Haemorrhoids (piles)

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Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels found inside or around the bottom (the rectum and anus).

When symptoms do occur, they may include:

  • bleeding after passing a stool – the blood is usually bright red
  • itchy bottom
  • a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
  • a mucus discharge after passing a stool
  • soreness, redness and swelling around your anus

Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.

When to seek medical advice

See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked so your doctor can rule out more potentially serious causes.

The symptoms of haemorrhoids often clear up on their own, or by using simple treatments that can be bought from a pharmacy without a prescription.

Speak to your GP if your symptoms don’t get better or you experience pain or bleeding.

Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.

Some people with haemorrhoids are reluctant to see their GP. But there’s no need to be embarrassed – GPs are very used to diagnosing and treating haemorrhoids.

What causes haemorrhoids?

The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause theblood vessels in your back passage to become swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet as a result of prolonged constipation. This is often caused by a lack of fibre in a person’s diet.

Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.

Other factors that might increase your risk of developing haemorrhoids include:

  • being overweight or obese
  • age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
  • being pregnant – this can place increased pressure on your pelvic blood vessels, causing them to enlarge; read more about piles in pregnancy
  • having a family history of haemorrhoids
  • regularly lifting heavy objects
  • a persistent cough or repeated vomiting
  • sitting down for long periods of time

Preventing and treating haemorrhoids

Haemorrhoid symptoms often settle down after a few days without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.

Making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended.

These can include:

  • gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
  • drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
  • not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
  • avoiding medication that causes constipation – such as painkillers that contain codeine
  • losing weight if you’re overweight
  • exercising regularly – this can help prevent constipation, reduce your blood pressure, and help you lose weight

 

These measures can also reduce the risk of haemorrhoids returning or even developing in the first place.

Treatment

Medication that you apply directly to your back passage (topical treatments) or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools.

More severe cases need to be treated by a specialist.

One possible treatment is rubber band ligation. Rubber band ligation can be performed in the doctor’s surgery or outpatient clinic and does not require hospital admission.

The procedure involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid, which eventually falls off after a few days.

Injection of a substance that makes the blood in the haemorrhoid clot is another option (sclerotherapy).

The most serious cases are third-degree haemorrhoids. These protrude through the back passage and can require surgical removal or ‘haemorrhoidectomy’. Such operations are successful in 90 per cent of cases. However, many third-degree haemorrhoids shrink and become symptom-free without surgical treatment.

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