Sorry to hear about the story of your cousin.
Hemorrhoids or pile are when the veins or blood vessels in and around your anus and lower rectum become swollen and irritated. And this only happens when putting much pressure on the veins.It can be seen inside your anus or under the skin around anus. In other words, when there's an inflamed or swollen along the anus, it's causes hemorrhoid, just as you mention it's cane cause by different factor like prolonged sitting, pregnancy ans lifting heavy weight.

Good luck.