Haemorrhoids

Haemorrhoids or piles are swelling and inflammation of veins in the rectum and anus. They are common.

Causes:
Increased straining during bowel movements, by constipation or diarrhoea, may lead to haemorrhoids. Hypertension, particularly portal hypertension, can also cause haemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall.

Obesity can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause haemorrhoids. Poor muscle tone or poor posture can result in too much pressure on the rectal veins.

Pregnancy causes hypertension and increases strain during bowel movements, so haemorrhoids are often associated with pregnancy.

Excessive consumption of alcohol or caffeine can cause haemorrhoids. Both can cause diarrhoea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension.


Symptoms
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as haemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, haemorrhoidal symptoms will go away within a few days.

Although many people have haemorrhoids, not all experience symptoms. The most common symptom of internal haemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal haemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding haemorrhoid.

Symptoms of external haemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external haemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.


Food

Insufficient liquid can cause a hard stool, or even chronic constipation, which can lead to haemorrhoidal irritation.

Eating fruit helps avoid conditions that lead to haemorrhoids.

Food considered "probiotic", such as yogurt with active culture, may help keep the gut functioning normally and thus prevent flare-ups.


Types of haemorrhoids

External haemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external haemorrhoids, is more commonly due to skin irritation.  External haemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the haemorrhoid becomes a thrombosed haemorrhoid.

Internal haemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal haemorrhoids are usually not painful and most people are not aware that they have them. Internal haemorrhoids, however, may bleed when irritated.  Untreated internal haemorrhoids can lead to two severe forms of haemorrhoids: prolapsed and strangulated haemorrhoids:
Prolapsed haemorrhoids are internal haemorrhoids that are so distended that they are pushed outside the anus.
If the anal sphincter muscle goes into spasm and traps a prolapsed haemorrhoid outside the anal opening, the supply of blood is cut off, and the haemorrhoid becomes a strangulated haemorrhoid. 

Prevention

Prevention of haemorrhoids includes drinking more fluids, eating more dietary fibre (such as fruits, vegetables and cereals high in fibre), exercising, practicing better posture, and reducing bowel movement strain and time. Haemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote haemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight underwear.

Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking extra dietary fibre and fluids a couple days prior to that time.

Many people do not get a sufficient supply of dietary fibre (20 to 25 grams daily) and small changes in a person's daily diet can help tremendously in both prevention and treatment of haemorrhoids. Products such as Senokot Hi-Fibre sachets and Normacol granules can be used to increase fibre intake.

Treatments
For many people, haemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure haemorrhoids, but local treatments such as warm baths, cold compress, or topical pain relief, can provide temporary relief. Especially in the case of external haemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around rectal region to be relaxed. Consistent use of medicated creams during the early stages of a haemorrhoid flare-up will also provide relief and may stave off further development and irritation. However, creams containing steroid preparations weaken the skin and may contribute to further flare-ups. Keep the area clean and dry, with some lubrication provided by haemorrhoidal creams or a lubricant.

Anusol cream and Anusol suppositories soothe itching and relieve pain and discomfort and can be used safely on a frequent basis. Some products like Hemocane cream contain a local anaesthetic which provides rapid relief of discomfort and comes with an applicator to apply internally. Anodesyn cream also contains a local anaesthetic but can only be used for 7 days at a time. Local anaesthetics can cause sensitization. Germoloids cream and suppositories contain a local anaesthetic.

More recent additions to over the counter treatments include hydrocortisone which is very effective against swelling and irritation. Anusol Plus ointment and Anusol Plus HC Suppositories and Germoloids HC spray are examples. These are the most effective products for treating piiles but because of their strength they can only be used for 7 days at a time. Very good for particularly severe flare-ups. Choice depends on location and convenience, Ointment is good for external piles, Suppositories for internal piles and the spray is useful for people who do not want to or find it difficult to apply cream to the area.

A word of caution for your safety:
Symptoms associated with rectal cancer, anal fissure, anal abscess, anal fistula, Perianal hematoma, and other diseases may be similar to those produced by haemorrhoids and may be reduced by the topical analgesic methods described above. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue.

For much more information click HAEMORRHOIDS or go to NHSDirect at www.nhs.uk BUT DON'T FORGET TO COME BACK TO US. 

This page was last updated: Monday 25 September, 2017