Haemorrhoids, also known as 'piles', are a very common condition, with about half of adults having experienced them by the age of 501. In fact, over 300,000 cases of haemorrhoids are treated each year around Australia. Haemorrhoids are not a new condition, people have been seeking treatment for thousands of years, and procedures to remove haemorrhoids have been around since about 460 B.C.2
Haemorrhoids are swollen and inflamed veins in the anus and lower rectum, which can be internal or external.3 Internal haemorrhoids occur within the rectum whereas external haemorrhoids develop under the skin around the anus and can feel like hard lumps. Many problems such as anal fissures, fistula, abscesses and anal tears are incorrectly referred to as haemorrhoids as they have similar symptoms such as bleeding and anal pain.4
Symptoms of haemorrhoids can vary from one person to the next, particularly depending on the duration and severity. Some examples include:
- Anal pain
- Rectal pain
- Anal itch
- Bleeding during bowel movements
- Swelling around the anus
- Leakage of faeces1
- Rectal burning
Symptoms usually depend on the location. Internal haemorrhoids often don’t cause discomfort or pain but straining during bowel movements can damage the surface and cause them to bleed. You may notice small amounts of blood on your toilet paper or in the toilet bowl. External haemorrhoids commonly itch and bleed and can cause considerable pain and discomfort.1
Haemorroids are caused by the supportive tissue inside the anus becoming weak. This usually happens when there is extra pressure placed on the blood vessels in the anus for some reason, causing swelling of the veins. Factors that commonly place extra pressure on the blood vessels in the anus include:
- Long term constipation or diarrhoea
- Being overweight
- Spending long periods of time on the toilet
- Straining during bowel movements
- Regularly lifting heavy objects
- Low fibre diet1
Haemorrhoids are more likely as you age because the tissues that support the veins in the rectum and anus can weaken and stretch with age.1 Constipation is a common factor in the development of haemorrhoids because it causes straining during bowel movements. During pregnancy, haemorrhoids are particularly common due to the extra pressure placed on the abdomen by the growing baby. Haemorrhoids are also more common in some families, suggesting a genetic link.2
Haemorrhoids are usually mild and do not cause serious problems to develop. However, sometimes chronic blood loss from hemorrhoids can lead to anaemia which can cause fatigue and weakness. Prolapsed haemorrhoids are a more severe and painful form of internal haemorrhoids, where veins push through the anus and hang out of the body, particularly after going to the toilet.
The ring of muscle, known as the anal sphincter can sometimes strangulate veins that hang out permanently.3 This is known as strangulated haemorrhoid, where blood supply to an internal haemorrhoid becomes cut off, or "strangulated". It can be very painful. External haemorrhoids can itch and bleed and sometimes blood can pool in the haemorrhoid and form a clot, this can cause severe pain, swelling and inflammation.1
External haemorrhoids may be easy to diagnose, simply by looking. Your doctor may diagnose internal haemorrhoids by examination of the anal canal and rectum. A digital rectal exam involves your doctor inserting a gloved and lubricated finger into your rectum and feeling for any unusual growths. Because internal haemorrhoids can sometimes be too soft to be felt, your doctor may use a specialised instrument to see into your anus and rectum.1 It is likely to be uncomfortable but not painful. These are very common procedures for your doctor and there is no need for embarrassment.2
Treatment of haemorrhoids using home remedies is often all that is required. Resolving constipation is an important component of most treatments to relieve haemorrhoids as it helps to reduce straining during bowel movements. Eating more fibre, exercising and drinking plenty of water may help resolve constipation, sometimes a mild laxative to soften bowel movements may be called for.2
Other home treatments of haemorrhoids include the use of over-the-counter creams and suppositories2 such as Proctosedyl. This soothing treatment provides relief by reducing inflammation and swelling, relieving anal itch, and providing long acting5 relief from anal pain and rectal pain. Proctosedyl can be used for up to seven days to relieve both internal and external haemorrhoids.
Other simple steps that can be taken at home include soaking regularly in a warm bath, keeping the anal area clean, soft toilet paper, and using cold compresses on the anus to relieve haemorrhoid swelling.1
In some cases minor surgery is required. Common procedures include sclerotherapy, where a chemical is injected into the hemorrhoid to numb the pain, stop the bleeding and decrease the size of the hemorrhoid. Rubber band ligation is also utilized. A very tight elastic band is placed around the haemorrhoid to cut off the blood supply. This causes the haemorrhoid to fall off within seven to ten days. Less often, surgical removal of the haemorrhoid under general anaesthetic may be required.2
Preventing haemorrhoids can be achieved by keeping stools soft so that they are easier to pass. The following tips may assist:
- Eating fiber – more fruits vegetables and whole grains will help to soften the stool and increase bulk. This will help avoid straining during bowel movements, a major cause of haemorrhoids.
- Drink fluids – six to eight glasses of water each day will help keep stools soft.
- Don’t strain – straining during bowel movements creates more pressure on the veins in the lower rectum which can cause haemorrhoids.
- Don’t hold on – go as soon as you feel the urge, holding on can cause the stool to become dry and harder to pass.
- Consider fiber supplements – many people do not get enough fiber per day, fiber products may help keep stools soft and regular.
- Avoid sitting for long periods – particularly on the toilet, this can increase the pressure on the veins in the anus, a major cause of haemorrhoids.
- Exercise – staying active can help to prevent constipation which can reduce the pressure on veins. It may also help lose excess weight which may be contributing to haemorrhoids.1
Myth: Only old people get haemorrhoids
Truth: Chances of having haemorrhoids increases with age due to the weakening of supportive tissue -but you can get them at any stage of your life.
Myth: Healthy people don’t get haemorrhoids
Truth: Being overweight increases the chance of haemorrhoids due to the extra pressure excess weight puts on the abdomen, but the pressure can also be the result of pregnancy, birth or straining during bowel movements. Although these things increase your risk, healthy people do still get haemorrhoids.
Myth: Haemorrhoids are not very common
Truth: Up to 50% of adults experience haemorrhoids by the age of 50.
Myth: Spicy foods cause haemorrhoids
Truth: Spicy foods may trigger upset stomachs but there is no evidence linking spices to haemorrhoids. However, the stomach upset some people may experience may result in stools becoming harder to eliminate, causing straining during bowel movements, a major factor in the cause of haemorrhoids.
Myth: Sitting on cold concrete causes haemorrhoids
Truth: Many people believe sitting on cold concrete causes haemorrhoids. This is not the case. However, prolonged sitting can be a factor in the development of haemorrhoids, due to the extra strain and pressure placed on the rectum. On the other hand, ice packs are recommended to relieve haemorrhoid pain and swelling.
Myth: Weight lifting is a cause of haemorrhoids
Truth: Lifting weights is not a direct cause of haemorrhoids. However, if the weight lifter incorrectly puts pressure on the pelvic area, straining may occur which is a major cause of haemorrhoids.
Myth: Haemorrhoids cannot be cured and are permanent
Truth: Haemorrhoids are not permanent. Treatment of haemorrhoids can often be achieved at home. For example, resolving constipation as well as using creams and suppositories such as Proctosedyl. This provides three way relief by reducing inflammation and swelling and relieving anal pain and anal itch.
- Mayo Clinic accessed 21 June 2015 http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/definition/con-20029852
- Health Direct accessed 21 June 2015 http://www.healthdirect.gov.au/#!/haemorrhoids-piles
- Better health channel accessed 21 June 2015 http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Haemorrhoids
- Centre for Digestive Diseases accessed 21 June 2015 http://www.cdd.com.au/pages/disease_info/haemorroids.html
- Proctosedyl Product Information, March 2018