Haemorrhoids

What are haemorrhoids?

Haemorrhoids, also known as piles, are swellings that develop in the rectum (the back passage) and anus. Haemorrhoids form as a consequence of the blood vessels in the back passage becoming dilated, swollen and filled with more blood than usual. The plump veins and surrounding tissue then develop into a small swelling, which is identified as a haemorrhoid. Haemorrhoids are common but estimates vary according to the classification of piles (sometimes bleeding from the rectum is classed as haemorrhoids). It is approximated that between 5% and 25% of people in the UK are affected by piles, and up to 50% of people will experience piles at some time in their lives.

Haemorrhoids can affect people of all ages but are most common among older people. It is also more common for pregnant women to suffer from piles.

Causes of haemorrhoids

The exact cause of piles is unknown, though experts believe there is a strong link between haemorrhoids and increased pressure around the anus. This can be caused by various reasons, including:

Straining when passing a stool.
Constipation.
Pregnancy.

Other risk factors include:

Age: the risk rises with age and piles are most common among people over the age of 60.
Being overweight.
Lifting heavy objects on a frequent basis.
Persistent diarrhoea.
Family history: some people inherit weak blood vessels in the anus.

Symptoms of haemorrhoids

Haemorrhoids are usually a mild condition and, in most cases, symptoms ease within a few days without any treatment. Some people do not even realise they have piles because they do not always cause symptoms. Symptoms that may become apparent include:

Straining when passing stools.
Itchiness around the anus.
Feeling like your bowels are not empty, even after going to the toilet.
Mucus discharge after passing a stool.
Bleeding after passing a stool (the blood is usually bright red).
A sore anus; which may be visibly sore and red.

There are different grades of haemorrhoids, ranging from grade 1 which are small and generally painless, to grade 4 which can be very painful and permanently hang down from the anus.

Complications of haemorrhoids

Haemorrhoids are usually not a problem but there is a possibility of complications with an external haemorrhoid (one that hangs outside the anus). In rare cases, a blood clot (known as a thrombosis) can develop inside the haemorrhoid and this can result in severe pain. It is wise to seek treatment as quickly as possible in this case.

How are haemorrhoids diagnosed?

Doctors can usually diagnose haemorrhoids very easily by talking to you about symptoms and examining the anus to check for the attendance of swellings. It is important to be honest with your doctor about symptoms and, although you may feel embarrassed to talk to them, rest assured they have talked about these kinds of things hundreds of times before and there is nothing to be ashamed about. It is important to tell your GP if you have:

Recently lost weight.
Experienced changes in bowel movements.
Noticed blood in your stools.
Noticed mucus in your stools.

If you have internal haemorrhoids (inside the anus) your doctor may carry out a digital rectal examination, which involves them using their finger to examine the anus. Your doctor will always wear gloves and lubricate the finger to reduce pain during these examinations. If a closer examination is required, your doctor may carry out a proctoscopy. This involves examining the rectum using an instrument called a proctoscope, which is a hollow thin tube with a light on the end. The proctoscope allows your doctor to see the anal passage in detail.

Treatment for haemorrhoids

In the majority of cases, haemorrhoids ease without any treatment and this usually takes just a few days. There are many treatments that can be used to ease symptoms, including ointments, creams and suppositories. Other things you can do to help prevent pain include:

Avoid straining on the toilet.
Eat lots of fibre: fibre-rich foods include vegetables and fruit, wholegrain cereals, bread and rice and nuts.
Drink plenty of fluid.
Take fibre supplements if your ingestion of fibre is too low.
Avoid taking medications that contain codeine.
Avoid waiting to go the toilet: if you have the urge to go, it is beneficial to go as quickly as possible.
Use baby wipes or moist paper to clean your bottom to reduce soreness.

Creams and ointments

There are creams and ointments available to reduce symptoms of piles, which are available over-the-counter and your pharmacist will be able to advise how and when to use them. Always make sure to read the instructions.

Medication

Painkillers can be used to ease pain caused by piles. These are available over-the-counter but make sure you read the dosage instructions carefully. Corticosteroids can be used to reduce inflammation but they should not be used for longer than a week since they can cause the tissue around the anus to become weaker and thinner. If you are suffering from constipation, your GP may advise you to take laxatives. These will help to stimulate the muscles in the digestive system and make the stools softer.

Banding treatment

This treatment is commonly used for grade 2 and 3 haemorrhoids and involves placing a tight band around the bottom of the haemorrhoid to stop the blood supply. This is eventually meant to cause the haemorrhoid to die. Banding treatment is carried out by a surgeon and is usually an outpatient procedure.

Sclerotherapy

This treatment is sometimes used as an alternative to banding treatment and involves injecting a chemical solution into the blood vessels around the anus, which helps to reduce pain by suppressing the nerve endings.