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Haemorrhoids are normal vascular structures in the anal canal. The term haemorrhoidal disease is used when they cause symptoms, such as bleeding, prolapse, itching, hygiene difficulties or pain in some circumstances. Addressing constipation and bowel habits may reduce symptoms and the risk of worsening, but it does not guarantee that the problem will not develop or recur.

1. Increase fibre gradually

Fruit, vegetables, pulses and wholegrains help produce softer, formed stools. Guidelines recommend fibre and improved bowel habits as the first intervention for patients with haemorrhoid symptoms. Increasing fibre too quickly may cause bloating or wind; a fibre supplement may be considered in some cases.

2. Drink an amount appropriate to your circumstances

Fluids help fibre work, but there is no fixed quantity suitable for everyone. Individual needs, climate, physical activity, diet and heart or kidney conditions should be considered. There is no need to force yourself to drink two litres a day when medical advice differs.

3. Avoid straining during bowel movements

Prolonged straining increases pressure on haemorrhoidal structures. It is better not to persist when a bowel movement does not occur and to address the cause of hard stools or difficulty passing them. Laxatives and other products should not be used long term without appropriate assessment.

4. Limit time spent on the toilet

Sitting on the toilet for a long time, including while using a phone or tablet, prolongs straining and local pressure. Respond to the urge without postponing it, but avoid prolonged sessions and repeated attempts.

5. Manage both constipation and diarrhoea

Constipation is not the only concern: frequent bowel movements and diarrhoea may irritate the anal area and worsen symptoms. Persistent symptoms warrant investigation of the cause. Medicines such as opioids, iron and other products may change bowel habits, but you should not stop them on your own.

6. Move regularly

Physical activity suited to your health supports bowel regularity and weight management. However, no specific exercise can prevent or cure haemorrhoids. During a painful episode, some activities may need temporary adjustment.

7. Maintain hygiene without irritating the skin

After a bowel movement, gentle cleaning is preferable, avoiding rubbing, harsh cleansers and scented wipes if they cause irritation. Spicy foods and alcohol are not universal causes of haemorrhoids: they can be limited if you notice a repeatable link with your symptoms, without imposing blanket exclusions.

Bleeding should not automatically be attributed to haemorrhoids

Blood requires clinical assessment, particularly if bleeding is new, recurrent or associated with anaemia, altered bowel habits, abdominal pain, weight loss or a family history of colorectal disease. Even after haemorrhoids have been diagnosed, persistent bleeding warrants reassessment. Necessary investigations depend on age, symptoms and screening programmes.

When to see a doctor

A consultation is appropriate when bleeding, prolapse, itching, pain or hygiene difficulties persist despite conservative measures. A suddenly appearing anal lump with severe pain may indicate a thrombosed external haemorrhoid and requires prompt assessment. Fever, increasing pain, discharge or significant bleeding should not be managed solely with home remedies.

When everyday habits are not enough

In appropriate cases, medical treatments, rubber band ligation, sclerotherapy and other outpatient or surgical procedures may be considered. Haemorrhoid sclerotherapy is one option for selected internal haemorrhoids: it is not always painless, not automatically more effective than alternatives and does not replace surgery for every patient.

Reference source

The recommendations are consistent with the 2024 American Society of Colon and Rectal Surgeons guidelines, which recommend dietary and behavioural changes as initial treatment and advise against automatically attributing rectal bleeding to haemorrhoids.

For an assessment, see the page about haemorrhoid treatment in Naples or book your first consultation.

VARIXIO is an automated system used to prepare sclerosant foam. Its purpose is to standardise some of the foam’s physical characteristics, reducing variation associated with manual preparation. However, the device does not determine whether sclerotherapy is indicated and does not, by itself, guarantee a better clinical result.

What is VARIXIO?

The system consists of an agitation device and a sterile single-use capsule in which the foam is prepared. Depending on the product and configuration used, preparation may use sterile air or a mixture of physiological gases, with different concentrations of sclerosant.

Standardisation mainly concerns the preparation process: the liquid-to-gas ratio, bubble size, stability and reproducibility. These factors may assist the operator, but treatment results also depend on diagnosis, venous anatomy, the concentration and volume of the medicine, injection technique, ultrasound guidance when needed and the patient’s characteristics.

When sclerosant foam may be used

Treatment with sclerotherapy may be considered for reticular veins, varicose veins or other selected venous conditions. Not all visible veins need the same treatment, and not everyone is a candidate for foam.

The problem to be treated must be established before proceeding. At Centro Medico Gargano, a sclerotherapy session is preceded by a vascular assessment with venous colour Doppler ultrasound to examine the superficial and deep systems, any reflux and the extent of insufficiency.

Standardisation does not mean an absence of risk

Automated preparation does not make sclerotherapy free of possible adverse effects or complications. Indications, contraindications, concentration, volume, gas and injection method must be chosen by the doctor for the individual case. It is therefore inappropriate to claim that using the device alone guarantees greater safety, no complications or a faster recovery.

As with any sclerotherapy treatment, goals, alternatives, limitations, possible adverse effects and the need for follow-up or additional sessions should be discussed before the procedure.

What the available studies show

Laboratory studies have described the physical characteristics of foam produced by automated systems. Observational studies of the clinical use of VARIXIO are also available. These data are useful, but they do not guarantee superiority for every patient over all manual preparation techniques.

An article published in 2024 reported follow-up of patients treated for great saphenous vein insufficiency using foam prepared with an automated system. Its findings also show that recanalisation and the need for further treatment can occur over time. This reinforces the importance of explaining limitations and follow-up to patients accurately.

