HEAMORRHOIDS / PILES

Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels found inside or around the bottom (the rectum and anus).

In many cases, haemorrhoids don’t cause symptoms and some people don’t even realise they have them.

But when symptoms do occur, they may include:

• bleeding after passing a stool – the blood is usually bright red
• itchy bottom
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
• a mucus discharge after passing a stool
• soreness, redness and swelling around your anus

Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.

When to seek medical advice

See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked so your doctor can rule out more potentially serious causes.

The symptoms of haemorrhoids often clear up on their own, or by using simple treatments that can be bought from a pharmacy without a prescription.

Speak to your GP if your symptoms don’t get better or you experience pain or bleeding.

Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a specialist for diagnosis and treatment.

Some people with haemorrhoids are reluctant to see their GP. But there’s no need to be embarrassed. Your GP or pharmacist is used to dealing with these conditions.

What causes haemorrhoids?

The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus.

This pressure can cause the blood vessels in your back passage to become swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet as a result of prolonged constipation. This is often caused by a lack of fibre in a person’s diet.

Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.

Other factors that might increase your risk of developing haemorrhoids include:

• being overweight or obese
• age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
• being pregnant – this can place increased pressure on your pelvic blood vessels, causing them to enlargehaving a family history of haemorrhoids
• regularly lifting heavy objects
• a persistent cough or repeated vomiting
• sitting down for long periods of time

Preventing and treating haemorrhoids 

Haemorrhoid symptoms often settle down after a few days without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.

Making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended.

These can include:

• gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, whole wheat pasta and bread, pulses and beans, seeds, nuts and oats
• drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
• not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
• avoiding medication that causes constipation – such as painkillers that contain codeine
• losing weight if you’re overweight
• exercising regularly – this can help prevent constipation, reduce your blood pressure, and help you lose weight

These measures can also reduce the risk of haemorrhoids returning or even developing in the first place.

Creams, ointments and suppositories are available from pharmacies without a prescription. Ask your pharmacist which products are best for you. If these products don’t help, see your GP.

There are various treatment options for more severe haemorrhoids.

One of these options is banding, a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off after about a week.

Surgery carried out under general anaesthetic, where you’re unconscious, is sometimes used to remove or shrink large or external haemorrhoids.