Haemorrhoids (piles)

Written by: 
Michelle Roberts, medical writer

What are they?

Haemorrhoids, or piles, are swellings originating from the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels in the back passage or anusThe external opening of the back passage, the rectum.. If these bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels come under pressure, they can dilate and become swollen, in a similar way to varicose veins, and protrude out into the anal canal.

Symptoms

They may cause no symptoms at all, especially if they are small. But they can cause:

  • Bleeding - seen as fresh bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. on the toilet paper after wiping, or in the toilet bowl after passing a motion
  • Mucous discharge
  • Itch and discomfort
  • A swelling that can come out from the anusThe external opening of the back passage, the rectum., and even be big enough to hang down. They are usually soft and can spring or be pushed back inside the anusThe external opening of the back passage, the rectum.. If more severe, they may hang down permanently and can become hard
  • A feeling that the bowels are full even after going to the toilet. More rarely, pain - if the pile has thrombosed (clotted).

Causes

Anything that increases the pressure inside the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. can cause piles. This includes:

  • Chronic constipation or straining on the toilet
  • Pregnancy and childbirth
  • Heavy lifting
  • Obesity.

Some people may have an inherent weakness that makes them more prone to piles. Piles are also more likely as we age because the supportive tissues within the anusThe external opening of the back passage, the rectum. become lax.

Treatment

In many cases, the symptoms will go away within a few days. It is important to avoid aggravating factors, such as constipation - eating enough fibre and drinking plenty of fluids will help this. Things you can also do to help include:

  • Regular baths in warm water - to ease the pain and itch and keep the area clean
  • An ice pack wrapped in a cloth held against the anusThe external opening of the back passage, the rectum. - to ease the pain and reduce the swelling, but should not be applied for more than half an hour at a time
  • Baby wipes or damp toilet paper used to wipe your bottom after passing a motion
  • An inflatable ring used as a cushion when sitting - to reduce some of the pressure on the haemorrhoids.

Pharmacies sell creams, ointments, sprays and suppositories (bullet-shaped medications that you insert into the anal canal to dissolve) that can ease the discomfort and swelling. There are many different formulations available and your pharmacist can give advice about which is best for you.

Your doctor can also prescribe treatments containing any of the following:

  • Bismuth oxide, bismuth subgallate, peru balsam, zinc oxide or witch-hazel to relieve irritation
  • Local anaesthetics to numb the area
  • An astringent to reduce the swelling
  • Corticosteroids to reduce the swelling.

Medications containing anaestheticA medication that reduces sensation. or corticosteroid should not be used for longer than a week. If the symptoms persist or worsen it is important to seek medical help.

For some cases, a hospital trip for surgery may be needed. This could involve injecting the piles with a chemical to make them scar and shrink, putting a tight band around the pile until it scars and drops off, or freezing or cutting them off.

Prevention

There are lifestyle changes that can help prevent piles occurring. These include:

  • Eating a healthy diet high in fibre - found in grains, fruits and vegetables
  • Drinking plenty of water - 1-2 litres a day
  • Exercising regularly
  • Losing weight if overweight - see weight-loss diets
  • Avoiding painkillers containing codeine as these can cause constipation
  • Using the toilet as soon as you feel you need to - whereas "holding on" causes constipation.
References: 
  1. Clinical Knowledge Summaries (CKS). Haemorrhoids. Newcastle upon Tyne, UK: CKS, 2008.
    Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336; 380-383.
  2. McLatchie GR (auth, ed), Leaper DJ (ed). Oxford Handbook of Clinical Surgery (second edition). Oxford, UK: Oxford University Press, 2003.
  3. Quijano CE, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database of Systematic Reviews, 2007, Issue 2.