2 weeks. Pain management, sitz baths, and stool softeners are important during recovery. Stapled hemorrhoidopexy generally has a faster, less painful recovery.

Can I eat Chinese food if I have hemorrhoids?
Yes, but be mindful of fiber content. Traditional Chinese cuisine can be low in fiber. Prioritize vegetable-rich dishes, choose whole grain options where available, stay well hydrated, and consider a fiber supplement. Spicy food does not cause hemorrhoids but may temporarily worsen anal irritation in some patients.

Is hemorrhoid treatment covered by international health insurance?
Yes. Hemorrhoid diagnosis and treatment — including office procedures such as rubber band ligation and surgical hemorrhoidectomy — are typically covered by international health insurance plans. CMCS can verify your coverage and coordinate the authorization process.