Haemorrhoids (piles)

What are they?

Haemorrhoids (piles) are swollen blood vessels in and around the anus and lower rectum. They are either inside the anus (internal) or under the skin around the anus (external).
An internal haemorrhoid may protrude outside the back passage when you open your bowels and this can be painful. It feels like a soft tender lump, but can be pushed back inside. Sometimes a haemorrhoid sticks outside and the sphincter muscles around the anus squeeze it tightly so the blood clots and it becomes hard and painful. This is known as a "strangulated haemorrhoid".
Piles shouldn't be muddled up with anal fissures, which are small splits in the skin lining the back passage.

What are the main symptoms?

Bright red blood which you'll probably first notice on the lavatory paper, though it can drip into the toilet bowl. There may be blood around the stool, but not usually mixed in with it.
A pain or ache around the anus and rectum, which can be quite severe.
A feeling of a bulge or lump at the anus.
Itching around the anus.

Most symptoms will go away within a few days. Some people have no symptoms at all, or only occasional symptoms.

What's the risk?

Most people will get haemorrhoids at some point in their lives and by the age of 50 half the population will have them.

What causes them?

Anything that puts a strain on the abdomen can cause piles. Many men develop them as a result of prolonged straining on the toilet, a practice that puts pressure on the veins in the back passage.
Lifting heavy weights, being overweight and persistent coughing can also cause haemorrhoids. You may also inherit a tendency to develop them.
But you won't get them from sitting on a radiator or cold damp surfaces — these things may make the symptoms worse, but won't cause them.

How can I prevent them?

Keep your stools soft by eating more fibre
Go to the lavatory when you get the urge
If you are overweight try to lose a few pounds by dieting and exercise

Should I see a doctor?

Yes, if your piles don't clear up in a couple of weeks or are painful. If you have rectal bleeding you also should get it checked out (in some cases, bleeding is a symptom of a more serious problems, such as bowel cancer). Your GP can also prescribe or suggest effective treatments.

Your GP will probably examine you internally with a gloved lubricated finger (it's not normally as bad as it sounds) to find out whether there are other causes for the bleeding, and he or she may also examine the rectum using a tube called a sigmoidoscope, though this is usually done in a hospital. You may have to give a stool sample, to check for the presence of blood or to see if you have a parasitic infection.

What are the main treatments?

Creams and suppositories, available from any pharmacy, can help itching or discomfort.
Short baths in warm, plain water can ease the discomfort.
Cold compresses or ice packs (a packet of frozen peas wrapped in a tea towel is ideal) can reduce the swelling.

Sometimes haemorrhoids need to be treated surgically — most of these procedures can be done at an outpatients clinic. The main treatments are:

Rubber-band ligation — a small rubber band is placed around the haemorrhoids inside the rectum so cutting off the blood supply, causing them to shrivel and wither away within a few days. This has a good success rate, but may not cure the problem permanently.
Injection sclerotherapy — a chemical solution is injected around the blood vessels to shrink the haemorrhoids.
Haemorrhoidectomy — the removal of severe piles under general anaesthetic.

How can I help myself?

Increase the amount of fibre in your diet so you don't become constipated. Good sources of fibre are bran cereal, beans, fruit, vegetables and wholegrains (oats, wheat, barley and corn).
Drink plenty of water, herbal drinks or fruit juices. Liquids add bulk to waste matter in the colon, making stools easier to pass. Tea, coffee and cola drinks are excreted quickly through the kidneys and do not remain in the gut long enough to soften waste matter.
Drinking aloe vera juice may help a sluggish digestion and help constipation. (You can buy it in most health food stores.)