Haemorrhoids, also known as piles, are swellings or enlarged blood vessels found inside or around the rectum and anus. In their normal state, haemorrhoids are vascular cushions that help with stool control. They become a disease when swollen or inflamed ; the unqualified term “hemorrhoid” is often used to refer to the disease.
Hemorrhoid cushions are important for continence . They contribute to 15–20% of anal closure pressure at rest and protect the internal and external anal sphincter muscles during the passage of stool. When a person bears down, the intra-abdominal pressure grows, and hemorrhoid cushions increase in size, helping maintain anal closure.
Two types of hemorrhoids occur: internal haemorrhoids, from the superior hemorrhoidal plexus and external haemorrhoids, from the inferior hemorrhoidal plexus. The
dentate line divides the two regions.
Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives. Males and females are both affected with about equal frequency. Hemorrhoids affect people most often between 45 and 65 years of age. It is more common among the wealthy.
Internal and external hemorrhoids may present differently; however, many people may have a combination of the two.
If not thrombosed , external hemorrhoids may cause few problems. However, when thrombosed, hemorrhoids may be very painful which typically resolves in two to three days. The swelling may, however, take a few weeks to disappear and a skin tag may remain after healing. If hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin, and thus itchiness around the anus.
Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following a bowel movement
(hematochezia), or on the toilet paper, or drips into the toilet bowl. The stool itself is usually normally coloured.
Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus,
itchiness , and fecal incontinence.
The exact cause of symptomatic hemorrhoids is unknown. A number of risk factors are believed to play a role, including
- Irregular bowel habits (constipation or diarrhea)
- lack of exercise
- nutritional factors (low-fiber diets),
- increased intra-abdominal pressure (prolonged straining, ascites , an intra-abdominal mass, or pregnancy )
- an absence of valves within the hemorrhoidal veins
- prolonged sitting
- a chronic cough
- pelvic floor dysfunction
- Squatting while defecating
A visual inspection should allow your physician to see if you have external haemorrhoids.
Tests and procedures to diagnose internal haemorrhoids may include:
- A digital rectal examination in which your doctor inserts a lubricated gloved finger into your rectum to feel for anything unusual, such as growths.
- A visual inspection of the inside of your anal canal and rectum using a viewing device such as an anoscope, proctoscope or sigmoidscope.
- A colonoscopy may be performed to do a more extensive examination of your entire bowel (colon) if your signs and symptoms suggest that you might have another digestive system disease, or if you have risk factors for colorectal cancer
You should consult your doctor if your haemorrhoids:
- bleed frequently or excessively
- do not respond to self-treatment
- if haemorrhoid symptoms have been accompanied by an obvious change in bowel habits
- if you are passing black or maroon-coloured stools
- blood clots have formed
- blood is mixed in with the stool
Most cases of haemorrhoids can be self-treated. More serious or repeat cases may require medication or a surgical procedure.
Home treatment is often all that is required to relieve mild symptoms. They include:
- Use of non-prescription haemorrhoid ointments, creams, suppositories, or pads containing a mild corticosteroid, e.g. hydrocortisone, or witch hazel extract.
- Soak the anal area in warm water for 10 to 15 minutes two or three times a day (Sitz bath).
- Use stool softeners, which help stools to be passed more easily
- Ensure that the anal area is kept clean by bathing or showering daily
- Use moist towelettes or wet toilet paper (that do not contain perfume or alcohol) rather than dry toilet paper, to help keep the anal area clean after passing a stool
- Applying ice packs or cold compresses on the affected area to relieve swelling
- Taking oral pain medication, such as paracetamol or ibuprofen, can help to relieve discomfort.
For persistent bleeding or painful haemorrhoids, the following non-surgical procedures to destroy the haemorrhoid can be performed in a doctor’s office:
- Rubber band ligation, which involves using a rubber band to cut off the blood supply to the haemorrhoid causing it to shrivel and die.
- Injection (sclerotherapy), which involves injecting a substance into the haemorrhoid to make it harden and shrink.
- Laser or infrared coagulation, which is a type of heat treatment that causes the haemorrhoid to harden and shrivel.
If non-surgical procedures are not successful or if the haemorrhoids are particularly large, one of the following surgical procedures may be necessary:
- Haemorrhoidectomy – removal of a haemorrhoid with a scalpel or laser.
- Haemorrhoid stapling – removal of a haemorrhoid with a special staple gun that also inserts a ring of staples to close the wound and prevent bleeding.
Making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended. These can include:
- Increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats.
- Drinking plenty of fluid, particularly water, but avoiding or cutting down on caffeine and alcohol.
- Not delaying going to the toilet. Ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet.
- Avoiding medication that causes constipation such as painkillers that contain codeine.
- Exercising regularly can help prevent constipation, reduce your blood pressure, and help you lose weight.