Overview
Haemorrhoids (piles) are swollen and enlarged veins inside the anal canal (internal) or around the outside of the anus (external). They are extremely common and usually cause itching, discomfort, and sometimes bleeding during or after a bowel movement. Most haemorrhoids can be managed conservatively.
How common is it?
About 1 in 2 people will experience significant haemorrhoids at some point in their lives. They are more common in people over 50 and during pregnancy.
Causes and risk factors
Increased pressure in the lower rectum and anus causes the venous cushions lining the anal canal to swell. Straining at stool is the most common cause.
Common risk factors
- Chronic constipation and straining
- Prolonged sitting on the toilet
- Low dietary fibre intake
- Pregnancy
- Obesity
- Chronic diarrhoea
- Ageing (supporting tissue weakens)
Symptoms
- Bright red blood on toilet paper or in the toilet bowl after defecation
- Itching and irritation around the anus
- Pain or discomfort, particularly during bowel movements
- Swelling around the anus
- A lump near the anus
- Feeling that bowels have not fully emptied
When to see a doctor
See a doctor for any rectal bleeding, especially if you are over 40, have unexplained weight loss, or if the blood is mixed into the stool rather than on the surface. Bleeding must not be assumed to be haemorrhoids without clinical assessment.
Diagnosis
Proctoscopy (a short rigid scope) visualises internal haemorrhoids. Digital rectal examination excludes other causes. Colonoscopy is recommended if there is any doubt about the cause of rectal bleeding.
Treatments
Conservative measures and dietary change
High fibre diet, adequate fluids, and not straining. Topical creams (e.g. Anusol, Preparation H) reduce symptoms. Sitz baths (warm water soaks) relieve discomfort.
Banding (rubber band ligation)
A small rubber band is placed around the base of an internal haemorrhoid, cutting off its blood supply. It then falls off within 1 to 2 weeks. Highly effective outpatient procedure.
Surgical haemorrhoidectomy
Surgical removal under anaesthetic for prolapsed or large haemorrhoids not responding to other treatments. Effective but more painful recovery than banding.
Self-care and lifestyle
- Eat at least 25 to 30g of fibre daily from wholegrains, fruits, and vegetables
- Drink 6 to 8 glasses of water daily
- Do not strain on the toilet and do not spend excessive time sitting on it
- Exercise regularly to improve bowel regularity
Prevention
Preventing constipation with a high-fibre diet and adequate fluids, avoiding prolonged straining, and not ignoring the urge to defecate are the main preventive measures.