Furqan is stuck in traffic on Shahrah-e-Faisal, sweating in the June heat. His car AC is not helping against Karachi’s 42°C temperature. After three hours on the road, he finally reaches his home in North Nazimabad. He rushes to the bathroom, but while passing stool, he has to strain a lot. He also feels a lump around his anus, and when he stands up, he sees bright red blood in the toilet.
Like many Karachi residents, Ahmed has been ignoring these warning signs for weeks. Long office commutes, spicy biryani lunches, and not drinking enough water during working hours have made his problem worse. What started as small discomfort and swelling has now turned into daily bleeding and painful lumps which even need to be pushed back inside.
Are you also suffering from the same situation? Well, You are not alone. Thousands of people in Karachi face this same problem every single day.
Hemorrhoids (also called piles) affect millions of people around the world. In Karachi’s hot weather and with our traditional eating habits, these swollen veins in the rectum are even more common here in your city. The good thing is, most hemorrhoids can be treated effectively with proper care and timely treatment.
As a colorectal surgeon and first laser proctologist in Pakistan, I will explain what hemorrhoids are, why it is more common in our country and Karachi city, what are the culprits in our local lifestyle, and what are the modern treatment options available today.
Before we deep dive into the hemorrhoids, it’s important for all of us to understand what are the different conditions that may affect you and what are the differences between them.
1. Hemorrhoids (Piles)
These are the swollen blood vessels in your anal canal that causes bleeding, pain, and itching.
2. Anal Fissures
This is a small tear in your anal canal. It causes sharp pain during bowel movements.
3. Anal Fistulas
This is an abnormal connection between your anal canal and your perianal skin. It usually happens just after an abscess or anal gland infection.
What Are Hemorrhoids?
Everyone has hemorrhoid tissue. Normally, whenever you pass stool, this tissue acts like a cushion that prevent wear and tear to your rectum. Problems start when this tissue swell beyond their normal size and creates a swelling.
This swelling happens due to increased pressure in the blood vessels in your lower rectum or anus.
Types of Hemorrhoids
1. Internal Hemorrhoids
These develop inside your rectum. You usually can’t see or feel them unless they start coming out. They rarely cause pain because the area has few pain sensors but their main symptom is bleeding. The bleeding in internal hemorrhoids is usually in the form of drops in the toilet.
2. External Hemorrhoids
These form under the skin around your anus. They’re more painful because the surrounding skin has many nerve endings. In this type of hemorrhoids, instead of bleeding, patient usually have a clotted blood which makes up the swelling and pain.
3. Prolapsed Hemorrhoids
Internal hemorrhoids that extend outside the anal opening are the prolapsed hemorrhoids. This is the 4th grade of hemorrhoids in which the hemorrhoidal tissue prolapses and has to be pushed back inside or otherwise may stay outside permanently. Bleeding and pain both can happen in this grade and patient may require urgent treatment.
It’s important here to tell that in local terminology for common people of Karachi, there are two types of hemorrhoids, i.e. Khooni bawaseer and Badi Bawaseer which translates into bleeding hemorrhoids (khooni bawaseer) and non bleeding or painful hemorrhoids (Badi Bawaseer)
Khooni Bawaseer (Bleeding Hemorrhoids)
Here in this type, there is visible bleeding from hemorrhoids. It doesn’t matter what is the grade of hemorrhoids if its bleeding it’s called Khooni bawaseer.
Badi Bawaseer (Non Bleeding Hemorrhoids)
This is a vague term in Urdu and it usually refers to any grade of hemorrhoids which does not bleed. It can be painful or painless.
Why Hemorrhoids Common in Karachi?
Hemorrhoids in Pakistan and specifically in Karachi is very common and atleast 8 to 12% of the population has some sort of hemorrhoid issue. It’s true that one of the main cause of piles is your genes, this means if your father or mother has hemorrhoids then there are higher chances of hemorrhoids in you also; but actually the main reason lies in our lifestyle, food and environment.
Yes, living in Karachi itself creates specific conditions that make hemorrhoids more likely in you. Let’s understand how it affects you.
Food:
Karachi is known for its food – Biryani, Nihari, BBQ, roll parathas, bun kebabs, fried items, and now Western fast food chains. The problem lies in the diet, because these food items are low in fiber and high in oil (saturated fats), which makes you constipated. Also late-night dinners and irregular eating habits slows your digestive system. Avoiding salads, fruits and whole grains further worsens the situation and predisposes you for complications.
So the common query is:
Which food triggers hemorrhoids and need to be avoided? (Pakistani Cuisine)
- Excessive red meat (especially in biryani, karhai, qorma)
- White rice
- Refined flour products (white atta)
- Fried foods (taali hui khanay)
- Spicy curries and chutneys (Mirchain)
- Fast Food and Junk Foods (Pizza, Burger)
- BBQ (dhaga kabab, gola kabab, malai boti)
- Insufficient water consumption
So what foods are good for Hemorrhoids?
- Fresh fruits like mangoes (aam), oranges (kinoo), bananas (kailay), papaya (papitta).