How it fits into care at Centro Medico Gargano

At Centro Medico Gargano, any use of VARIXIO forms part of a wider pathway: consultation, clinical assessment, preliminary venous colour Doppler ultrasound, selection of the technique and subsequent reviews. The device is a preparation tool; it does not replace diagnosis or make sclerotherapy the right solution for everyone.

For an overview of available options, see the page about varicose veins in Naples. For information about the professional background and diagnostic pathway, see Phlebology in Naples.

Sources and further reading

• Technical description of the VARIXIO system.
• Study with three-year follow-up on the use of an automated microfoam preparation system.

For an initial assessment, you can book Colour Doppler Ultrasound + Vascular Consultation. If you have already had the required vascular assessment and sclerotherapy has been recommended, you can book a Vein and Spider Vein Sclerotherapy Session.

Choosing a varicose vein clinic in Naples should not be based solely on slogans, lists of technologies or reviews. It is useful to check that the pathway begins with clinical assessment and, when indicated, venous colour Doppler ultrasound, and that the available options are explained with their expected benefits, limitations and alternatives.

What to check before choosing

• Training and professional experience: the doctor should have demonstrable expertise in assessing venous conditions and in the proposed techniques.
• Diagnostic pathway: treatment decisions should follow the consultation and tests that are actually needed, rather than simply the presence of visible veins.
• Individual recommendations: not all varicose veins require the same treatment, and not every method is suitable for every patient.
• Understandable information: goals, limitations, possible adverse effects, alternatives and subsequent reviews should be clear before proceeding.
• Follow-up: it is useful to know in advance how results will be checked and when further reviews may be needed.

Why diagnosis comes before treatment

Visible veins alone cannot establish the origin of the problem. Specialist assessment and colour Doppler ultrasound, when indicated, examine the venous circulation, identify any reflux and distinguish a mainly aesthetic concern from venous insufficiency. Read more on the page about varicose veins in Naples.

Which treatments may be considered

Depending on the clinical and ultrasound findings, options may include conservative measures, compression therapy, sclerotherapy, endovenous saphenous vein treatments or ambulatory phlebectomy in selected cases. The choice is not automatic: it depends on the distribution of reflux, symptoms, venous anatomy and the patient’s characteristics.

The pathway at Centro Medico Gargano

At Centro Medico Gargano, assessment is overseen by Dr Ciro Gargano. The pathway focuses first on diagnosis and then on choosing treatment proportionate to the findings, avoiding presenting one technique as a solution for everyone. For information about training and professional practice, see Phlebology in Naples.

For the address, contact details and practical information, see Contact and directions. For an initial assessment, book Colour Doppler Ultrasound + Vascular Consultation. If you have already had the required vascular assessment and sclerotherapy has been recommended, you can directly book a Vein and Spider Vein Sclerotherapy Session.

Venous insufficiency occurs when blood returns less efficiently from the legs to the heart. It may be associated with heaviness, swelling, pain, itching, cramps, spider veins or varicose veins. Everyday measures may help control symptoms, but they do not replace diagnosis or eliminate veins that are already dilated.

Which symptoms may suggest a venous problem

The most frequently reported symptoms include:

• heaviness or tiredness in the legs, often more noticeable towards evening;
• swelling of the ankles or lower limbs;
• pain, burning, itching or a feeling of tightness;
• night cramps;
• varicose veins, reticular veins or visible spider veins;
• pigmentation, eczema or other skin changes in more advanced cases.

These symptoms are not specific: swelling and pain may also have lymphatic, joint-related, medication-related or systemic causes. For more information, see the page about swollen and heavy legs.

What can help in everyday life

Walk and break up prolonged periods of immobility

Ankle movement and contraction of the calf muscles support venous return. Walking regularly and taking periodic breaks from long periods of sitting or standing may help reduce heaviness and pooling.

Address factors that worsen symptoms

If excess weight, inactivity, prolonged heat exposure or particular habits aggravate symptoms, addressing these factors realistically and gradually may help. However, there is no single rule that applies to everyone.

Elevate your legs when swelling increases

For patients whose swelling is genuinely related to venous stasis, short periods with the legs elevated may provide relief. If swelling is new, persistent or mainly affects one leg, it is preferable to establish the cause first.

Use compression only when appropriate

Compression stockings may help control swelling and symptoms in selected situations, but the type, size and compression class must be chosen correctly. They are not a universal treatment and do not eliminate varicose veins. The arterial circulation and the patient’s general condition may also need assessment before they are prescribed.

When a phlebological assessment is needed

It is useful to consult a specialist when symptoms persist, painful varicose veins appear, swelling increases, skin changes occur or a leg wound does not heal. Venous ulcers require a specific assessment.

Sudden swelling of one leg, significant pain, extensive redness, breathing difficulties or chest pain require urgent assessment. A vein that suddenly becomes hard and painful may indicate superficial venous thrombosis and should not be managed without medical advice.

The role of colour Doppler ultrasound

Venous colour Doppler ultrasound of the lower limbs examines the superficial and deep venous systems and, when indicated, identifies reflux or other abnormalities. It should not be requested automatically for every leg symptom: the need for the examination is determined by the consultation and the clinical question.

When everyday measures are not enough

If symptomatic varicose veins or clinically significant reflux are present, options may include conservative care, sclerotherapy, endovenous treatments or surgical procedures in selected cases. The choice follows diagnosis, rather than simply the availability of a technology.

The page about varicose veins in Naples provides a fuller explanation of symptoms, diagnosis, options and treatment limitations.

For an assessment at Centro Medico Gargano, see Phlebology in Naples or book Colour Doppler Ultrasound + Vascular Consultation.

Further reading: NICE, Varicose veins: diagnosis and management.