Haemorrhoids (Piles)
Haemorrhoids are very common, and many people experience them at some point in their lives. Although they are rarely serious, they can cause bleeding, discomfort and itching that affect your day-to-day life. Professor Arulampalam assesses and treats patients with haemorrhoids in Colchester and central London, offering treatment that ranges from simple lifestyle measures to procedures where these are needed.
What are haemorrhoids?
Haemorrhoids, also known as piles, are swellings of the blood vessels and supporting tissue in and around the anal canal. Everyone has these cushions of tissue, which help with bowel control. They become a problem when they enlarge, bleed or slip down out of the anus.
Internal and external haemorrhoids and grading
Internal haemorrhoids develop inside the anal canal and are often painless, although they may bleed or prolapse. External haemorrhoids develop under the skin around the anus and can be uncomfortable, particularly if a blood clot forms within them, which is known as a thrombosed haemorrhoid.
Internal haemorrhoids are commonly graded according to how far they prolapse:
- Grade 1: they remain inside the anal canal and may bleed.
- Grade 2: they prolapse when you open your bowels and go back in on their own.
- Grade 3: they prolapse and need to be pushed back in.
- Grade 4: they remain outside the anus and cannot be pushed back in.
The grade helps to guide which treatments may be suitable for you.
Causes of haemorrhoids
Haemorrhoids develop when there is increased pressure on the blood vessels in the anal area. Factors that may contribute include:
- Constipation and straining when opening your bowels
- Long periods sitting on the toilet
- Persistent diarrhoea
- Pregnancy and childbirth
- Being overweight
- A diet low in fibre
- Heavy lifting
- Getting older, as the supporting tissues weaken with age
Symptoms of haemorrhoids
Some people have haemorrhoids without any symptoms. When symptoms do occur, they may include:
- Bright red blood on the toilet paper or in the toilet pan after opening your bowels
- A lump inside or around the anus
- Itching or irritation around the anus
- Discomfort or a feeling of fullness after opening your bowels
- Mucus discharge
- Pain, particularly if an external haemorrhoid becomes thrombosed
Bleeding from the back passage should always be assessed, as it can occasionally be caused by other bowel conditions.
Diagnosis of haemorrhoids
Your doctor will ask about your symptoms, bowel habit and general health, and then carry out an examination with your consent. This usually includes a rectal examination and a proctoscopy, in which a short, narrow instrument is used to view the inside of the anal canal. The examination is usually brief and should not be painful.
Depending on your age, your symptoms and your family history, your doctor may recommend further investigation, such as a flexible sigmoidoscopy or colonoscopy, to rule out other causes of bleeding.
Treatment of haemorrhoids
Treatment depends on the type and grade of your haemorrhoids and how much they affect you. Many people improve with simple measures, and procedures are considered when symptoms persist.
Lifestyle and dietary measures
Keeping your stools soft and avoiding straining can ease symptoms and may help to prevent haemorrhoids from returning. This may include increasing the fibre in your diet, drinking plenty of fluids, keeping active, not delaying when you need to open your bowels and avoiding long periods on the toilet. Creams, ointments or suppositories may help to relieve discomfort and itching in the short term.
Banding
For some internal haemorrhoids, a minor outpatient procedure called banding may be recommended. A small elastic band is placed around the base of the haemorrhoid, cutting off its blood supply so that it shrinks and falls away, usually within a week or so. You can read more about banding of haemorrhoids, including what to expect on the day and afterwards.
Surgical options
If your haemorrhoids are large, prolapsing or have not responded to other treatments, surgery may be considered. Treatment options may include procedures to remove the haemorrhoids or to reduce their blood supply and lift them back into place, depending on your assessment. Each option has different benefits, recovery times and risks, and your doctor will explain which may be suitable for you.
Recovery after haemorrhoid treatment
Recovery depends on the treatment you have. After banding, most people return to normal activities on the same day or the next day, although some discomfort, a feeling of fullness and minor bleeding are common for a few days. Recovery after surgery usually takes longer, and pain when opening your bowels is common in the first week or two.
Pain relief, stool softeners and warm baths can help during recovery. Possible complications vary with the procedure and may include pain, bleeding, infection, difficulty passing urine and recurrence of haemorrhoids. You should seek advice promptly if you have heavy bleeding, increasing pain or a high temperature.
Haemorrhoids FAQs
Are haemorrhoids dangerous?
Haemorrhoids are not usually dangerous, but their symptoms can overlap with other bowel conditions. Bleeding from the back passage or a change in bowel habit should be checked by a doctor.
Will my haemorrhoids go away on their own?
Mild haemorrhoids often improve with changes to diet and toilet habits. Larger or prolapsing haemorrhoids are less likely to settle without treatment and may benefit from a procedure.
Is banding painful?
Banding is usually well tolerated. Most people feel some discomfort or a dull ache afterwards, which is usually manageable with simple pain relief and settles within a few days.
Can haemorrhoids come back after treatment?
Yes, haemorrhoids can return after any treatment. Keeping your stools soft and avoiding straining may help to reduce the chance of recurrence.
Do I need a colonoscopy?
Not everyone does. Depending on your age, symptoms and family history, your doctor may recommend a camera examination of the bowel to rule out other causes of bleeding.
Book an appointment for haemorrhoids
If you are troubled by bleeding, discomfort or a lump caused by haemorrhoids, Professor Arulampalam sees patients for assessment in Colchester and central London, and you can book an appointment online or view the practice locations and contact details to arrange a consultation at the location that suits you best.
Please speak to your GP or seek urgent medical advice if you develop severe pain, a high temperature, heavy bleeding or feel generally unwell.