A lady of African background sitting on a pile of rocks watching a panoramic view of green vegetation.

What are Haemorrhoids and how are they treated?

Haemorrhoids are also known as piles.

They are problems affecting the anus, and are they are essentially large, swollen veins in that area.

A lady of African background sitting on a pile of rocks watching a panoramic view of green vegetation.
Photo by Mick Haupt on Unsplash

Haemorrhoids occur quite commonly and may affect over 50% of the population at some time in their lives.

They are most often found in people aged 45 – 64 years. In some cases, piles may run in families.

 How do Haemorrhoids happen?

We think haemorrhoids happen because the blood vessels (veins) around the anus and rectum come under repetitive strain which causes them to grow bigger and protrude from the anus. 

When they get bigger, they stretch the skin and soft tissues around the area causing pain from the effect on the nerves closely related to the area; and itching. 

From time to time, bleeding also occurs.

How do Haemorrhoids happen?

The following conditions can lead to haemorrhoids:

Sitting on the toilet for a prolonged period of time such as with:

  • Chronic* constipation
  • Chronic diarrhoea (Overusing laxatives/ enemas)
  • Lifting heavy weights or objects often 
  • Persistent cough 
  • Pregnancy (from pressure on the abdomen, constipation and hormones of pregnancy).
  • Any other activity that causes you to strain and place pressure on the vessels/veins in your back passage.

*Chronic means a problem that has been going on for a prolonged period – usually over 6 weeks.

Can Children get Haemorrhoids?

Haemorrhoids in children are rare but they can develop chiefly as a result of constipation.

 Are haemorrhoids a serious or dangerous problem?

Although they are not dangerous, if they are untreated and bleeding continues they can lead to anaemia which can have serious effects.

However, the symptoms of haemorrhoids can behave like bowel cancer and so we advise people with the symptoms to be examined promptly to exclude serious diagnoses.

Usually, haemorrhoids are diagnosed by a rectal examination which can be carried out by your doctor at a routine appointment.

Types of Haemorrhoids 

Some haemorrhoids are felt under the skin outside the anus as lumps or bumps – they are usually painful, bleeding and itchy and are called external haemorrhoids. 

A second type resides higher up within the anus – known as internal haemorrhoids.

They are usually painless but sometimes they can get bigger and push out (prolapse) from within.

 How are haemorrhoids prevented? 

In the first instance, avoiding some of the conditions listed above will reduce the risk of developing haemorrhoids. 

For example, constipation should be appropriately treated.

If this is a chronic problem from poor lifestyle and diet then increasing fluids, vegetables and fibre, as well as exercise, can help. 

 Next, avoid staying on the loo (toilet) seat for long periods.

Take care when lifting very heavy weights – maintain appropriate posture or seek help and lifting aids to avoid undue pressure within the abdomen.

A high abdominal pressure increases the risk of haemorrhoids.

For women who are pregnant, haemorrhoids quickly resolve as soon as the baby is born.

It may be that ensuring one eats fibre and takes plenty of fluids to avoid hard stools also helps in reducing the risk of haemorrhoids.

Simple lifestyle changes can lower your chances of getting haemorrhoids.

Having fibre in your diet can help prevent constipation, which lessens the strain and pressure on your rectum when passing stools.

Drinking plenty of water and regular exercise also can improve digestion and make bowel opening easier.

 Treatment of haemorrhoids

This is aimed at reducing the symptoms (pain, bleeding and swelling), promote healing, and prevent a recurrence. 

Non-Surgical Measures
  • Simple pain medication may help with mild pain symptoms. 
    • Some other pain medicines containing opiods and NSAIDS (anti-inflammatories)are probably best avoided as they can cause constipation and bleeding from the bowel respectively which can worsen things.
    • If the individual is constipated, they should also be given medication to treat this as left untreated it makes it harder for the haemorrhoids to go away.
  • For some people, soaking in a warm shallow bath can help with relief of pain symptoms; as can using an ice pack to manage pain.

  • For someone with haemorrhoids, you can control the pain by using medicines local to the area – that is, topical* medicines ie creams, ointments or pessaries inside the anus.
    • You apply topical medicines directly to the organs where they work like the skin or eyes – creams, ointments or eye drops etc).
    • Topical medicines can contain a combination of local anaesthetics, corticosteroids, astringents, lubricants, and antiseptics. 
  • They provide symptomatic relief of local pain and itching but the evidence does not suggest that any preparation is more effective than any other.
  • Topical preparations containing local anaesthetics (like lidocaine) are only taken for a few days otherwise they cause sensitivity of the skin of the anus following longer periods of use.
  • The usual recommendation is to avoid their use for more than 7 days at a time.
  • Topical preparations combining corticosteroids with local anaesthetics and soothing agents are available for the management of haemorrhoids.
  • Although these may reduce inflammation around the anus, they may not usually reduce swelling, bleeding, or protrusion.
  • Topical preparations with corticosteroids are suitable for occasional short-term use (no more than 7 days).
  • It is important to make sure that infections have been excluded – such as:(such as streptococcal infection, herpes simplex or perianal thrush). 
  • Additionally, long-term use of corticosteroid creams can cause ulcers or permanent damage due to thinning of the perianal skin and should be avoided.
  • Continuous or excessive use carries a risk of a serious condition known as adrenal suppression and systemic corticosteroid effects.
  • For recurring haemorrhoid problems, patients should be referred to secondary care for further investigation and management.
Surgical Measures

Treatments available from specialists include:

  • Rubber band ligation (in this treatment a doctor places a small rubber band around an internal haemorrhoid to cut off its blood supply. After a few days, it falls off.
  • Injection sclerotherapy (here, chemical injections around the anus destroy internal haemorrhoids).
  • Infrared coagulation/photocoagulation and bipolar diathermy and direct-current electrotherapy are methods using heat, light and electrical therapy to treat haemorrhoids
  • Haemorrhoidectomy is the procedure for removing large or prolapsing haemorrhoids.
  • Stapled haemorrhoidectomy is a procedure where doctors use surgical staples to cut away internal haemorrhoid tissue or to shrink external haemorrhoids.
  • Haemorrhoidal artery ligation ties off blood vessels in order to treat the haemorrhoid.

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