Haemorrhoids

What are haemorrhoids (piles)?

Haemorrhoids (or hemorrhoids)- commonly known as piles - occur when the walls that line the anal canal become inflamed. These are vascular structures and rich in blood vessels that can become easily irritated, presenting with very specific symptoms. Haemorrhoids tend to occur internally, although inflamed sections can push their way out of the anal opening, making the condition very painful. External haemorrhoids, on the other hand, are blood clots that form around the edge of the opening, and are rare in comparison.

Often, haemorrhoids can go away on their own, however if you experience symptoms lasting beyond 7 days it is recommended to seek treatment. If you're prone to haemorrhoids, it is also advised to have a stock of medication, in case of an outbreak.

What are the different types of haemorrhoids?

Internal haemorrhoids

Most people with haemorrhoids suffer from the internal form; these are swellings that occur 2-4cm above the anal opening, but can prolapse. Haemorrhoids are classified into first, second, third and fourth degrees.

These swollen blood vessels usually rest inside the anal cavity, they therefore cannot be seen or felt. Due to there being fewer pain-sensing nerves in the rectum, bleeding may be the first indication of haemorrhoids. However, there are times where an internal haemorrhoid prolapses and appears outside the anal sphincter. They can be described as moist skin tags that present with a pinker appearance compared to the surrounding skin.

Prolapsed haemorrhoids are usually more irritable and may be considerably more painful when passing stool, or if they make contact with clothing. With time they generally retract into the anal passage, however if they do not return naturally they can either be pushed in gently or surgically removed. There are four grades of internal haemorrhoids, these include:

First-degree haemorrhoids are swellings of the internal lining that are not visible. Second-degree swellings are larger and may drop from the anus when passing stools, only to return. Third-degree haemorrhoids are small lumps that hang from the anal opening, but can be pushed back in again after passing stools. Those classed as fourth-degree are large external lumps that cannot be pushed back in.

External haemorrhoids

Perianal haematoma (external haemorrhoids) is a rare occurrence. This is when the ridge of the anus becomes inflamed as a result of blood clots beneath the surface of the skin. Although these may sometimes get confused with prolapsed internal haemorrhoids, external haemorrhoids in fact are formed just outside the anal sphincter. Due to the heightened sensory glands present in this type of piles, they are more likely to be irritated and painful.

What causes haemorrhoids (piles)?

While the exact cause of haemorrhoids (piles) isn't clear, according to the NHS, most cases are thought to be linked to increased pressure in blood vessels located in and around the anus. This pressure causes the blood vessels to become inflamed and swollen. Other factors that can increase the risk of getting haemorrhoids include:

Piles and constipation

Piles can be the result of a number of different factors, but it's most commonly associated with constipation. This is because constipated bowels can place additional pressure on the vascular structures that line the rectum, causing them to swell when you strain during a bowel movement.

If you have developed piles before, you can be more susceptible due to recurring risk factors and/or simply being genetically predisposed.

Is it true that sitting on cold surfaces gives you piles?

No, this is a common myth. Piles are the result of pressure and strain placed on blood vessels that line the back passage. This can cause them to stretch and swell so that they become irritated.

What are the symptoms of haemorrhoids?

Many times people aren't even aware that they have piles, due to the lack of obvious symptoms. If symptoms are experienced, they may include bright red blood after visiting the bathroom, piles that descend and need to be pushed back afterwards, discharge of mucus, anal itching, and a sore and inflamed anus. You may also have the feeling that you still need to pass a stool even after the bowels have been emptied.

These symptoms can also be caused by other colorectal problems such as anal cancer, bowel disease or bowel cancer, which is why it is important that you visit your GP if any of these symptoms occur.

How are haemorrhoids treated?

Treatment for haemorrhoids will depend on the severity and the persistence of the symptoms.

Prescription medication

If diet and exercise don't relieve symptoms, and your haemorrhoids aren't severe, you may need a prescription for over-the-counter treatments designed to reduce inflammation. These types of treatments can either be suppositories, ointments, gels or sprays. The prescription options include:

• Anusol HC
• Proctosedyl
• Scheriproct
• Uniroid-HC
• Xyloproct
• Betnovate

As effective as these medications are, to get the most out of your treatment, it's advised that you use one of these treatments whilst adopting an appropriate diet.

Dieting

Normally swelling will go down on its own, or can be encouraged through manipulating your diet. This could be increasing fibre and fluid intake- avoiding caffeine can also help. A doctor is likely to recommend these changes first, alongside exercise and laxatives, before moving on to more intensive treatment.

Surgical measures

If diet and treatment do little to improve your situation, other more hands-on measures can be explored. This is uncommon and is generally associated with third-degree swellings. The majority of these do not require any invasive surgical intervention, however minor procedures may include:

• Banding- this process involves the haemorrhoid being tied off at its base. This prevents blood flow thereby causing shrinkage. This usually works for internal haemorrhoids.
• Injections (sclerotherapy) - an oily, chemical solution is injected into the haemorrhoids, this numbs the area alleviating any pain. The haemorrhoid tissue is also hardened and should deteriorate with weeks.
• Infrared coagulation- this procedure treats small or medium-sized haemorrhoids and utilises a device that cuts off the blood supply with an intense infra-red beam.

These methods are only necessary in severe cases, and often, third-degree swellings can shrink without the use of these methods.

How can haemorrhoids (piles) be prevented?

Haemorrhoids can't always be prevented, but avoiding constipation and ensuring stools are soft and regular can significantly minimise the risk. You can do this by employing the following steps:

• Consuming a diet that is rich in fibre
• Drinking plenty of fluids (preferably water)
• Minimise caffeine and alcohol consumption
• Staying physically active can also ensure that your bowels remain healthy
• If you are currently overweight, you may also want to consider losing weight, as this can also be helpful

Reducing the amount of straining when passing stool can also aid in preventing inflammation of the anal walls.

What treatment options do we offer?

If you are experiencing uncomfortable symptoms associated with haemorrhoids, medications are available to relieve them. HealthExpress treatments consist of ointments and creams, all of which are approved by UK-qualified doctors. Treatments such as Anusol HC, Betnovate and Proctosedyl are clinically proven to aid swelling and speed up the healing process significantly. Ordering is simple and can be done by completing our discreet online consultation, at which point our doctors can decide if the treatment is right for you.