Haemorrhoids (piles)

Health and Nutrition > Diseases > H Reviewed by Mr Robert Diggory, consultant general surgeon and Dr John Pillinger, GP

What are haemorrhoids?

Haemorrhoids are small, blood-filled swellings caused by dilated varicose veins. Initially, they are located just inside the anus (internal haemorrhoids) but can sometimes protrude (external haemorrhoids). Haemorrhoids are not dangerous.

Constipation and prolonged straining when using the toilet are thought to contribute to the formation of haemorrhoids by increasing the pressure in the veins.

What are the symptoms of haemorrhoids?

Haemorrhoids may be present for many years but remain undetected until symptoms appear. They can cause anal bleeding and itching and also pain and discomfort.

Normally, the bleeding is limited to small stains of fresh blood on the toilet paper, but more severe bleeding can sometimes be present when stools are passed.

A lump may also be felt in the anus and large haemorrhoids give a sensation that the bowel hasn't emptied completely.

If you observe blood in your stools, and have the symptoms mentioned above, you should visit your doctor for a check-up.

If haemorrhoids are present ,the doctor will then perform an examination to find out if there are any other possible causes of the bleeding that may be more serious. The doctor will feel the anal canal, and inspect the mucous membrane of the rectum and lower part of the large intestine using an examination tube called a proctoscope or sigmoidoscope.

How are haemorrhoids treated?

Some haemorrhoids can get better without medical treatment. This can happen if they are caused by constipation. The doctor may recommend a change of diet with the addition of more fibre and roughage particularly green vegetables, fresh fruit, wholegrain cereals and bran. Drinking 8 to 10 glasses of fluid daily is advisable.

The person is also told to avoid straining when passing a bowel motion. Nobody should strain to push out a stool. The feet can be placed on a low foot stool to aid the bowel movement. Sitting in a shallow bath of hot water for 15 minutes several times a day, will reduce the pain.

In the case of a pile protruding from the back passage, which has become swollen and painful, a day's bed rest with an ice pack applied to the anal area should be helpful. A pack of frozen peas wrapped in a tea towel is ideal for this purpose. Never allow the ice to come directly into contact with the skin and only use this treatment for 20 minutes in an hour for a limit of three hours a day.

Relatively minor haemorrhoids can be treated using creams available directly from your local pharmacy or on prescription. A few days' treatment is usually enough, and then the irritation will settle spontaneously.

More severe cases need to be treated by a specialist. One possible treatment is rubber band ligation.

Rubber band ligation can be performed in the doctor's surgery or outpatient clinic and does not require hospital admission. The procedure involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid, which eventually falls off after a few days. Injection of a substance that makes the blood in the haemorrhoid clot is another option (sclerotherapy).

The most serious cases are third-degree haemorrhoids. These protrude through the back passage and can require surgical removal or 'haemorroidectomy'. Such operations are successful in 90 per cent of cases. However, many third-degree haemorrhoids shrink and become symptom-free without surgical treatment.

After surgery

. After haemorrhoids have been removed, small skin tags can develop beside the back passage. In some cases they will be slightly painful or itchy and if so they can also be surgically removed by a minor operation.

Following any treatment for haemorrhoids, it is very important to avoid constipation and straining or the condition may recur.

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