Haemorrhoids (Piles)

Haemorrhoids, also known as piles, are enlarged and swollen blood vessels in or around the lower rectum and anus.

Symptoms of haemorrhoids

Haemorrhoids (piles) are usually mild and, in most cases, the symptoms will go away naturally within a few days. Most people may not even realise they have haemorrhoids as they do not experience any symptoms.

The symptoms of haemorrhoids include:

• Itchiness around your anus (the opening at the end of the digestive system where solid waste leaves the body)
  
• Discomfort around your anus, such as feeling sore or it being visibly red
• Excessive straining when passing a stool
• Bleeding after you have passed a stool (this will be bright red blood)
• Discharge of mucus present after passing a stool
• Pain while passing a stool
• Feeling like your bowels are still full and need emptying .

Types of haemorrhoids

Haemorrhoids can be:

• Internal haemorrhoids
• External haemorrhoids

Internal haemorrhoids develop 2-4cm above the opening of the anus. External haemorrhoids develop on the outside edge of the anus.

Causes of haemorrhoids

Haemorrhoids (piles) occur due to increased pressure in the blood vessels in your rectum and anus. This is often because of straining when trying to pass a stool.

Others factors that can increase your chances of having haemorrhoids include:

• Being overweight
• Being constipated regularly, often due to a lack of fibre in your diet
• Prolonged diarrhoea
• Regularly lifting heavy objects
• Pregnancy, where you experience increased abdominal pressure on your pelvic blood vessel, causing your blood vessels to enlarge (the haemorrhoids often disappear after giving birth)
• Being over 50 years of age (ageing can make the support structures in your body tissues weaker, making haemorrhoids more likely)
• Having a family history of haemorrhoids

Diagnosing haemorrhoids

Haemorrhoids (piles) are easily diagnosed by your doctor

It is important to tell your doctor:

• If you have recently lost a lot of weight
• If your bowel movements have changed
• If your stools contain any blood
• If there is any mucus present in your stools

Digital rectal examination

Wearing gloves and using lubricant, your doctor will use their finger (‘digit’) to feel for any abnormalities in your anus and rectum.

Proctoscopy

This is an examination of the inside of your rectum using an instrument called a proctoscope, which is a hollow tube fitted with a light on the end.

Treating haemorrhoids

There are a number of treatments that will reduce the itching and discomfort that haemorrhoids can cause. Lifestyle changes are usually the first step of treatment.

Dietary changes

If your haemorrhoids are a result of constipation, try to keep your stools soft and regular. By making changes to your diet, you can avoid straining while on the toilet:

• Increase the amount of fibre in your diet. Aim to eat insoluble fibre every day (insoluble fibre is fibre that the body cannot digest, so it passes through the bowels and helps other food and waste move through more easily), such as wholegrain bread and cereal, and raw fruits and vegetables.
  
  
• Drink lots of water. Aim to drink six to eight glasses of fluid every day and avoid too much caffeine (which is found in tea, coffee and coca-cola).

Self care

Follow the advice below when passing stools:

• Avoid straining to pass a stool as this may make your haemorrhoids worse
• After passing a stool, clean your anus with moist toilet paper instead of dry toilet paper
• Using baby wipes can ease any discomfort that occurs after passing a stool
• Pat, rather than rubbing, the area

Creams, ointments and suppositories

Over-the-counter (OTC) creams and medicines can be used, however these will only treat the symptoms of haemorrhoids, and will not cure the haemorrhoids themselves.

These products should only be used for five to seven days at a time. If they are used for longer than this, they may irritate the sensitive skin around your anus. Combine taking any medication with the diet and self-care advice above.

Painkilling medication

Painkillers, such as paracetamol, can be taken to relieve the pain caused by haemorrhoids. Products containing local anaesthetic (a painkilling medication) may also be prescribed to treat the pain that haemorrhoids cause. They should only be used for a few days, as they can make the skin around the anus more sensitive.

Laxatives

If you are constipated, your GP may prescribe a laxative. This could either be:

• A bulk-forming laxative, which contains fibre to make your stools heavier and softer
• An osmotic laxative, which increases the amount of water in your bowels to make your stools softer

Surgical treatment:

Banding

Banding involves putting a very tight elastic band around the base of the haemorrhoid inside your anus. This cuts off the blood supply. Within seven days of having the treatment, the haemorrhoids should fall off.

Injections (sclerotherapy)

Sclerotherapy is a common treatment for grade two or three internal haemorrhoids. It is often used as an alternative to banding. A chemical solution can be injected around the blood vessels in your anus. This relieves pain by numbing the sensory nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.

Surgery

Surgery is often used to treat internal haemorrhoids that are either very large or are grade three or four.

If other treatment has not worked on your haemorrhoids (piles), you may be referred to a surgeon. There are several different surgical procedures you can have. These are explained in more detail below.

Haemorrhoidectomy

This is an operation to remove the haemorrhoids.

It is less likely that the haemorrhoids will come back after surgery than it is with injections or banding, but a high-fibre diet is always recommended as a preventative measure.

Alternative procedures

Some alternative surgical procedures are explained below.

Stapling

Stapling, also known as stapled haemorrhoidopexy, is an alternative to a traditional haemorrhoidectomy. It is usually only done to treat prolapsed haemorrhoids. The haemorrhoids are stapled to the wall of the anal canal, which reduces their blood supply and makes them smaller. However, after stapling, more people experience a further prolapsed haemorrhoid than after a haemorrhoidectomy.

Haemorrhoidal artery ligation

Haemorrhoidal artery ligation, also known as transanal haemorrhoidal dearterialisation (THD), is an operation to reduce the flow of blood to the haemorrhoids. A stitch is placed in these arteries so that the blood supply to the haemorrhoid is blocked. This causes the haemorrhoid to shrink over the following days and weeks.

Preventing haemorrhoids

There is no guaranteed way to prevent haemorrhoids (piles), but a high-fibre diet will keep your stools (faeces) soft, reducing your risk of becoming constipated (when you are unable to empty your bowels). This will ensure that you avoid straining to pass a stool, which is the main cause of haemorrhoids.

It is also recommended that you empty your bowels when you need to. If you delay passing your stool, it could become harder and drier. This increases the likelihood of pressure building up in the blood vessels in your anus and rectum.

Possible ways to prevent haemorrhoids include:

• Eating plenty of fresh fruit and vegetables (at least five portions a day)
• Cutting down on fat (particularly fat in meat, sugary food and refined and processed food)
• Eating plenty of pulses, such as peas, beans and lentils
• Eating plenty of wholegrain foods, such as wholemeal bread, pasta and breakfast cereals
• Drinking plenty of fluid. You should drink 1-2 litres (six to eight glasses) of water every day to keep your stools soft
• Losing weight if you need to. Being overweight can be a contributing factor to having haemorrhoids
• Exercising regularly, which can prevent constipation, reduce the pressure in your blood vessels and help you lose weight
• Avoiding medication that causes constipation, such as painkillers that contain codeine