Haemorrhoids & Piles

Haemorrhoids are also known as piles. They occur when blood vessels around the anus and rectum swell up and enlarge, creating a hanging lump that can protrude from the anus. This lump may need to be pushed back in after going to the toilet. There are several degrees of piles, in most cases the symptoms are mild and relatively painless and often clear up on their own. In cases where piles are causing some discomfort, for example an itch or soreness around the anus, then non-prescription treatments are available to purchase. If these treatments don’t relieve the discomfort, or you experience pain or bleeding after passing a stool then it is recommended you speak to your GP.

What exactly causes piles is still unclear. What we do know is that they are associated with increased pressure in the blood vessels located in and around the anus. The majority of cases are believed to be caused by excessive straining when using the toilet. This is often due to a low fibre diet resulting in constipation. There are other factors that can increase the likelihood of developing haemorrhoids, these include:

• Pregnancy
• Having a family history of piles
• Being overweight
• Being over 45 years of age
• Regularly lifting heavy weights
• Long periods of sitting down
• Prolonged diarrhoea
• A persistent cough
• Repeated vomiting

There are two main types of piles, these are internal piles and external piles. Internal piles occur above the line inside the anus called the dentate line. External piles will occur below this line. The dentate line is a visible line that marks where the nerves inside the anal canal are able to detect pain. Nerves below the dentate line are capable of detecting pain signals whereas the nerves above it are not.

There are varying degrees of piles, which are classified by their size and severity.

• First degree haemorrhoids cannot be seen outside the anus. They develop on the lining inside of the anus and are small in size.
• Second degree haemorrhoids are larger in size. These swellings may protrude out from the anus when going to the toilet, before retracting back inside.
• Third degree haemorrhoids comprise of one or more soft lumps that hang down from the anus. These can be pushed back inside, known as reducible.
• Forth degree haemorrhoids differ from third degree haemorrhoids by being larger in size. They are also irreducible – they cannot be pushed back inside.

For a lot of people, piles can come and go without presenting any symptoms and aren’t generally painful. They tend to only cause pain if their blood supply is reduced or interrupted.

For those who have a higher degree of haemorrhoids, the following symptoms may present:

• An itch, soreness or redness around your anus
• A visible lump that hangs down outside the anus
• A discharge of mucus or blood after passing a stool

If your symptoms are persistent and don’t respond to over-the-counter treatments then it may be necessary to see your doctor. If in any circumstance you are experiencing rectal bleeding then it’s advised to always seek medical advice.

Haemorrhoids/piles is a condition that is normally very easy for your doctor to diagnose - you should always seek a formal diagnosis on the first instance. It usually only involves a quick examination of the anal area. Sometimes a visual inspection is enough to identify external piles but there may also be the need to perform an internal examination, where a lubricated, gloved finger is inserted into the anus. This means your doctor will be able to feel for any abnormalities.

In a small number of cases it may be deemed necessary for further internal examination. This will be done using a proctoscope. A proctoscope is a thin tube that has a light attached to one end. When inserted into a patient’s anus it will allow the doctor to see the entire anal canal and make an accurate diagnosis.

After your initial diagnosis by your doctor it may be appropriate to self-treat your haemorrhoids as long as your symptoms have not changed or got worse since they were diagnosed. You should always check with your doctor if you have blood in your stools, especially if it is dark in colour or if your symptoms significantly change.

Lifestyle changes

Simple lifestyle changes can often be the answer to a mild case of piles, especially if constipation and over-straining were the cause.

• By introducing more fibre into your diet, you can help make your stools softer and easier to pass, which will reduce the amount of straining.
• Do not ignore the call to use the bathroom, it can lead to straining and haemorrhoids.
• Be sure to drink plenty of water as dehydration can lead to constipation and then to piles.
• Exercise helps to keep the bowels moving and thus can ease constipation and therefore piles.

Over-the-counter treatments

If you require medication, there are many different over-the-counter remedies available. These topical treatments include; ointments, creams, sprays and suppositories. Anusol, Germoloids, Preparation H and Anodesyn are all treatments are designed to soothe irritation in and around the anus. They are zinc-based, which provides a barrier for the sore skin, to ease irritation and helping to prevent infection. Some also contain local anaesthetics to help to ease the pain of piles.

Prescription-strength treatments

If there is severe inflammation around the anus then certain preparations, such as Scheriproct Ointment and Proctosedyl Ointment contain a steroid, which will help reduce inflammation. They also contain different ingredients designed to ease pain and irritation or act as a barrier. They are suitable for more serious cases of haemorrhoids (second and third degree) where over-the-counter treatments are ineffective. They are normally used in courses of 7-10 days at a time.

Constipation treatment

If your piles are the result of constipation then a laxative may be necessary. These are medicines designed to empty the bowel and relieve any straining associated with passing stools. See our constipation section for further information on laxatives and treating constipation.

Treatment of serious internal haemorrhoids

If your haemorrhoids have developed above the dentate line (high inside the anus), then over-the-counter treatments are not appropriate and your GP may refer you to a specialist. The recommended procedures in these cases are banding and sclerotherapy. Banding is a procedure that involves reducing the haemorrhoid’s blood supply by attaching a very tight elastic around their base. Sclerotherapy is an injection that both numbs pain as well as hardening the tissue of the haemorrhoid, causing it to ultimately reduce and shrivel up.

Preventing piles in most cases is actually quite simple. The key is not burdening your stomach and bowels with any unnecessary pressure. A healthy lifestyle is essential for reducing your risk of developing the condition.

• Ensure you stay hydrated by drinking plenty of fluids, especially water and fruit juices. Try to avoid alcohol and caffeine as this can dehydrate you and lead to hardened dry stools and then constipation.
• Make sure your diet is rich in fibre so that things keep on moving. Fibre rich foods include; wholemeal bread, fruit, vegetables, brown rice, nuts and seeds.
• Take regular light exercise. Simple activities such as walking and swimming are great ways to help prevent piles.
• When possible never ignore the call of nature. If the urge presents itself then it’s important to answer it. Holding it in repeatedly can result in constipation and piles.
• Try to avoid sitting on the toilet for too long as this posture has the body’s weight bearing down on the backside, exactly the kind of pressure that it is important to avoid.
• Take over the counter painkillers if your piles are sore. In addition to any cream, ointment or suppositories, over the counter painkillers can help to offer relief from discomfort. Avoid painkillers containing codeine as this can cause constipation and avoid ibuprofen or aspirin if your piles are bleeding.
• Wipe your bottom with damp toilet paper. This can help to make the toilet paper less rough and allow the piles to heal without being further inflamed. Make sure you don’t wipe too hard and further irritate your piles.

Some times constipation may be cause for your haemorrhoid's, if you think this is the case you should try and keep your stools soft and regular to try and prevent straining when going to the toilet.

This can be done by increasing the amount of fibre you have in your diet. Foods like wholegrain bread, fruit and vegetables and cereal. In addition to these types of foods you should ensure you drink plenty of water and avoid caffeine.

As well as making changes to your diet, when going to the toilet you should try; avoiding straining to pass stools, try using baby wipes or damp toilet paper and pat the area rather than rubbing it.

These changes should help to prevent the haemorrhoid's from getting worse. As well as these recommendations there are plenty of OTC (over the counter) medications available, some include: Anusol Cream, Ointment and Suppositories and many more.