What are haemorrhoids?
Haemorrhoids, or piles, are a clump of swollen or enlarged veins in the lower rectum and anus. They are very common in both men and women.
There are three types of haemorrhoids:
- internal – these are inside the rectum. They often bleed but don’t usually cause pain
- prolapsed – these are internal haemorrhoids that get pushed out. They hang outside the anus, especially after passing stool. They can be painful, particularly if the internal anal sphincter constricts their blood supply
- external – these are hard lumps under the skin around the anus.
Haemorrhoids are not usually serious but they can be annoying and uncomfortable. Fortunately, treatments are readily available.
What are the symptoms of haemorrhoids?
Many people with haemorrhoids don’t know they have them because they have no symptoms.
When symptoms do occur, they include:
- painless anal bleeding – often after passing stool
- irritation or itchiness around the anus
- tissue bulging around the anus
- mucous discharge after passing stool
- pain, redness and swelling around the anus.
These symptoms can occur with other conditions. It’s important to report any symptoms to your doctor so you get the right diagnosis and the right treatment.
What causes haemorrhoids?
The biggest cause of haemorrhoids is excessive straining to go the toilet. This can be from chronic constipation or diarrhoea.
The straining causes the veins in your anus to engorge and dilate. Over time, this can lead to the veins becoming enlarged and misshapen.
Other things that increase the pressure on the veins in the anus and lead to haemorrhoids are:
- straining to lift heavy things
- pregnancy
- being overweight
- sitting down for long periods of time.
You are also more likely to develop haemorrhoids if your parents had them.
How are haemorrhoids diagnosed?
Haemorrhoids can usually be diagnosed during physical examination. The physical examination involves gently parting your buttocks to see the anal area and a digital rectal examination. This is where your doctor inserts a gloved, lubricated finger into the anal canal and feels for anything abnormal.
Sometimes your doctor may use an anoscope (a small tube with a light) to get a closer look.
Your doctor may also suggest a colonoscopy with a haemorrhoid specialist.
How are haemorrhoids treated?
Haemorrhoids often settle down after a few days without treatment.
One of the most import steps in treating (and preventing) haemorrhoids is avoiding constipation. Other treatments aim to relieve pain, itchiness and bleeding.
Adding fibre to your diet
If you have haemorrhoids, it’s best avoid straining and pushing to pass a bowel motion. Increasing fibre in your diet is a good way to do this. Fibre works by absorbing water into the stool, which increases stool bulk and softens stool.
You can add fibre to your diet by eating more vegetables and fruits, or by using fibre supplements.
Laxatives
If adding fibre does not relieve your constipation, laxatives can be helpful.
Bathing the area
Immersing the anal area in warm water for 10–15 minutes two or three times daily can improve blood flow and relax the internal anal sphincter. You can use a special ‘sitz’ bath or you can fill a regular bath with 5–10 cm of warm water. Don’t use soap or fragrances in the water. A hand-held shower can be used to spray the area if you don’t have a bath.
Topical treatments
Various creams and suppositories are available to relieve pain and itching, at least temporarily. Many are available without a prescription.
If your symptoms don’t get better with these treatments, you need to see your doctor.
Banding
If you have bothersome haemorrhoids despite other treatments, your haemorrhoid specialist may suggest banding. This involves placing a rubber ring around the base of the haemorrhoid. Over several days, the haemorrhoid shrinks and disappears because of the restricted blood supply.
This is the most widely used procedure and has a high success rate.
Haemorrhoid surgery
If you continue to have symptoms from haemorrhoids despite medical therapies or office-based procedures, you may require surgery.
Surgical treatments for haemorrhoids include:
- haemorrhoidectomy – which is removing excess haemorrhoidal tissues
- stapled haemorrhoidopexy
- haemorrhoidal arterial ligation.
Your haemorrhoid specialist will help you decide which procedure is best for you.