- Green Vegetables such as okra (bhindi), spinach (palak) and cucumbers ( kheera).
- Whole grain rotis instead of white flour (chakki ka ata).
- Plenty of water throughout the day.
- Yogurt and buttermilk for digestive health.
Hot Weather:
Beside food, living in Karachi itself create specific conditions that make hemorrhoids more likely. Karachi’s temperature often reaches 40°C or higher which makes you dehydrated. If you don’t drink enough water throughout the day, chances are you will end up with constipation and hemorrhoids.
Prolonged Sitting
A daily commute of two to three hours on Shahrah-e-Faisal, M.A. Jinnah Road or Lyari Expressway is common for many Karachittes. Sitting for hours in traffic and at office desks is a risk factor for hemorrhoids. Thus researches indicate that hemorrhoids is particularly common among drivers, shopkeepers, IT workers, call center agents, and bankers.
Lack of Washrooms in Markets
If you go to Saddar, Burns Road, Jama Cloth, or any other small markets in any other area of Karachi such as Nazimabad or Korangi, you will find there are hardly any public washrooms available. People who work long hours in these markets tend to “hold” their urge to defecate, which leads to constipation and anal diseases.
These were some reasons why hemorrhoids is more common in Karachi but beside these local factors, there are some general factors such as
Straining During Bowel Movements:
This is the most common cause. If you have constipation and you have hard stools, you have to strain or put extra effort to pass the stool. This increases pressure on anal veins and your chances of having hemorrhoids.
Chronic Constipation or Diarrhea
Its important to understand that not only chronic constipation leads to hemorrhoids but even chronic diarrhea also stresses the anal area and irritates sensitive tissue.
Pregnancy
Pregnancy is also a risk factor as growing babies put pressure on pelvic blood vessels.
Age
Tissues supporting hemorrhoidal veins weaken with age and most people over 50 experience some hemorrhoid problems. This is also the reason you note why your hemorrhoids are gradually increasing over time.
Heavy Lifting
If you are regular weight lifter there are high chances that you will end up with hemorrhoids. Heavy weight lifting increases abdominal pressure and you veins dilate also.
Symptoms of Bawaseer:
Many people in Karachi, don’t care about piles problem unless they see blood or feel too much pain. But this is wrong. If you notice any sign, like swelling or discomfort while sitting—then you should contact your doctor as soon as possible.
1. Bleeding
This is the most common symptom that you may notice if you have piles. Bleeding in piles patient is bright red color in color. You may either notice blood in toilet bowl or on the tissue paper. Though bleeding in hemorrhoids is in drop form and after you pass stool but it can happen even while passing stool as a streak of blood on the stool. Though it looks scary but mostly this bleeding is not too serious.
2. Swelling:
Right after bleeding, the second most common symptom that people get is swelling at the time of passing stool.
You might feel it as a small soft lump or bump around your anal canal. In most patients, this swelling is painless and goes back in after passing stool. If it’s tender it is more probably an external hemorrhoids or prolapsed hemorrhoids which remains outside anal canal and does not go back in.
3. Pain and Discomfort
With internal hemorrhoids, you may feel constant aching or soreness around your anus. This become much worse when you have to sit for a long time on a hard chair or when you are trying to pass a hard stool.
Sharp or severe pain is not a common symptom of hemorrhoids unless patient has an external hemorrhoids or prolapsed hemorrhoids pain is uncommon.
4. Itching
Another common symptom you may notice is that the skin around your anus is itchy and irritated throughout the day. This happens mainly because the hemorrhoids can leak a small amount of mucus that makes the skin wet and then it gets itchy. If you try to scratch that area for relief, it can actually make the irritation more worse and cause more problem.
5. Feeling of Incomplete Bowel Movement:
Many people with hemorrhoids feel that their bowel movement is incomplete and they feel they still need to go, even after they pass stool. When you feel this you should try not to push or strain too much because that can put more pressure on the veins and make the swelling worse. This feeling is just a false sensation caused by the swollen lumps around your anal canal and it is not that there is actually more stool left inside.
Hemorrhoid Stages and Grades
It is important for you to understand grades of hemorrhoids
Grade 1 (First Degree)
In grade 1 hemorrhoids there is small swelling inside the anal canal. You may also have a bit of bleeding but without pain.
Grade 2 (Second Degree)
Here hemorrhoids prolapse during bowel movements but return inside on their own. You may feel bleeding and discomfort also but usually only at the time of passing stool.
Grade 3 (Third Degree)
Here the hemorrhoids have to be manually pushed back inside. They are more painful and prone to bleeding.
Grade 4 (Fourth Degree)
Here hemorrhoids are permanently prolapsed. This means they cannot be pushed back inside with finger or force. These require immediate medical attention and procedure
Best Piles Treatment Options You Should Know in 2025
Treatment options do range from simple home remedies to advanced medical procedures. The right choice depends on your hemorrhoid grade and symptoms.
Conservative Treatments
Dietary Changes
The simplest way to treat your hemorrhoids is by adding fiber to your diet. This helps to create your stool softer and easy to pass. Thus, reducing straining and allows hemorrhoids to heal naturally.
