Haemorrhoids or Piles

Common bulges at the anus that can irritate and bleed.

The first and most important thing to say about haemorrhoids is that you should make sure that a qualified doctor has confirmed that this is the correct diagnosis.  This is because other much more serious conditions such as anal or rectal cancer can frequently give exactly the same symptoms as haemorrhoids.  Although for many people it is embarrassing, it is very important that you ask a GP or specialist doctor to examine your bottom if you have anal or bowel symptoms.

Haemorrhoids are also called piles.  They are vascular cushions that sit inside the anal canal and we all have them to keep us continent as without them we might seep water out of the bottom.  I often tell my patients to think of haemorrhoids like a red Incredible Hulk!  If they are made angry then they become engorged and swollen and they can bulge at the anus and cause bleeding, discomfort and itching.  The main things that make them angry are constipation and straining.  Just like the Incredible Hulk they shrivel back down to their normal smaller size if they are pacified.  They are pacified if there is minimal constipation and straining.  It is improtant not to spend too long sitting on the toilet seat.  A toilet seat has a hole in it and it does not give support to the anal area like a chair does so if you sit on a toilet seat for a long time then this allows the haemorrhoids to become unnecessarily engorged with blood making them bulge and expand.  Large haemorrhoids press on the millions of nerves around the anus and they give the sensation that there is some poo there to come out.  If you sit on the toilet and strain and nothing comes out then it could be engorged haemorrhoids giving the sensation of needing to go to the toilet rather than there actually being poo there and you should wipe your bottom and leave the toilet and go about your business and come back to the toilet another time later.  If you continue to strain then all you are doing is making haemorhoid disease even worse.  If you are unable to pass faeces for days then you should discuss this with your GP or specialist.

Therefore it is important to recognise that haemorrhoids is a condition that comes and goes, with good spells and bad spells, and that your lifetsyle factors and toilet habits can have a big impact on haemorrhoid size and whether or not you will end up needing an intervention or operation.

If you enter a bad spell and your haemorrhoids start playing up, then you should really concentrate on making your bowel motions softer with a high fibre and high fluid intake diet and regular moderate exercise.  It is well known that immobility can lead to sluggish bowels and constipation.  Sometimes people find it helpful to take some mild laxatives for a couple of days and to use a haemorrhoid cream that they can buy from the chemist.  For most people their haemorrhoids will shrink back down over a period of about two weeks and life will get back to normal.

If symptoms persist past six weeks then you should seek help from a doctor.  In some people the haemorrhoids cause enough trouble that they require further treatment.  Further treatment includes haemorrhoid banding or injection by a specialist surgeon in the out-patients clinic.  This treatment acts by scarring the haemorrhoids and pulling them back up into the anal canal.  The procedure is performed in an area of the bowel which does not have pain fibres so it should not be painful.  Afterwards patients may get a feeling of fullness and a feeling that they need to open their bowels but this often disappears after two days and is helped by simple painkillers such as paracetamol.  Other patients with more severe haemorrhoids may require surgery which entails stapling the haemorrhoids or excising them.  Mr Moore also offers the new haemorrhoid operation technique of Transanal Haemorrhoidal Dearterialistaion (THD) which involves using dissolvable sutures rather than staples with no painful excisions which is thought to be much more comfortable for patients.  This frequently requires a general anaesthetic but the operation can often be done as a daycase procedure and most patients are back to normal activities within 2 weeks.