What are Haemorrhoids ("Piles")

Haemorrhoids are swollen but normally present blood vessels in and around the anus and lower rectum that stretch under pressure, similar to varicose veins in the legs.

The increased pressure and swelling may result from straining to move the bowel. Contributing factors include pregnancy, aging, and chronic constipation or diarrhoea.

Haemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

What are the symptoms of Haemorrhoids?

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as haemorrhoids.

Haemorrhoids usually are not dangerous or life threatening. In most cases, haemorrhoidal symptoms will go away within a few days.

Although many people have haemorrhoids, not all experience symptoms. The most common symptom of internal haemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal haemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding, or prolapsed, haemorrhoid.

Symptoms of external haemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms, This condition is known as a thrombosed external haemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Excessive production of mucus may also cause itching.

How Common are Haemorrhoids?

Haemorrhoids are very common in men and women. About half the population have haemorrhoids by age 50. Haemorrhoids are also common among pregnant women. The pressure of the foetus in the abdomen, as well as hormonal changes, cause the haemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, haemorrhoids caused by pregnancy are a temporary problem.

How are Haemorrhoids Diagnosed?

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding is often due to haemorrhoids but may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate haemorrhoids and will also perform a examination with a gloved, lubricated finger to feel for abnormalities.

A hollow, lighted tube, known as a proctoscope, is also often used to look for internal haemorrhoids and examine the lining of the rectum.

To rule out causes of gastrointestinal bleeding above the rectum, the doctor may examine the rectum and lower colon (sigmoid) with a rigid or flexible tube known as a sigmoidoscope. The entire colon can be examined with a flexible colonoscope, but this examination can only be done in a fully equipped hospital department after preparation to empty the bowel.

What is the Treatment?

Medical treatment of haemorrhoids initially is aimed at relieving symptoms. Measures to reduce symptoms include:

	Warm baths several times a day in plain water for about 10 minutes.
	Ice packs to help reduce swelling.
	Application of a haemorrhoidal cream or suppository to the affected area for a limited time

Prevention of a recurrence of haemorrhoids is aimed at changing conditions associated with the pressure and straining of constipation. Doctors will often recommend increasing fibre in the diet. Eating the right amount of fibre results in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on haemorrhoids caused by straining. Eliminating straining also helps prevent the haemorrhoids from protruding.

Good sources of fibre are fruits, vegetables and whole grains. In addition, doctors may suggest a bulk stool softener or a fibre supplement such as psyllium (ispaghula) or methylcellulose. Several brands containing these plant-based preparations are available.

In some cases, haemorrhoids must be treated surgically. These methods are used to shrink and destroy the haemorrhoidal tissue. The doctor can perform most of these procedures during a visit to the hospital surgical out-patient department.

A number of methods may be used to remove or reduce the size of internal haemorrhoids. These techniques include:

	Rubber band ligation	a rubber band is placed around the base of the haemorrhoid inside the rectum. The band cuts off circulation, and the haemorrhoid withers away within a few days.
	Sclerotherapy	a chemical solution is injected around the blood vessel to shrink the haemorrhoid.

Techniques used to treat both internal and external haemorrhoids include:

	Electrical or laser heat (laser coagulation) or infrared light (infrared photo coagulation)	both techniques use special devices to block the circulation of haemorrhoidal tissue.
	Haemorroidectomy	occasionally, extensive or severe internal or external haemorrhoids may require removal by surgery known as haemorrhoidectomy, a procedure performed under general anaesthetic in hospital.

How are Haemorrhoids Prevented?

The best way to prevent haemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs. Increased fibre in the diet helps reduce constipation and straining by producing stools that are softer and easier to pass. In addition, a person should not sit on the toilet for a long period of time.

The Digestive Disorders Foundation

The Digestive Disorders Foundation was founded in 1971 by leading gastroenterologists and exists to:

	Fund new research into digestive diseases
	Help sufferers with, for example, practical guidelines on controlling their symptoms
	Provide information to the public.

Will You Help Us?

Many digestive disorders are still not curable and thousands of people suffer from their effects every day. The only hope of alleviating this problem is through more research. As a charity, we rely entirely on the support of people like you. Every donation, large or small, can make a difference.

Please send your donation to:

The Digestive Disorders Foundation
FREEPOST LON 4268
London
NW1 0YT