Haemorrhoids (Piles) by Dr Trisha Macnair

Piles are swellings that develop from three pads or cushions of tissue that line the anal canal or back passage.

What are they?

The tissue of the anus is rich in blood vessels. If these become dilated and swollen, they may project into the anal canal or out of the back passage (a prolapse) to form visible swellings. Some people describe them as varicose veins of the anus.

Piles are incredibly common - at least 50 per cent of people suffer with them at some time.

Causes

Piles tend to be caused by factors that cause the blood vessels to swell, including anything that increases pressure inside the abdomen such as constipation, pregnancy and being overweight

Symptoms

Piles may cause no symptoms, especially if they're small, and many people don't realise they have them. However, they can also cause a range of problems:

• A swelling protruding from the anus. Piles may be felt as small soft lumps at the opening of the back passage, sometimes compared to a 'bunch of grapes'. They're usually soft and fleshy but may become hard if thrombosis occurs. The piles may only appear after straining on the toilet.
• Bleeding from the back passage. The mucosa that covers the piles is quite delicate and if it is damaged, for example as you open your bowels, there may be bleeding, which is usually seen as small amounts of bright red blood on the toilet paper or on the surface of the motions. Occasionally, piles cause severe bleeding.
• Mucus discharge.
• Itching. Piles can cause intense itching of the skin around the back passage.

Piles can be painful, but this is uncommon. Acute pain and the appearance of a hard lump protruding from the anus can signal thrombosis of the haemorrhoid.

Treatment

The treatment of piles depends on the severity of symptoms. Firstly, it's important to take steps to avoid aggravating factors such as constipation or being overweight. Keeping your bowel motions soft and regular will also help to avoid straining.

• Make sure you eat plenty of fibre to provide bulk in your diet by including lots of bread, vegetables, cereal and nuts.
• Consider fibre supplements.
• Avoid dehydration by drinking plenty of water and fruit juice.
• Keep to a regular bowel habit and go to the toilet when you feel the need to - don't try to hold it in.
• Get plenty of exercise - this helps keeps the bowels regular.
• Avoid causes of constipation, such as painkillers that contain codeine.

These measures may be all that's needed to allow small haemorrhoids to settle. More persistent piles may need specific treatments.

Pain-relieving creams and ointments, which may contain an anaesthetic, can help soothe the discomfort of piles and allow you to open your bowels more easily. If piles become thrombosed this can be acutely painful. Cold packs and strong pain relief may be needed.

Surgical options

Surgery may be necessary to treat persistent or very painful piles. Many different techniques are used including injecting the piles with a chemical to make them scar and shrink, putting a tight band around the pile until it scars and drops off (ligation), or freezing or cutting them off.

Another operation which is often done to help piles is to gently stretch the anus (while the person is under anaesthetic) as there may be overactivity of the internal anal sphincter (a muscly control valve).

Recent research has looked at injections of botulinum toxin or creams containing nitroglycerine ointment to relax the muscle sphincter.

Haemorrhoidectomy, or surgical removal of the piles, is necessary when clots repeatedly form, ligation fails to work or there is persistent bleeding. Haemorrhoidectomy is usually done under general anaesthetic in hospital. There is a small risk of anal stricture (a scarred narrowing of the anal canal) and injury to the sphincter.

Haemorrhoid facts

• Piles are common and usually painless
• There is no link between piles and bowel cancer, although your doctor may take the opportunity to check for bowel cancer while examining your piles
• One of the most effective ways to prevent piles is to avoid constipation

Advice and support

Core - the Digestive Disorders Foundation
Tel: 020 7486 0341
Website: www.corecharity.org.uk

From http://www.bbc.co.uk/health/conditions/haemorrhoids1.shtml