Haemorrhoids or piles are enlarged veins around the anus and in the lower rectum. Haemorrhoids can either be internal or external. Internal haemorrhoids develop inside the rectum, and external haemorrhoids develop outside of the anus.

Causes and risk factors for haemorrhoids

When there is too much pressure on the veins around the anus, the veins become wider and engorged with more blood than usual. The swollen veins and underlying tissue may then develop into piles. Factors that cause haemorrhoids to develop include:

• Straining during bowel movements.
• Spending a lot of time sitting on the toilet.
• Chronic constipation or diarrhoea.
• Being overweight.
• Eating a low-fibre diet.
• Being pregnant.
• Being over the age of 50.
• Hereditary factors.
• Consistently engaging in heavy lifting.
• Persistent chronic cough or anything that causes persistent strain on the body.

Symptoms of haemorrhoids

Symptoms of piles depend on the type, size and grade.

Internal Haemorrhoids

Internal haemorrhoids rarely cause symptoms and usually can’t be seen as they are inside the rectum. Irritation of the haemorrhoids and straining when passing stool can cause:

• Blood in the stool, toilet or on the tissue paper.
• Protruding swelling from the anus.

External Haemorrhoids

Symptoms of external haemorrhoids include:

• Itchy anus.
• Swelling around your anus.
• Pain in the anus, especially when sitting.
• Bleeding from the rectum.

Complications of haemorrhoids

Haemorrhoids or piles can cause discomfort and pain but rarely cause complications. Complications can include:

• Thrombosed Haemorrhoid. A blood clot (thrombus) can form within an external haemorrhoid. This thrombus causes severe pain, inflammation, and swelling.
• Prolapsed Haemorrhoid. Both external and internal haemorrhoids can prolapse. They bulge out of the anus and cannot be pushed back. They may bleed and cause pain.
• Strangulated Haemorrhoid. The blood supply to an internal haemorrhoid can be cut off. This is known as strangulation. It can lead to severe pain.
• Anaemia. Ongoing blood loss from haemorrhoids may lead to iron deficiency anaemia.
• Infection. Irritation and breaks in the skin may cause external haemorrhoids to become infected.
• Skin tags. Skin tags may form around the anus.

Diagnosis

Haemorrhoids are diagnosed based on a clinical history and physical examination. A visual examination of your anus may be enough to diagnose haemorrhoids. Your healthcare provider will confirm the diagnosis by performing a digital rectal examination. A gloved, lubricated finger is inserted into the rectum to check for abnormalities. Your doctor may request a colonoscopy to examine your entire colon.

Management and Treatment

Piles can often be treated at home, but you will have to see a doctor if you are bleeding, passing black stools or have any complications. You will also have to see a doctor if your symptoms are getting worse and there is no improvement after 7 days of home treatment.

Home remedies

• Topical treatments. Apply over-the-counter haemorrhoid creams, ointments or suppositories that contain hydrocortisone or lidocaine to the affected area.
• Pain relief. Take paracetamol or NSAIDs, such as ibuprofen to relieve pain. Avoid painkillers that contain codeine, as they cause constipation.
• Eat high-fibre foods. Increase your dietary intake of fibre and drink a lot of water to help soften your stools and prevent constipation.
• Warm sitz baths. Soak your anus regularly in warm water for 10 to 15 minutes two or three times a day.
• Practice good hygiene. Practice good hygiene by wiping your bottom properly when you visit the toilet. Avoid using dry or rough toilet paper. Wipe your bottom with tissue moistened with water after visiting the toilet. Wash your anus with warm water during a bath or shower every day.
• Cold Compress. Use a cold compress, such as an ice pack, on your anus to help relieve swelling and discomfort.
• Take laxatives to soften your stool if you are constipated.

Medical Treatment

Other medical treatments may be needed to treat piles depending on the grade and whether you have complications. Haemorrhoids can be treated with or without surgery. Non-surgical procedures include rubber band ligation, electrocoagulation and sclerotherapy. In rubber band ligation, a rubber band is placed around the haemorrhoid to cut off the blood supply. This causes the haemorrhoid to shrink. Surgical procedures to treat haemorrhoids include haemorrhoidectomy and haemorrhoid stapling.

Prevention

Preventing constipation will help prevent haemorrhoids. To prevent haemorrhoids:

• Do not push too hard during bowel movements, and don’t sit too long on the toilet.
• Do not delay bowel movements when you feel the urge to empty your bowels.
• Do not wipe your bottom too hard after a bowel movement.
• Drink a lot of water every day.
• Eat foods high in fibre, such as fruits, vegetables and whole grains.
• Exercise regularly to prevent constipation.

References:

Patient information. Piles. (https://patient.info/digestive-health/rectal-bleeding-blood-in-faeces/piles-haemorrhoids#do-i-need-to-see-a-doctor-about-piles).

Healthline. Causes of Hemorrhoids and Tips for Prevention. (https://www.healthline.com/health/hemorrhoids).

Cleveland Clinic. Hemorrhoids. (https://my.clevelandclinic.org/health/diseases/15120-hemorrhoids)

Mayo Clinic. Hemorrhoids. (https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-caus