Haemorrhoids

What are haemorrhoids?

Haemorrhoids, commonly known as piles, are swellings that develop from three pads or cushions of tissue that line the anal canal or back passage. They are incredibly common - at least 50 per cent of people have them at some time.

Causes of haemorrhoids

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.

Haemorrhoids tend to be caused by factors that cause the blood vessels to swell. These include anything that increases pressure inside the abdomen, such as constipation, pregnancy and being overweight. Some people describe them as varicose veins of the anus.

Symptoms of haemorrhoids

Haemorrhoids 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, including

• A swelling protruding from the anus. Haemorrhoids 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 (when a clot forms in the blood vessel, blocking it). They may only appear after straining on the toilet.
• Bleeding from the back passage. The mucosa or membrane that covers the haemorrhoids is quite delicate and if it's damaged there may be bleeding. This is usually seen as small amounts of bright red blood on the toilet paper or surface of the motions. Occasionally, they cause severe bleeding.
• Mucus discharge.
• Itching of the skin around the back passage.

Haemorrhoid treatments

The treatment of haemorrhoids 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 containing codeine

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

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

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

One operation that helps some people involves gently stretches 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 haemorrhoids, is necessary when clots repeatedly form, ligation fails to work or there's persistent bleeding. Haemorrhoidectomy is usually done under general anaesthetic in hospital. There's a small risk of anal stricture (a scarred narrowing of the anal canal) and injury to the sphincter.