Haemorrhoids (piles) occur when the veins inside and around the anus become inflamed and swollen, which can happen when you strain to pass faeces. Constipation and straining can contribute to haemorrhoids forming as increased pressure is put on your veins. Veins are located inside your anus, but they can protrude and create external haemorrhoids.

Who do they affect?

Haemorrhoids can affect both men and women and occur at any age. They are extremely common, with at least 50 per cent of the population ⁽¹⁾ experiencing them, and are not a serious medical condition, although they can be painful.

People more likely to suffer from haemorrhoids include the elderly and pregnant women. They are very common in pregnancy because of the extra pressure from the baby pushing down on the bowels. Haemorrhoids can result from straining hard to push out your faeces or from lifting heavy weights.

There are two types of haemorrhoids:

Internal haemorrhoids - these occur inside your anus and are not as painful as external haemorrhoids. The size of internal haemorrhoids is classified by a grading system of one to four ⁽²⁾.

External haemorrhoids - these occur outside your anus and are known as perianal haematoma. You will feel a small lump which will require immediate treatment.

What are the symptoms?

Some people may not realise they have haemorrhoids as they may not experience any symptoms, but noticeable symptoms include:

• Itchiness and discomfort around your anus
• A hard lump around your anus
• Excessive straining when passing a stool
• Bleeding from the back passage after you have passed a stool
• A mucus discharge after passing a stool
• Pain when passing a stool
• Feeling of needing to empty your bowels, even when they are empty

What are the causes?

Several factors can increase the chances of suffering from haemorrhoids including:

• Being overweight ⁽³⁾
• Lack of fibre in your diet which causes constipation ⁽⁴⁾
• Lifting heavy objects on a regular basis which strains your body
• Getting older ⁽⁵⁾
• Pregnancy, which puts increased abdominal pressure on your pelvic blood vessels

How are haemorrhoids diagnosed?

Your GP will examine your anus to check for swollen blood vessels and may ask whether your stools contain blood, whether mucus is present in your stools and enquire about your bowel movements.

For internal haemorrhoids a digital rectal examination may be performed. A small tissue sample may be taken from inside your rectum with an anoscope. This is a hollow tube with a light that allows your GP to look inside your anal canal.

Your GP may also check for other conditions which may have similar symptoms, such as colitis, inflammatory bowel disease and colorectal cancer (bowel cancer).

How are haemorrhoids treated?

The treatment of your haemorrhoids depends on the severity of your symptoms.

Some haemorrhoids may not require treatment and may disappear on their own. If symptoms persist, first take steps to avoid aggravating factors, such as constipation or being overweight.

Over-the-counter creams can treat minor haemorrhoids. They contain anaesthetic and can sooth painful symptoms, allowing you to make bowel movements more easily. Using a cold compress or ice pack is a good way to ease pain and reduce swelling around your anus.

Other procedures to alleviate haemorrhoids include ligation, when a small rubber band is placed at the base of the haemorrhoid with an applicator. This cuts off the blood supply, so the haemorrhoid decreases in size.

Sclerotherapy is the injection of a substance to shrink the blood vessels in your anus.

If you experience regular bleeding, or pass blood clots, you may need surgical removal of the piles, or haemorrhoidectomy.

How can haemorrhoids be prevented?

Although they cannot always be prevented, you can reduce your chances of getting haemorrhoids by changing your diet and lifestyle in the following ways:

• Drink plenty of water - at least eight glasses of water a day - to soften your stools, so you do not have to strain
• Eat more fibre, as it can help to encourage regular bowel movements. Good sources of fibre include fruit, vegetables and wholegrain foods
• Exercise regularly - this can reduce the amount of pressure on your blood vessels and also help with weight loss. Being overweight increases your risk of getting haemorrhoids

Infolinks:

• NHS Choices

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