Haemorrhoids

Haemorrhoids are swollen and enlarged blood vessels in the anal passage. They are very common - it's thought 50% of the population have piles. Over 300,000 cases are treated in Australia each year and they are the most common anal problem treated by doctors. Often piles are nothing to worry about, but they can become painful if not dealt with.

The risk of developing haemorrhoids is raised if you suffer from constipation. Other risks include:

• Being 50 years or over
• Being pregnant
• Being overweight

There are two different types of pile - these are internal and external classifications.

Internal haemorrhoids

Internal haemorrhoids are usually located just inside the anus. They are liable to prolapse, which means they protrude from the anal opening. Generally you won't feel internal piles as there are few nerves in that area. They can be classed in four ways depending on their severity:

• First degree which are small lumps on the inside lining of the anus. They aren't visible.
• Second degree which are lumps that may protrude from your anus after passing a stool.
• Third degree which are small soft lumps that hang down from the anal opening but can be pushed inside.
• Fourth degree which are large lumps hanging from the anal opening but can't be pushed inside.

External haemorrhoids

External haemorrhoids are rare. This happens when the anus becomes inflamed due to blood clots underneath the surface. These should not be confused with prolapsed internal piles. This type is often painful and usually requires surgery.

Haemorrhoids often produce bright red blood on the toilet paper after you have opened your bowels. Protruding haemorrhoids may itch or hurt, and sometimes you may feel a lump protruding from the anal opening.

Other symptoms include:

• Itching and stinging
• Soreness and inflammation
• Mucus in the bowel movement

Piles don't usually hurt unless one has been trapped outside the anal opening and the blood supply is reduced. Gently pushing the lump back into the anus can help.

The symptoms of piles are also caused by more serious problems such as bowel cancer or bowel disease. Often blood produced by bowel cancers is a deep dark red, but this is not always the case. If you have these symptoms over a period of time you should see your doctor for further tests.

Haemorrhoids are most likely caused by pressure on blood vessels in the anus. This pressure creates swelling and inflammation in the veins.

There are several lifestyle factors associated with piles. The most common is constipation. When constipated, pushing to open your bowels creates pressure inside the rectum. This causes the swelling that creates haemorrhoids.

Other factors that can increase the risk are:

• Pregnancy
• Medications
• Being overweight
• Sitting down a lot / inactivity
• Age
• Diarrhoea
• Lifting heavy objects
• Hereditary traits

You should always see your doctor if you have severe symptoms of haemorrhoids.

Haemorrhoids are diagnosed when a doctor checks your anus for swollen blood vessels. It is a very common complaint, so there is no need for embarrassment or worry about approaching your doctor. You can easily begin the conversation by saying that you think you have haemorrhoids. Your doctor can continue the consultation from that point.

You will also be asked about your lifestyle and any other symptoms you might have such as weight loss or whether your bowel movements have changed.

In some cases patients are referred to a clinic that will check the whole length of the large intestine via a proctoscope. This is a thin tube with a torch and camera attached that's inserted into the anus to check for irregularities.

Often haemorrhoids clear up by themselves after a few days with lifestyle changes, but if not, there are many effective treatments for haemorrhoids.

Lifestyle changes you can make:

• Increase your fibre and water intake to avoid constipation as that makes piles worse. Fluid and fibre will soften stools so that they don't irritate piles or cause you to strain when having a bowel motion.
• Try to eat more wholemeal foods such as brown bread, fruit, vegetables, and cereals. Avoiding caffeine and alcohol can help too.
• Moving around more can help with constipation. Spending a lot of time sitting down causes piles, and by moving you create better cardiovascular health. Try to walk in your lunch break and get up for a break every hour if you work at a desk.
• A combination of diet and exercise will help you shed weight which is another cause of haemorrhoids.
• Manage your bowel movements by avoiding straining, don't spend a lot of time sitting on the toilet, pat yourself clean and use wipes instead of dry toilet paper. It will help if you don't delay opening your bowels, no matter how nervous you are.
• If you take medications that cause constipation like painkillers, speak to your doctor about changing to another type without the side effects.
• Pregnant women often experience haemorrhoids due to the baby's weight pressing on blood vessels. These piles often disappear after giving birth, though they may be made temporarily worse during the process. Try to move around as much as possible, eat plenty of fruit and vegetables, and take gentle exercise.

Over-the-counter preparations

If lifestyle changes don't help piles you can try an over-the-counter medication. These help by soothing piles and reducing inflammation. Over the counter medications are available as creams, sprays, ointments, and suppositories. You can often find them in supermarkets and online too.

Prescription Medications

If lifestyle changes and over-the-counter medications don't help your doctor can prescribe a steroid cream to reduce any swelling. These shouldn't be used indefinitely as they can thin the skin and this can lead to further complications with piles; however, they can break the cycle of pain and swelling so that lifestyle changes can take effect.

Surgery for haemorrhoids

Surgery for piles is rare and only carried out if other methods have not worked and piles are painful. There are a few techniques. A surgeon will decide on the best way forward depending on the severity of your haemorrhoids.

• Banding- Haemorrhoids are tied at the base to prevent blood flow. Haemorrhoids will fall off after a short period of time.
• Injections - A chemical injection hardens the haemorrhoid that will shrivel and disappear.
• Electrotherapy - An electric current is placed at the haemorrhoid base. This thickens the blood supply and causes the haemorrhoid to fall off after a few weeks.
• Infrared coagulation- An infra-red beam cuts off blood supply to the haemorrhoid. It will fall off after a few weeks.

If these outpatient techniques are not suitable you may need more invasive surgery.

• Haemorrhoidectomy – This in an operation carried out under general anaesthetic. During this procedure haemorrhoids are cut out and you will need a week to recover.
• Haemorrhoidal artery ligation– This is an operation to reduce haemorrhoid blood flow. It's done under general anaesthetic with an ultrasound probe. Blood vessels are located and stitched to block the blood supply.
• Stapling can be used to treat prolapsed haemorrhoids under general anaesthetic. It's less common than the other techniques due to an increase in risks.

Other options include freezing and laser treatments, but these are less commonly used.

If you have haemorrhoids, or you are not sure but have bleeding with or without pain, try making some lifestyle changes and using an over-the-counter preparation to ease any discomfort. If the symptoms continue, you are worried at any point, or they are accompanied by a sudden loss of weight or change in stool habit, see your doctor for a check up. Rectal problems are common so you should not feel worried about approaching your doctor.