Piles, known medically as haemorrhoids, occur when the blood vessels of the anus are put under pressure, causing them to become swollen and stretched. Internal piles occur completely inside the anus, while external piles, known as perianal haematoma, may occur wholly outside the anus and can actually protrude out of the anal opening.
Piles are common with up to half of the population having them at some time in their life. Lifestyle factors, such as obesity, straining to lift heavy weights, constipation and pregnancy can increase the incidence of piles, as can genetic factors and the blood vessel degeneration that comes with advancing age.
Piles cause a range of embarrassing and unpleasant symptoms including itching around the anus, a dragging sensation, pain or difficulties when passing stools, discharge including blood spots from the anus and a feeling like you need the toilet often throughout the day.
What do I do if I think I have piles
Your GP will be able to diagnose piles from the symptoms you describe and a simple examination of your rectum. This may just involve a digital exam, in which a finger is inserted to feel for piles, or a more thorough examination using a proctoscope, which allows your GP to view more of your rectum and to take tissue samples for analysis if required.
In many cases, piles will go away of their own accord within a few days of the initial flare up. You can assist this process with a range of over the counter or prescription medications. These medications come as creams, ointments or suppositories and contain several different chemicals to help with your piles:
- Astringents or corticosteroids: these help to reduce swelling and inflammation.
- Emollients: these protect the skin around the anus.
- Antiseptics: these help to avoid infection if the skin of the anus is torn.
- Painkillers or anaesthetics: these reduce the discomfort of itching so that you are less likely to cause further damage by scratching.
You should avoid using pile treatments for more than a week at a time as they can start to have an adverse effect on the surrounding skin. It is also unwise to use more than one treatment at a time as they may contain similar ingredients resulting in an excessive dose.
Coping with persistent piles
If your piles do not respond to pile medication and ease naturally, there is a range of further treatment available. Most of these treatments involve depriving the piles of their blood supply so that they die away naturally:
- Banding: a very tight elastic band is fixed in place around the bottom of the pile. It will then shrink within around seven days. This is an uncomfortable procedure, but it can be done as an outpatient appointment and you will be able to return to work as soon as you feel comfortable to do so.
- Sclerotherapy: this uses a similar principle to banding, but this time the blood supply is cut off by scar tissue created by injecting chemicals into the base of the pile. The piles take 4 – 6 weeks to shrink away. This can also be done as an outpatient appointment and can be less uncomfortable than banding, allowing you to return to work sooner.
- Infrared coagulation: the blood vessels supplying the pile are destroyed by infra-red light, causing the pile to shrink within a couple of weeks. This is a minor procedure and you can return to work the following day.
For larger, or more persistent piles, a more substantial procedure may be called for. These include:
- Stapling, or haemorrhoidopexy: protruding piles are taken back into the anus and stapled into position. This not only holds them in place, but the stapling cuts the blood supply causing the pile to wither away.
- Haemorrhoidal artery ligation: a Doppler probe is used to identify the arterial source of the pile. This is then stitched to cut off the supply of blood from the pile.
- Haemorrhoidectomy: if piles do not respond to other forms of treatment, it may be necessary to remove them by surgery. This is a major operation and requires a general anaesthetic and around a week off work to recover. However, it is by far the most effective treatment and has the lowest recurrence rate.
Living with them
If you are prone to piles, there are several steps you can take to cope with a flare up and to reduce the chances of recurrence following treatment.
During a flare up, you should always wash your bottom after you have used the toilet and pat it gently dry. You may find that using moist toilet tissue or baby wipes is easier to tolerate than dry toilet tissue. You should also try to eat a high fibre diet and drink plenty of water, to keep your stools soft and avoid pressure on your piles as you defaecate.
Once your piles have eased, or you have undergone treatment, you can reduce the risk of recurrence by taking regular exercise, eating plenty of high fibre foods, limiting your intake of alcohol and coffee and establishing a regular and swift toilet habit.