Haemorrhoids, also known as “piles”, are swollen veins located in the lower part of the rectum and anus. They can occur in both men and women of all ages, but are more common in people over the age of 50.¹

Haemorrhoids are more common in chronically constipated patients who sit for prolonged periods on the toilet whilst passing stools, or in those who strain excessively during bowel movements. Any condition which causes an increase in abdominal pressure, such as pregnancy, liver disease, obesity and intra-abdominal or pelvic tumours also increase the risk of developing symptomatic haemorrhoids. A sedentary or inactive lifestyle which contributes to constipation, is also a risk factor.

Some patients may have a genetic predisposition to developing piles

These factors result in an increase in the pressure within the veins of the anal canal causing them to swell. These swollen veins can then cause discomfort, pain, itching and bleeding.

Types of Haemorrhoids

There are two main types of haemorrhoids: internal and external.

Internal haemorrhoids are located inside the rectum and anal canal and are generally not visible. However with straining or bearing down, these haemorrhoids can be pushed outward.  Internal haemorrhoids are generally less painful than external haemorrhoids, but are a common cause of painless, bright red bleeding from the anus.

External piles are located just outside the anus and are visible and palpable. These external haemorrhoids can become very sensitive and painful if blood within the distended veins clots, forming a thrombosed haemorrhoid.

The symptoms of haemorrhoids can vary from asymptomatic to anal pain and bleeding.

Some common symptoms of haemorrhoids include:

• Pain or discomfort in the anus
• Bleeding from the anus, usually during or after passing a stool.
• Itching or irritation in the anus
• Swelling or lumps around the anus, which can be sensitive or painful to touch.
• A feeling of fullness in rectum or anal canal.
• Leakage of faeces⁴

To diagnose haemorrhoids, an examination of the anus and rectum is needed. This may include a digital examination (inserting a gloved finger into the rectum.) Bleeding from the anus should always include an examination which allows visualisation of the anal canal and rectum. Your doctor may perform an anoscopy or refer you for a sigmoidoscopy or colonoscopy to further investigate and most importantly to exclude other more sinister causes of bleeding.

Initial treatment of haemmorrhoids should include the following:

1. Preventing and treating constipation (increasing exercise, increasing water intake, increasing dietary fibre and taking laxatives.)
2. Relieving pain with pain killers, being careful to avoid medication which could cause constipation.
3. Soaking the anal area in a bath of warm water (so-called “warm sitz baths”) for approximately 10 to 15 min which helps to reduce inflammation and to relax muscles.
4. Using topical remedies (creams) to reduce pain and inflammation.

If haemorrhoids do not respond to these therapies, minimally invasive techniques can be used. These include:

• Rubber band ligation: a small rubber band is placed around the base of the haemorrhoid to cut off its blood supply, causing it to shrink and fall off.
• Sclerotherapy: a chemical is injected into the haemorrhoid to shrink it.
• Laser, Infrared or bipolar coagulation: a laser, infrared light or heat source is used to shrink the pile.¹

In rare cases, surgery may be necessary to remove the haemorrhoids.²

There are several steps you can take to prevent haemorrhoids or reduce your risk of developing them. These include:

• Eating a high-fibre diet: This can help to prevent constipation and reduce the pressure on the veins in the anus and rectum.
• Drinking plenty of water: This can help to soften stools and make them easier to pass.
• Exercising regularly: This can help to improve bowel function and reduce the risk of constipation.
• Avoiding prolonged sitting: Sitting for long periods of time can put pressure on the veins in the anus and rectum, increasing the risk of haemorrhoids.
• Using the bathroom when you need to: Holding in bowel movements can lead to constipation and increase the risk of haemorrhoids.⁵³