Haemorrhoids (sometimes called 'piles') occur when the veins in the lower part of the rectum and around the anus become swollen, enlarged or damaged. Other conditions can also cause discomfort, pain or bleeding in this area. They include anal fissure and anal itching (pruritus).
Although haemorrhoids are the most common cause of bleeding from the anus or rectum, they are not the only cause. Rectal bleeding may be the first sign of a serious condition such as cancer, so it should always be checked by a doctor to find out the exact cause and to allow the best possible treatment.
What Causes Haemorrhoids?
The veins that are involved in haemorrhoids are a normal part of our anatomy. They become enlarged if the flow of blood through them slows down or is obstructed - a little like varicose veins in the leg. Factors that can interfere with the blood flow and increase the risk of haemorrhoids include:
• constipation and straining to pass a bowel motion
• pregnancy and childbirth
• lifting heavy weights incorrectly
• chronic coughing
• being overweight
• liver disease
Who Is Most At Risk Of Getting Haemorrhoids?
Haemorrhoids are very common in our society, particularly in older people. Up to half the population will suffer from them at some time in their lives. Haemorrhoids are less common in people younger than 40, although they may suffer from anal or rectal discomfort due to other causes. The list of factors that contribute to haemorrhoids (above) indicates the people who are most at risk. Constipation is the biggest factor, and it's also one that we can do something about.
The enormous changes in the body associated with being pregnant and having a child also hasten the development of haemorrhoids. Abdominal strain from coughing or lifting heavy weights may be difficult to avoid, but at least if you use the correct technique for lifting, you will help to reduce the problem. When lifting a heavy object, you should stand close to the object with your feet apart and bend your hips and knees, keeping your back straight. Then grip the object, keeping it close to you, and straighten your legs.
What Are The Symptoms Of Haemorrhoids?
The symptoms of haemorrhoids depend on the blood vessels involved, how long they have been present and the severity of the problem.
• Internal Haemorrhoids
Internal haemorrhoids develop from the veins in the lower part of the rectum. Usually they are not painful to start with, although they may cause a vague aching sensation. Often the first sign will be a small amount of bright red blood on the toilet paper or in the toilet bowl after passing a motion, or on the surface of the bowel motion itself. Haemorrhoids tend to grow in size over time.
Pain and discomfort also become more likely, particularly if the haemorrhoid becomes inflamed or infected or if it develops a blood clot inside it. The haemorrhoid may become so large that it's pushed through the anus when passing a bowel motion (prolapse), and then it may become 'strangulated'.
• External Haemorrhoids
Sometimes when an internal haemorrhoid prolapses through the anus it is called 'external'. However, the phrase 'external haemorrhoids' usually refers to changes in the blood vessels lying under the skin around the anus. These veins, too, can become enlarged and cause difficulties. An aching pain is often the first symptom of external haemorrhoids. The biggest problems occur when a blood clot inside the vein causes a blood blister to form just beneath the skin. Because the skin is rich in nerve endings, this can be very painful.
But Is It Haemorrhoids?
Several other common conditions can cause pain, itching or discomfort around the anus. An anal fissure is a tear in the skin lining the anus. It can be very painful, especially when passing a bowel motion, and can also lead to bleeding. Anal itching (pruritus) is another very common complaint. There are many causes for itching and tenderness, including:
• Thrush (infection with a fungus called Candida)
• Pinworms or threadworms
• Diarrhoea and other diseases of the digestive system
• Some sexually transmitted diseases
Often, though, it isn't possible to find the exact cause. Anal itching tends to be made worse by hot, humid weather, excessive sweating, and friction between the skin surfaces during exercise or from being overweight.
What Is Haemorrhoids Treatment?
Lifestyle changes, such as controlling constipation, weight loss and sensible hygiene can make a very big, long-term contribution (see box at the bottom of this article). Several types of medication are available to reduce the size of haemorrhoids and control symptoms of pain and itching. Surgery may be needed to treat large haemorrhoids or other conditions such as a clot in an external haemorrhoid.
Conditions affecting the anus and rectum are extremely common. Your doctor and pharmacist are used to discussing them, and you should not feel embarrassed about seeking their help. Your pharmacist will be able to give advice about medication to relieve the symptoms, and also advise about lifestyle changes such as reducing constipation.
Remember that many conditions can cause anal and rectal symptoms. Unless you talk to your doctor, you could suffer more discomfort and anxiety than you need to. Also remember that bleeding from the rectum or anus can be the first sign of very serious diseases including colorectal cancer. Although bright blood after passing a bowel motion is likely to be due to haemorrhoids, it should be investigated by a doctor - just to make sure.
You Should See Your Doctor:
• If you have a change in your bowel habits (for example, constipation or diarrhoea), or any unexplained weight loss or anaemia.
• If you have sudden or severe pain in the anus or rectum.
• If treatment of the symptoms doesn't provide enough relief.
How Can I help?
• Eating more fibre, drinking lots of liquids, and good bowel habits (such as trying not to postpone visits to the toilet) will help to reduce constipation.
• Don't add to the irritation around the anus by scratching, or trying to clean or scrub the area excessively when bathing.
• Keep the area as dry and cool as possible.
• Wear loose clothing and underwear (avoid synthetic fabrics if possible).
• Clean gently after bowel movements. Use moistened cotton wool if necessary.
• Do not use perfumed soaps or talcum powder (including baby powder), as these sometimes add to the irritation of sensitive skin.
• Talk to your doctor.