Haemorrhoids are swollen blood vessels in the lining of the anus (back passage). They are very common and affect 50% of people at some time in their life. They more commonly affect the elderly, the overweight and pregnant women. There is a wide range of symptoms extending from a very mild itch to very severe pain.
The blood vessels around the anus fill up with blood and enlarge into a haemorrhoid if the pressure inside the bowel is high when passing very hard motions. The commonest cause is constipation and straining at the toilet.
Internal haemorrhoids are small swellings in the blood vessels about an inch (2.5 cm) inside the anus. There is nothing to see or feel outside and the symptoms are usually very mild and settle spontaneously. There is occasional discomfort on going to the toilet and sometimes blood on the toilet paper. As the haemorrhoid increases in size it may be partly pushed down when passing a motion. This usually goes back inside the anus but sometimes causes a discharge of mucus associated with irritation and itch. Occasionally in more severe cases, the haemorrhoids hang down permanently outside the anus. They can be pushed back up but the fall down again. These are known as 'prolapsed piles' and they can become very large, swollen and painful and almost impossible to push back inside the anus.
These are less common than the internal haemorrhoids and feel like tiny lumps on the edge of the anus which usually settle down and shrink to become skin tags.
Internal haemorrhoids often settle spontaneously, especially if constipation can be avoided and motions are kept as soft as possible without any straining at the toilet. Ointments, creams and suppositories often help to ease the irritation or itch associated with haemorrhoids. Most women who have haemorrhoids during pregnant find that they settle after the birth. If the haemorrhoids have prolapsed, they can become very painful and this can occasionally be eased by an ice pack (or something from the freezer) and they also occasionally require very strong painkillers for a very short period of time.
Increase fluid intake - most adults should be drinking approximately 5 pints of fluid per day. This can be water, juice or tea. Any sort of fluid will do. This helps to soften the motions.
Increased dietary fibre - especially wholemeal bread, cereals, vegetables and fruit.
Fibre supplements - when increasing dietary fibre has not helped, fibre supplements such as Fybogel, are often very useful.
Regular exercise - regular activity helps to keep the bowels active.
Toileting - if you feel the need to go to the toilet, you should go. Do not resist the feeling as this often leads to constipation.
Painkillers - any painkiller that contains codeine such as co-codamol, Solpadeine and Solpadol can cause constipation. Simple paracetamol alone does not cause constipation.
Ointments, creams and suppositories do not cure piles but they often help to relieve the symptoms. There is a wide choice of topical treatments for haemorrhoids but none have been shown to be any better than the other. It is simply a question of trial and error in using the one which you find to be most helpful.
If conservative measures do not help to settle your haemorrhoids, then more active treatment may be required, especially for large prolapsed piles. There are several alternative treatments including freezing, tying off with elastic bands, injecting or surgery to remove the haemorrhoids.
Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.
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