Prevention & Treatment of Haemorrhoids (Piles)

What are Haemorrhoids?

Haemorrhoids (Piles) are abnormally enlarged “cushions” in the anus (back passage). Most people have piles to some degree. Often patients think they have piles as they have a tearing pain on opening bowels, but this is usually a “fissure”. Investigations may show the piles but importantly will aim to rule out other causes of bleeding.

Symptoms

  • Bright bleeding from the back passage. Not mixed in with the motion, but often seen on the toilet paper
  • Often accompanied by a feeling of something coming down, or a bulge or lump in the anus which can be uncomfortable or cause itching

What causes Haemorrhoids?

  • Spending a long time on the toilet straining whilst reading books
  • Constipation due to not enough fibre (eg fruit and vegetables) in diet
  • Poor fluid intake
  • During and after pregnancy

What does treatment involve?

Haemorrhoids may resolve themselves, especially if the above causes are avoided. If this is not the case then the treatment options are:

  • Rubber band ligation is used in order to cut off the blood to the haemorrhoid. As a result, the blood flow will slowly diminish and the haemorrhoid will begin to shrink after some weeks.
  • A more effective method of shrinking piles is ligating with a stitch in theatre, though this usually requires anaesthetic.
  • If the piles pop out (prolapse) and are large, bigger procedure may be necessary which can be discussed with your surgeon.

Risks and Complications after banding / ligation

You may expect discomfort or pain for a day or two in the area of treatment, this should be relieved by your usual painkiller, but avoid constipating opioids like codeine.
The rubber bands may take up to a week to ‘drop off’ and you may be aware of some slight bleeding at this time. Bleeding from the back passage, may occur for up to 2 weeks but should not be heavy, although this does vary from person to person. If you are concerned please contact your GP for advice.

Advice

When using toilet paper ‘dab’ gently rather than wipe. You may apply lubricant such as Vaseline to the area; this may help with any discomfort when emptying your bowels.
Do not use steroid containing pile creams for more than 2 weeks as the cream can thin the anal skin and may cause or worsen a skin ulcer called a “fissure”
If you have had treatment for haemorrhoids it is important to think about what you will do to prevent them occurring again. You will need to think about changing your lifestyle;

  • Eat a diet high in fibre (cereal, fruit, vegetables and brown bread/rice)
  • Drink plenty of fluids such as water or squash
  • Avoid becoming overweight by increasing exercise
  • Avoid straining or reading on the toilet