Increased Water Intake
Drinking 8-10 glasses of water daily helps your gut to retain water and prevents constipation. However, on hot days especially during summer this must increase to 16 glasses of water.
Sitz Baths:
Sitting in warm water for 10 – 15 minutes several times daily and specially after passing stool reduces swelling of hemorrhoids and discomfort.
Topical Treatments
Some medications and over the counter creams and ointments are available that can help you with the initial grade of hemorrhoids. They tend to work well when you combine it with life style changes.
Remember with conservative treatment, significant symptom relief is possible within days when using proper treatment and dietary precautions. However, true symptomatic healing takes 1-2 weeks for minor hemorrhoids and several weeks for severe cases.
Surgical Options:
When conservative treatment options fail, or when you have refractory hemorrhoid bleeding which is not controlled with medicines or when you have 3rd or 4th grade of hemorrhoids, then there is no option left beside surgery.
Modern laser technology offers significant advantages over traditional hemorrhoid treatments. Dr. Abdullah Iqbal is the first laser proctologist or piles laser specialist who has introduced laser hemorrhoids procedure in Karachi in 2021. Since then, he performs over 1000 cases each year with 100% success rate.
Benefits of Laser Treatment:
- Minimal pain or discomfort after procedure
- Faster healing time (3 to 4 days)
- Reduced bleeding risk
- Day-care procedure (12 Hrs of admission duration)
- Quick return to normal activities
Why Choose Laser Treatment in Karachi?
Karachi is the commercial and financial hub. Given our busy lifestyle, laser treatment fits well with working professionals’ schedules. With traditional procedure where it takes months to heal and get pain free, with laser treatment, you can return to work within 2-3 days.
Read: Major differences between piles laser vs. conventional surgery
Other Procedures:
Rubber Band Ligation
Hemorrhoids when small can be treated with rubber band ligation. Here small rubber bands are applied to cut off blood supply to internal hemorrhoids, causing them to shrink and fall off.
Hemorrhoidectomy
This is the complete removal of hemorrhoidal tissue. This is now, with introduction of laser procedure is reserved for severe cases where hemorrhoids do not reduces even after pushing them in (4th grade of hemorrhoids)
Stapled Hemorrhoidopexy:
Instead of cutting out hemorrhoids one by one, this technique uses a circular stapling device to remove excess tissue. It removes a circular tissue and reposition remaining hemorrhoids. Chances of anal stenosis are higher with this procedure.
Prevention:
If you have undergone surgery or you have responded well to the medicines, its important for you to understand that how you can prevent yourself from recurrence or having piles again. Yes, you need to adapt a few lifestyle adjustments that can greatly reduce your chances of having hemorrhoids in the future.
Dietary Modifications:
- Reduce spicy food intake
- Try to add more fruits and vegetables in your diet
- Choose whole grains over refined products
- Limit red meat consumption
- Stay hydrated throughout the day
Lifestyle Changes
- Take breaks from prolonged sitting
- Use cushions like a donut pillow when driving long distances
- Practice proper toilet posture
- Don’t hold your stool
- Exercise regularly
- Exercise proper hygiene, keep your anal area clean and dry
Climate Considerations:
- Drink extra water during summer months
- Wear breathable cotton underwear
- Take cool showers to reduce anal irritation
- Use air conditioning when possible
FAQ’s
No, hemorrhoids never become cancer. However, if you are having bleeding, you should always consult your doctor. It is important to rule out any serious disease.
No. Most hemorrhoids heal completely on their own with proper treatment and lifestyle changes. Those which are small, do not need any procedure or intervention; however, severe cases may require medical intervention.
Yes, you can do cardiac exercises. Heavy weight lifting and high-impact activities should be avoided at all cost. However, walking and swimming are excellent choices during recovery.
Pregnancy commonly causes hemorrhoids due to increased pressure on pelvic veins and hormonal changes. Most improve after delivery.
Laser treatment causes minimal pain compared to traditional surgery. This minimal pain is controllable with oral analgesics which are prescribed after laser procedure.
Why Dr. Abdullah Iqbal is the Best Doctor for Hemorrhoid Treatment in Karachi
Dr. Abdullah Iqbal is a specialized colorectal and laser surgeon in Karachi. He understands the specific challenges faced by Karachi residents. His treatment approaches consider your local dietary habits, climate factors, and lifestyle patterns. He
- Specialized Expertise: Trained in advance piles laser surgery technique.
- Minimally invasive procedures: This ensures precise and tissue friendly treatment.
- Faster Recovery with minimal pain: With Dr. Abdullah Iqbal you will experience faster recovery with minimal post-operative pain
- Lower Recurrence Rate: The chances of recurrence with laser is minimal.
- Proven Success Rate: Dr. Abdullah Iqbal is doing laser procedures since 2021. Having a 100% success rate he has treated wide range of anorectal conditions with excellent outcomes.
- Trusted Reputation: Dr. Abdullah Iqbal is known as the best in his field with high patient flow and 100% positive reviews across the internet.
