My recurrent haemorrhoid flare-ups are almost always followed by high fever and chills. Why?

I was born in 1987, so I'm almost 33 at the time of writing. Since the last 4 years or so I have suffered from episodes of haemorrhoid flare-ups, many of which have been followed by a fever within hours. After the first couple of episodes I have been referred by my GP for a colonoscopy. The diagnosis has been grade II piles. This is not surprising as, unfortunately, these seem to run in the family. However, I seem to be the only one developing a fever during flare-ups.

Let me give you a bit of extra details about these episodes. Ever since reaching the adult age, I occasionally noticed little traces of blood on the toilet paper. It has always looked bright red and it has always been an inconspicuous amount (almost like a faint line traced by a ball pen). About 10/11 years ago I had my first "big" flare-up during a bowel movement and I could literally see blood dripping into the toilet bowl from the rectum. As far as I can remember, I did not develop a fever that time. Then, about 4 years ago, I had a similar episode, with quite the same "copious" amount of blood. This time though, I started developing a fever. It got up to about 39 C pretty quickly as I had quite some violent chills. The first time I went to the GP I was dismissed with "it's just the flu". After the episode occurred again after a couple of months, the GP referred me for the colonoscopy, which confirmed grade II piles and excluded, e.g. Crohn's disease or anything more serious. Ever since I had about 6/8 more of these episodes and the latest diagnosis is now a simple "inflammatory response".

Let me add that I have also had some flare-ups with a fair amount of blood that haven't been followed by a (high) fever. I have somehow noticed a positive correlation between the "violence" of the inflammation and the amount of blood that I lose during these episodes (and while we talk about blood, let me also add that I carry beta-thalassemia minor, which is a common trait of Mediterranean people).

The cure that I have received for these episodes is paracetamol for the temperature (I tend not to take any paracetamol unless the temperature goes above 38.5 C; if my body wants a higher temperature than normal, it probably needs it to fight some infection) and hydrocortisone suppositories for the piles. From my side, I try my best to ensure a good intake of soluble fibre and water to keep the stool soft. Indeed I manage to keep them so and have regular bowel movements each day.

Given that the only diagnosis I could get from my GP so far is "inflammatory response", I have tried to come up with a couple of theories to really explain what is actually happening, as I appreciate that haemorrhoids are very rarely followed by more serious complications. My main theory is that, when the laceration is quite large, either the tissue or the bloodstream gets infected with bacteria on the stool and generally in the gut. The fever is then a response to a generalised inflammation to get rid of the pathogens that made their way in. As for why some times these episodes are not followed by a fever, I think it is because in those cases I was able to pass all the stool. In the cases where I develop a fever, the stool felt harder to pass and would remain to press against the haemorrhoid, temporarily blocking the blood flow and allowing the infection to get in.

As for the causes of the flare-ups themselves, that remains a mystery to me. I have thought that there might be some foods (in particular, something contained in a particular type of foods) that could cause the haemorrhoids to swell. Looking back at my diet, there usually have been bell pepper in my meals following the episodes (I do not normally eat bell peppers). Other times, a spice like ginger seemed to have been present in my meals. However, there have been cases where such foods and spices have caused me no problems at all, so I don't have enough empirical evidence against this or that food.

My main worry about the recurrence of these episodes is that, whilst my immune system seems capable of coping (or perhaps overreacting) to whatever is triggering it, I might not be this lucky in the future, especially when it starts weakening with age. Perhaps these episodes will stop occurring, but what if they get worse? So, apart from the most sensible recommendation of trying to avoid causing flare-ups by avoiding straining and keeping the stool loose (consider that my job forces me to spend hours seated on a chair), what else can I do to prevent these episode, which are clearly recurring despite my efforts? And furthermore, what is actually happening to me? Could this be the indication of a more serious underlying disorder?

Thanks.

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