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Piles (haemorrhoids)

Key points

  • Piles is a condition in which the veins in or around your anal canal become swollen.
  • The condition can develop at any age but is more common as you get older and during pregnancy.
  • Symptoms include rectal bleeding and pain, swelling and itching around your anus.
  • Reduce your risk of piles by eating a diet that is high in fibre and drinking enough non-caffeinated, non-alcoholic fluid.

Piles, also known as haemorrhoids, are swollen and inflamed veins around your anus or in your anal canal.

About piles

Piles are round swellings on the inside of or just outside your anal canal. The anal canal is the short, muscular tube that connects your rectum (back passage) with your anus. Piles develop in areas known as the haemorrhoidal cushions, which can become swollen, often as a result of straining when you go to the toilet.

You can get piles at any age, but they are most common in people aged between 45 and 65. It’s difficult to know exactly how many people get piles, but in the UK the condition is thought to affect between four and 25 people in every 100. Piles aren’t cancerous and you can’t catch them from someone else.

Piles are common during pregnancy. They develop as a result of changes in the hormones (chemicals) in your body and the increased pressure in your abdomen (tummy. They usually get better once your baby is born.

Types of piles

Internal piles develop inside your anal canal, but they can hang down outside your anus. Internal piles can be graded according to how far they protrude, if at all, from your anus.

  • First degree piles are swellings on the inside lining of your anal canal. They may bleed but can't be seen from outside your anus.
  • Second degree piles are larger than first degree piles. They come out of your anus when you have a bowel movement, but go back inside on their own afterwards.
  • Third degree piles hang down from your anus and only go back inside when you push them in.
  • Fourth degree piles permanently hang down from your anus and you can't push them back in. They may become very swollen and painful if the blood inside them clots.

Illustration showing different grades of piles

External piles are swellings that develop further down your anal canal, closer to your anus. They can be more painful than internal types of piles.

Symptoms of piles

Common symptoms of piles include:

  • bleeding from your anus – you may only see this as bright, red blood on toilet paper
  • a lump in or around your anus
  • a slimy discharge of mucus
  • a feeling that your bowels haven't emptied completely
  • itchy skin around your anus
  • swelling around your anus
  • pain and discomfort after a bowel movement (if you have external piles)

These symptoms may be caused by problems other than piles. If you have any of these symptoms, see your GP for advice.

Causes of piles

Piles develop when the veins in your anal canal become swollen. This can happen for a number of reasons, including:

  • increased pressure in your abdomen, for example as a result of pregnancy
  • straining to empty your bowels, for example if you have constipation
  • ageing – as you get older you may be more likely to get piles because the support structures in your rectum weaken
  • not eating enough fibre
  • frequently lifting heavy objects
  • having a weakness in your rectum
  • having a family history of piles

It isn’t true that you can get piles by sitting on cold, hard surfaces.

Diagnosis of piles

Your GP will ask about your symptoms and examine you. He or she is likely to examine your rectum by gently inserting a gloved finger into your anus. Your GP may also use a proctoscope to look inside your rectum. A proctoscope is a short, narrow, tube-like instrument with a light source. Air can be blown through the tube to open up your bowel so it can be seen more clearly. This test should not be painful but it may be uncomfortable and make you feel as though you want to have a bowel movement.

Depending on the results of these tests, your GP may refer you to hospital to have a flexible sigmoidoscopy or colonoscopy to examine your large bowel. This can help to rule out other conditions.

Treatment of piles

Piles are often mild and get better with simple lifestyle changes. There are a number of things that you can do to help to relieve the symptoms.

Self-help

Diet and lifestyle changes can often help to relieve your symptoms. For example, eating a high-fibre diet will make your stools softer and easier to pass. This is important for reducing the increased pressure on the veins in your anus caused by straining when you have a bowel movement. Drink enough fluids to keep hydrated and don’t have too much caffeine.

Try not to strain when you’re passing a bowel movement and gently clean around your anus with baby wipes afterwards. Regular warm baths may relieve any irritation and help to keep your anal area clean. See our frequently asked questions for more information.

Medicines

If you still have symptoms after about seven to 10 days despite using self-help measures, you may wish to consider taking a medicine or seeing your GP for advice.

There are a range of medicines that can help relieve the symptoms of piles.

  • If you're passing hard or infrequent faeces, a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxatives such as lactulose, will soften your faeces. Don't use laxatives that stimulate your bowel, such as senna, unless your GP advises you to.
  • Over-the-counter painkillers, such as paracetamol or ibuprofen, may help to ease any pain you have.
  • Soothing creams, ointments and suppositories may ease any pain and itchiness. There are many different products available over the counter. Some contain a local anaesthetic such as lidocaine.
  • Products containing corticosteroids, such as Anugesic-HC and Proctosedyl, may reduce inflammation and pain. Don’t use these for more than a week as they can damage the skin around your anus. These are generally only available on prescription.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice. See our frequently asked questions for more information.

It’s important to be aware that it can take several weeks for some of these medicines to have an effect. If after this time your symptoms haven’t improved and are troublesome, or your haemorrhoids are severe, your GP may refer you to see a specialist for treatment.

Non-surgical treatments

There are certain treatments that you will need to go into hospital for, but you won't have to stay overnight. These include the following.

  • Banding. This involves placing a small elastic band around the pile, which cuts off the blood supply and causes it to die and fall off after a few days. The area left behind will heal up naturally.
  • Sclerotherapy. This involves having your piles injected with an oily solution, which makes them shrivel up.
  • Infra red coagulation or laser treatment. This uses infra red light to seal the veins above the pile, which causes it to shrink.
  • Bipolar diathermy and direct current electrotherapy treatment. This uses an electrical current to burn off the pile.

Surgery

Surgical treatments for piles are an option if you have severe piles and other treatments haven't worked. There are different types of surgery, including haemorrhoidectomy or stapled haemorrhoidopexy. The type that is recommended for you will depend on the size and number of piles you have.

Prevention of piles

If you have daily bowel movements that are solid but soft and you don't need to strain, faeces will pass easily and won't put pressure on the veins in your anal area. This can help to prevent piles.

The following lifestyle measures can help to keep your bowel movements soft and prevent constipation, and therefore piles.

  • Eat plenty of fibre-rich foods such as fruit, vegetables, bran and wholegrain cereals (for example, brown rice, wholemeal bread and wholemeal pasta). Aim to eat 25 to 30g of fibre a day – as a guide, a slice of wholemeal bread contains 2 to 3g and a medium-sized apple has about 3.5g.
  • Drink plenty of fluids (about six to eight glasses a day of non-caffeinated, non-alcoholic drinks).

 

Reviewed by Polly Kerr, Bupa Health Information Team, June 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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