Bawaseer is the Urdu and Hindi term for hemorrhoids, also commonly called piles. It refers to swollen, enlarged cushions of tissue and blood vessels in and around the anus that cause symptoms like bleeding, pain, itching, or a noticeable lump. Nearly 1 in 4 adults will deal with hemorrhoids at some point, and while the condition can be alarming (especially when you see blood), most cases are manageable with straightforward lifestyle changes.
What Happens Inside the Body
Everyone has small cushions of tissue lining the anal canal. These cushions contain blood vessels and connective tissue that help with bowel control. There are typically three major cushions and several smaller ones. Bawaseer develops when these cushions swell, slide downward from their normal position, and the blood vessels inside them become abnormally dilated. At the same time, the connective tissue that holds them in place weakens and stretches, allowing the cushions to bulge or protrude.
The swollen vessels in hemorrhoids look distinctly different from healthy tissue. They become thin-walled and lose the normal constriction that regulates blood flow, which is why they bleed so easily.
Internal vs. External Hemorrhoids
Hemorrhoids are classified by their location relative to a boundary inside the anal canal called the dentate line.
Internal hemorrhoids form above this line, inside the rectum. You typically can’t see or feel them. Their hallmark symptom is painless bleeding, usually bright red blood on toilet paper or in the bowl. They only become painful if they prolapse (push out through the opening) or lose their blood supply, a condition called strangulation that causes intense pain.
External hemorrhoids develop under the skin around the anus, where there are more pain-sensing nerves. They tend to cause itching, discomfort, swelling, and sometimes bleeding. When a blood clot forms inside an external hemorrhoid (a thrombosed hemorrhoid), it creates a hard, discolored lump near the anus with severe pain and swelling.
The Four Grades of Severity
Doctors grade internal hemorrhoids based on how much they protrude:
- Grade I: No prolapse. The hemorrhoid bleeds but stays inside the rectum.
- Grade II: Protrudes during a bowel movement but slides back in on its own.
- Grade III: Protrudes during a bowel movement and needs to be pushed back in manually.
- Grade IV: Permanently prolapsed and cannot be pushed back in.
Grades I and II generally respond well to home care. Grades III and IV are more likely to need a procedure.
Common Causes and Risk Factors
Anything that increases pressure on the veins around the anus or weakens their supporting tissue can trigger bawaseer. The most common culprits are constipation and straining during bowel movements. Hard, dry stools force you to push harder, which puts direct pressure on the anal cushions and stretches the connective tissue holding them in place.
A low-fiber diet is a major contributor because it leads to firmer stools. Obesity increases the risk by about 1.5 times compared to people at a healthy weight. A sedentary lifestyle, sitting for long periods (especially on the toilet), and heavy lifting also raise pressure in the area.
Pregnancy is one of the strongest risk factors. About 25 to 35 percent of pregnant women develop hemorrhoids, most often in the last trimester or the first month after delivery. The growing uterus presses on rectal veins, blood volume increases, and the hormone progesterone relaxes the walls of blood vessels while slowing digestion, all of which promote swelling. Vaginal delivery adds further strain. Having a family history of hemorrhoids roughly quadruples the likelihood of developing them.
How Bawaseer Is Diagnosed
External hemorrhoids are usually visible during a physical exam. For internal hemorrhoids, a doctor performs a digital rectal exam, feeling for swelling, tenderness, or lumps. If more detail is needed, a short procedure called anoscopy allows the doctor to view the lining of the lower rectum using a small, hollow tube with a light. This is quick and done in a clinic.
If there are concerns about other causes of bleeding, a more thorough look using a sigmoidoscopy or colonoscopy may be recommended, particularly for people over 45 or those with additional symptoms like unexplained weight loss, changes in bowel habits, or persistent abdominal pain.
Home Treatment and Lifestyle Changes
Most mild to moderate hemorrhoids improve significantly with changes to diet and bathroom habits. The single most important step is increasing your fiber intake. The average adult diet contains only about 15 to 20 grams of fiber per day, but the target for healthy bowel function is 38 to 40 grams. That means most people have a daily deficit of 20 to 25 grams. Fiber supplements can fill the gap, but they only work if you drink enough water alongside them. Aim for at least 500 milliliters (about two glasses) of water with your fiber supplement so it can absorb moisture and soften your stool effectively.
Good fiber sources include whole grains, lentils, beans, fruits with skin, and vegetables. Adding fiber gradually over a week or two helps avoid bloating.
Sitz baths are another reliable home remedy. Sitting in warm water (around 94 to 98°F, or about 34 to 37°C) for 15 to 20 minutes soothes irritation, relaxes the muscles around the anus, and improves blood flow to the area. You can use a small basin that fits over your toilet seat. Doing this two or three times a day, especially after bowel movements, helps reduce discomfort and swelling.
Other practical tips: avoid sitting on the toilet longer than necessary, don’t strain or hold your breath while passing stool, and stay physically active. Even regular walking helps keep bowel movements consistent.
Medical Procedures for Persistent Cases
When home care doesn’t resolve symptoms, especially for Grade II and III internal hemorrhoids, rubber band ligation is the most common first-line procedure. A doctor places a tiny rubber band around the base of the hemorrhoid, cutting off its blood supply. Over a few days, the tissue shrinks and falls off. Success rates range from 69 to 97 percent, with better results for Grade II (about 80 percent excellent outcomes) than Grade III (around 54 percent). Mild pain for the first 48 hours is the most common side effect, reported by 25 to 50 percent of patients. The procedure is done in a clinic without general anesthesia.
For Grade III and IV hemorrhoids that don’t respond to banding, surgery becomes an option. Traditional hemorrhoid removal (hemorrhoidectomy) is the most effective long-term solution but involves a more painful recovery. A newer alternative, stapled hemorrhoidopexy, offers less postoperative pain, shorter hospital stays, and quicker recovery. However, it comes with a significant trade-off: patients who have the stapled procedure are about three times more likely to have their hemorrhoids return. In one large analysis, 37 out of 479 stapled patients experienced recurrence compared to only 9 out of 476 who had traditional surgery.
When Rectal Bleeding Needs Closer Attention
Hemorrhoids are the most common cause of rectal bleeding, but not the only one. Certain patterns of symptoms warrant prompt evaluation because they can signal colorectal cancer or other serious conditions. Rectal bleeding combined with persistent abdominal pain, ongoing diarrhea, iron-deficiency anemia (which causes fatigue, weakness, and pale skin), unexplained weight loss, or a change in the shape or frequency of your bowel movements should not be attributed to hemorrhoids without further investigation. Rectal bleeding showed the strongest association with early-onset colorectal cancer in a large study of over 5,000 cases, particularly when it appeared alongside these other signs. This is especially important for people with a family history of colorectal cancer or those noticing symptoms before age 50.