Haemorrhoids – commonly known as piles – can affect anyone of any age. It is impossible to say with absolute accuracy how many people have them as most people don’t go and see the doctor for piles and some people do not have any symptoms. However, it is believed that they are a very common problem. You are more likely to get them as you get older or during or after pregnancy.


What are they?

Piles are enlarged blood vessels that appear as small, round, purplish lumps inside or around your anus.

Internal piles start inside your anal canal but they might hang down outside too. They are graded according to whether, and how far, they protrude:

  • First degree piles may bleed but don’t protrude outside your anus.
  • Second degree piles protrude when you pass stools but go back inside by themselves.
  • Third degree piles protrude but can be physically pushed back inside.
  • Fourth degree piles protrude and can’t be pushed back inside. They may be very painful and swollen.

External piles develop further down your anal canal, close to your anus. They can become very painful, particularly if they contain blood clots. You can have both internal and external piles simultaneously.


Causes

Piles develop when the veins in your anal canal become swollen. This can be due to straining when you pass stools (if you have constipation or long-term diarrhoea, for example); pregnancy which causes changes in your hormones and an increased pressure in your tummy; ageing which causes the muscles in your anal canal to weaken; and lifting heavy objects or coughing.


Symptoms

You may or may not have any symptoms if you are suffering from piles. If you do, they might include:

  • Pain and discomfort after you pass stools
  • Itchy, sore skin around your anus
  • A lump in or around your anus
  • Bleeding when you pass stools
  • Feeling as though your bowels haven’t completely emptied after passing stools
  • Discharge of mucus from your anus

Diagnosis

It is important to get a proper diagnosis if you suspect you have piles as some of the same symptoms may be experienced with more serious conditions like anal cancer and bowel cancer. Your doctor will gently put a finger inside your anus to test for piles.

If necessary they may refer you to a specialist who will look inside your anus using a proctoscope (a short, rigid instrument).


Treatment

If a diagnosis of piles is confirmed, there are several possible courses of treatment depending on the location and extent of the problem. These include:

  1. Medication – a mild laxative or fibre supplement can help to soften hard stools and you can buy soothing creams, ointments and suppositories that can ease pain and itchiness. Some products containing corticosteroids (such as Anusol HC) may help to reduce swelling and pain but should not be used for more than a week. Painkillers can help to ease the discomfort of piles.
  2. Non-surgical treatments – if the piles don’t go away on their own, there are a range of non-surgical treatments that can treat them. Banding involves putting a small elastic band around the pile to reduce its blood supply. It will normally fall off within a week or two. Other treatments are: sclerotherapy (injecting an oily solution into the piles to make them shrivel up) and using an electric current to destroy the pile (bipolar diathermy or direct current electrotherapy).
  3. Surgery – most piles can be successfully treated without surgery. However, persistent piles may require surgery. There are several possible surgical procedures, your doctor will discuss which is best for you: haemorrhoidectomy (surgery to remove piles); stapled haemorrhoidopexy (stapling the area of tissue affected by piles higher up your anal canal causing the piles to shrink) and haemorrhoidal artery ligation (stitching the arteries in the anal canal to limit blood supply to the piles).

Prevention

If you have piles or you are keen to prevent the problem from developing or recurring, there are several things you can do to help:

  • Drink plenty of fluids to stay well hydrated but avoid too much caffeine.
  • Eat a diet that is high in fibre. This will make your stools easier to pass which will prevent you from having to strain, which can put pressure on the veins in your anus.
  • Try not to strain when passing stools. Afterwards, gently clean around your anus with water and pat the area dry.

For advice on diagnosing and treating haemorrhoids, contact us.