Haemorrhoids (piles) Mate tero puta
Hemorrhoids (piles) are swollen blood vessels in or just outside your anal canal (where your poo comes out).
Causes of haemorrhoids (piles)
Sometimes the blood vessels in haemorrhoids fill with too much blood and become swollen lumps, causing symptoms. This is very common, occurring in up to 50% of the adult population at some time.
If they swell in the upper part of your anal passage (rectum), they are called internal haemorrhoids. These are often painless. Sometimes they can extend out past your anus, but they are still internal haemorrhoids. This can be painful if they will not go back in.
When the blood vessels under the skin around your anus (poo hole) swell up, they are called external haemorrhoids. These often project out of the anus, but not always. These can be painful because you have nerve fibres in this area.
Swollen haemorrhoids usually develop due to pressure in the anal region, but sometimes they happen for no apparent reason.
They can be caused by:
- constipation and straining on the toilet
- passing frequent or hard poos
- pregnancy – due to pressure from the baby and from the effect of hormones on your veins
- ageing
- hereditary factors that can run in families due to an inherited weakness in the tissues of the anal canal
- other causes, including heavy lifting and a persistent cough.
Symptoms of haemorrhoids (piles)
There are several possible symptoms.
Bleeding from your bum
It is usually bright red blood. You may notice it when you wipe, or it may be in the toilet.
Itching or irritation of your anal area
Especially if there is a mucus discharge from the haemorrhoids. Internal haemorrhoids can make you feel as if you have not completely emptied your bowels when you go to the toilet.
A lump in your anal area
This may come down after you do a poo and then go back up. If an internal haemorrhoid comes down and gets caught in your anus, it may become strangulated. This can be very painful as the blood supply to the haemorrhoid gets cut off. Sometimes it goes back up by itself, or you may need to push it back up.
An external haemorrhoid can form a blood clot in it, which can also be very painful. This is called a thrombosed external haemorrhoid.
You need to see your healthcare provider if you have any of these symptoms, as they can also be caused by more serious problems.
It is particularly important to report any bleeding from your bottom to have it checked and rule out more serious causes.
Diagnosing haemorrhoids (piles)
Your healthcare provider will ask you about your symptoms and then examine you. This involves:
- a visual inspection of your anal area
- inserting a lubricated gloved finger into your anal canal to feel for lumps and
- looking for bleeding.
Sometimes your healthcare provider may need to look inside your anal canal if they cannot see anything externally. They will use a small hollow plastic tube (proctoscope), which is inserted into your anus to view the anal passage.
If your healthcare provider does not find any haemorrhoids, they may refer you to a specialist for further investigation.
Treating haemorrhoids (piles)
There are surgical and non-surgical methods of treating haemorrhoids.
Your haemorrhoids could go away without surgery by trying these options:
- go to the toilet as soon as you get the urge. Delaying going can make your poo harder and more difficult to pass
- avoid straining or pushing when you do a poo
- clean yourself carefully after you do a poo. Do not rub or wipe too hard. You might find it is easier to use damp toilet paper or a fragrance-free baby wipe
- drink at least 8 cups of fluid daily
- eat plenty of fibre-rich foods such as wholegrains, vegetables, fruit, legumes, nuts and seeds. Along with plenty of fluid they will help to keep your poo soft
- keep physically active. Aim for at least 30 minutes of activity most days
- have a warm bath to ease itching and pain.
If these measures do not work, you may need to use a cream or ointment. You can use a simple soothing cream such as Anusol, which contains zinc. You can buy this over the counter at your pharmacy.
Your healthcare provider may prescribe something that helps reduce inflammation and pain in your anal area. This could be a cream that you can apply to the outside or insert into your anus with an applicator. It could also be a suppository that you insert into your anus. You may need to use these for up to 3 weeks.
If you have ongoing problems, your healthcare provider may refer you to a surgeon for further treatment.
Having surgery involves some risks, but these are usually outweighed by the benefits. Your surgeon will discuss the likely risks with you.
There are 3 options for surgical treatment.
Sclerotherapy
A substance is injected into the base of the haemorrhoid. This causes a reaction in the tissue and cuts off the blood supply to the haemorrhoid. This is a common way to treat internal haemorrhoids.
Banding
A rubber band is placed around the base of the haemorrhoid, causing the blood supply to be cut off. This causes it to shrivel and fall off. This is a common treatment for internal haemorrhoids that bleed or hang down outside the anus. It is usually done in the clinic without local anaesthetic.
Haemorrhoidectomy
The haemorrhoids are cut away, and the bleeding vein is sealed with a source of heat. This is carried out under a general anaesthetic (where you are put to sleep). It is an effective treatment, but it can be painful in the days following the operation. You go home the same day as your surgery.
Some surgeons prefer one procedure over another. You will need to talk to your surgeon to see which method they recommend for your situation.
Self care after a haemorrhoidectomy
After your surgery, you will feel some discomfort, so you will need to take regular pain relief. Having a regular warm salt bath will help soothe and cleanse the wound – especially after having a poo.
Other things to consider as you recover:
- drink at least 8 cups of fluid daily to reduce the chance of becoming constipated
- eat a well-balanced diet with plenty of fibre-rich foods to keep your poo soft
- avoid heavy lifting or exercise for at least a week
- avoid straining when you do a poo. If you are having plenty of fibre-rich foods and are still straining, talk to your healthcare provider or pharmacist. You may need a laxative.
It can take 6 to 8 weeks to heal completely after a haemorrhoidectomy. During this time, any swelling and pain in the area will go away.
Fibre and fluid for healthy bowels