Haemorrhoids (or piles) are cushions of swollen tissue in the anal canal that contain arteries and bulging, dilated veins. They are sometimes called ‘varicose veins of the anus’, They are very common in both men and women, affecting about half of those over the age of 45. Most don’t know they are there until they become large and cause problems. Pregnant women may also have them because the growing baby puts increased pressure on the rectal veins.
Doctors grade haemorrhoids which arise inside the back passage (internal haemorrhoids) according to whether or not they come down and appear outside it. Grade 1 stays inside. Grade 2 can be pushed out of the back passage when passing a motion but goes back on its own later. Grade 3 and 4 hang down outside the back passage and you can feel them as soft lumps. You can push grade 3 back in but grade 4 ones always stay outside (prolapsed). External haemorrhoids are small lumps that occur outside the back passage. These lumps can get hard and very tender for a few days if blood clots inside them (thrombosed haemorrhoids).
You may have no symptoms at all with small haemorrhoids. Bright red bleeding is a common problem. This may drip into the toilet after opening your bowels or appear on the toilet paper after wiping. You may also notice small lumps which appear outside the back passage after going to the toilet. They may go back on their own or you may be able to push them back up inside. If these lumps remain outside, the skin around the back passage may itch and irritate as they can produce a clear discharge.
To diagnose haemorrhoids the doctor will examine you and put a short hollow tube with a light attached into your back passage (proctoscope) which will enable him to see any haemorrhoids inside. A similar but longer tube (sigmoidoscope) may be used so that the doctor can see further up the bowel. These examinations may be uncomfortable but should not be painful.
The symptoms of haemorrhoids can often be relieved with simple measures (see below). If they are troublesome, the doctor can treat you in outpatients by:
Rubber band ligation – a rubber band is put over the base of the haemorrhoid. This cuts off its blood supply so that it drops off after a few days, and then the area heals with a small scar.
Sclerotherapy – a chemical is injected into the haemorrhoid which makes it shrivel.
An operation (haemorrhoidectomy) and short stay in hospital may be needed to remove prolapsed haemorrhoids which are painful or whose blood supply is cut off (strangulated haemorrhoids).
Outcomes and further sources of support
You can do a lot to reduce the symptoms of haemorrhoids, or to prevent them from coming back after medical or surgical treatment:
Keep your stools soft by eating fruit and vegetables, wholemeal foods and drinking at least 6 glasses of water a day. A regular fibre supplement (Fybogel) from chemists can help to bulk and soften stools.
Get good toileting habits by going as soon as you can when you get the urge. Avoid straining. Spend as little time in the toilet as it takes (don’t read in there!)
Ease symptoms of discomfort and itching with soothing creams or suppositories (Preparation H, Anusol) obtained from your local chemist, warm baths or cool compresses. Pat the area dry rather than rubbing it and if possible wear non restricting cotton underclothes.
The information on this page is reproduced from material put together by the Colorectal Development Unit at the Royal London Hospital, part of Barts Health NHS Trust.