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Haemorrhoids

What are haemorrhoids (piles)?

They are knobbly varicose veins of the rectal or anal area, which can prolapse outside the anus and hang as small grape-like lumps.

What are the different kinds of haemorrhoids?

Internal haemorrhoids are those that form inside the rectum near the beginning of the anus. They are generally not painful and often are only noticed when they bleed.

Prolapsed haemorrhoids are internal haemorrhoids that protrude through the anus when the stool is passed or when a person stands or walks. They are usually painful.

External haemorrhoids are small, painful haemorrhages under the skin around the anus. They form a hard clot after 24 hours. Their proper medical name is perianal haematoma. When they settle, they sometimes leave a small skin tag.

What causes haemorrhoids?

The commonest cause is constipation, mainly due to the excessive straining at toilet because of hard faeces. Some experts say that sitting on the toilet for long periods causes haemorrhoids, but this problem is related to constipation.

It is important to get into the habit of answering the 'call of nature'. The problem tends to run in families. Other associations are heavy manual work, sitting for long periods (such as bus driving) and pregnancy.

How common is the problem?

Haemorrhoids are common and tend to develop between the ages of 20 and 50. About 1 out of 4 Westerners suffer from them at some stage of life.

What are the symptoms?

Bleeding is the main and in many people the only symptom. The word haemorrhoid means 'flow of blood'. The blood is bright red and appears when you defecate. You may notice it as streaks on toilet paper or in the faeces.

Piles often cause a mucous discharge and itching around the anus. Any consequent scratching makes the irritation worse.

What are the risks?

Haemorrhoids are not dangerous, but continuous bleeding may result in anaemia. Any bleeding from the anus, especially in someone over the age of 40, should be reported to your doctor. Occasionally the bleeding attributed to haemorrhoids can come from cancer of the bowel.

What is the treatment?

• The best treatment is prevention, and softish bulky faeces that pass easily prevent haemorrhoids. Train yourself to have a diet with adequate fibre by eating plenty of fresh fruit, vegetables, whole-grain cereals or bran.
• Try to complete your bowel action within a few minutes and avoid using laxatives.
• If you have haemorrhoids, clean yourself thoroughly but gently after each bowel action (using soft toilet paper and soapy water) and dry yourself carefully.
• Special astringent ointments or suppositories (advised by your doctor) may relieve the congestion and shrink the haemorrhoids. Mild cases may clear up completely.
• If the problem persists, your doctor may advise injections or minor surgery. Occasionally surgery to remove the piles-call haemorrhoidectomy-may be the only answer.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia