Haemorrhoids (piles) - Description, Causes, Symptoms, Treatment

Piles, haemorrhoids

Gastro-intestinal system

Piles, also known as haemorrhoids, are swollen veins in the area of the bottom or anus. They exist in two forms - external piles and, more commonly, internal piles.

External piles develop outside the anal passage in an area just below the anal sphincter (the band of muscle at the exit of the bowel that helps retain the faeces until ready to go to the toilet).

Internal piles develop inside the anal passage in the rectum, the lower part of the large bowel above the anal sphincter. In some cases, internal piles become so swollen that they protrude from the anus.

Piles are extremely common. Over half of the population will develop piles at some time during their lives. All age groups are affected, but piles tend to first appear in the mid-teens and become progressively more common as one gets older.

Constipation is the most common cause of piles. Straining when going to the toilet in an attempt to pass large hard stools damages the lining of the anal passage and increases the pressure in the blood vessels supplying the area. The blood vessels swell under the increased pressure, leading to piles.

Pregnancy, straining during childbirth, being overweight and lifting heavy objects can also cause an increase in pressure in the anal and rectal veins and produce piles.

External piles appear as small bluish lumps under the skin in the area around the anus. They often do not produce any symptoms, but if the blood inside the pile clots they can be very painful.

Internal piles are not visible unless they protrude from the anus. Some of the smaller protruding piles return spontaneously or can be pushed back into the anal passage, the larger protruding piles cannot. Symptoms include itching and pain around the anus, bleeding and discomfort while having a bowel movement, a discharge of mucus and a feeling of an incomplete bowel movement. Bowel motions may be streaked on their surface with bright red blood or blood will appear on toilet paper. Large piles can prevent the anal sphincter from closing properly and, as a result, faeces may escape to soil underwear. Escape of faeces may also lead to intense itching of the anal area.

If constipated, bulk laxatives containing ispaghula husk, faecal softeners containing docusate sodium, or osmotic laxatives such as lactulose or macrogols can be used to reduce straining when going to the toilet. This helps reduce damage to the anal passage and blood vessels, allowing piles to retract and prevent new piles from forming.

If piles are causing discomfort or irritation there are a number of products that will help. These include:

Astringents - An astringent is a chemical that shrinks body tissues and reduces bleeding. Astringent preparations for the treatment of piles include substances such as hamamelis, allantoin, zinc oxide and bismuth oxide.

Local anaesthetics - Local anaesthetics help ease pain and irritation. Preparations are available that include cinchocaine, lidocaine or pramocaine. Some local anaesthetic preparations cause sensitisation. If itching becomes more severe after using these preparations, their use should be stopped.

Topical steroids - Topical steroids help reduce pain and inflammation. They include hydrocortisone and prednisolone. Topical steroids may thin the skin and so they should not be used for long periods. They should not be used if the piles are infected, and are best avoided during pregnancy.

All of these products are available in a variety of formulations such as creams, ointments and suppositories which, in themselves, can help soothe the discomfort of piles. Some of the creams and ointments are supplied with a special applicator allowing them to be squeezed through the anal sphincter so they can be used to treat both internal and external piles. Suppositories are used for the treatment of internal piles.

Severe or recurrent piles may require more complicated treatments, such as:

• Haemorrhoidectomy - removal of the pile by surgery under a general anaesthetic
• Rubber band ligation - a band is placed around the base of the pile, cutting off its blood supply. The pile eventually withers and drops off in a few days
• Sclerotherapy - a substance called phenol is injected into the pile. The injections causes the vein to collapse, eventually causing the pile to drop off in a few days.

Do not be embarrassed to talk to your pharmacist about piles, they are a very common problem. Your pharmacist will need to ask you some questions about your symptoms, in particular, whether there is any blood mixed with your faeces, whether you have any abdominal pain, have lost weight or if your bowel habits have changed. Your pharmacist will also want to know how long you have had the symptoms and what treatments you have already tried. If your pharmacist is satisfied that you are not suffering from something more serious, he or she will recommend one of the products described above that is best suited to the symptoms you have described.

Seek medical advice if over the counter treatments prove ineffective, or if symptoms persist for more than 2 or 3 weeks. See your doctor if it becomes too uncomfortable to move the bowels satisfactorily, if rectal bleeding occurs or if there is any associated abdominal pain or vomiting.

Your doctor will examine you to determine whether you have external or internal piles. Depending on their severity your doctor may prescribe more powerful products than can be purchased from your pharmacy, or a decision may be made to send you to a specialist to have the piles removed.

As constipation is the main cause of piles, avoiding constipation by eating a high fibre diet rich in bran, wholemeal bread, fresh fruit and vegetables and drinking plenty of water is the best way of preventing piles from occurring, and reducing them if they are present. Taking regular exercise will also help maintain regular bowel movements, as well as helping by losing weight and developing muscle tone. Do not ignore the urge to go to the toilet and, when you do go, do not sit for long periods. Be gentle when wiping your bottom, if particularly sore use moist toilet wipes instead of toilet paper.

If you do have to take laxatives to ease constipation, do not take them for long periods as they eventually reduce the intestines' natural contractions. It is much better to achieve regular bowel movements by adding more fibre to the diet and drinking water frequently throughout the day.

Wash your bottom regularly, if possible after each bowel movement, in a bath or bidet. The use of warm water helps remove any traces of faeces left after wiping that can be a cause of irritation around the anal area, and helps ease discomfort.

Learn to lift weights correctly. Know your limitations and ask someone to help you lift heavy objects that are beyond your limits. Bend your knees, keep a straight back and contract your stomach muscles when lifting to avoid undue pressure on your anal and rectal areas.

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