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Treatments
Haemorrhoids
Haemorrhoids, also known as piles, can be an embarrassing condition to seek treatment for and people may hesitate to seek a solution to their issue. However, there are many treatments that are available to treat this condition. Fill out the health questionnaires below and one of our prescribers will make sure that you receive the most suitable treatment for your condition.
Proctosedyl Ointment
From £24.99
Uniroid-HC Ointment
From £17.99
Overview
Haemorrhoids/piles
Haemorrhoids (or piles) are swollen blood vessels or lumps inside the rectum or around the anus, which can be internal (inside the anal canal) or external (around the opening of the anus).
They are very common, affecting up to 8 million people in the UK (A community-based studies in the UK reported that haemorrhoids affect 13-36%). Haemorrhoids may be present for years without being detected, often becoming noticeable when they bleed.
Symptoms can include pain, rectal bleeding, and anal itching. While they usually resolve within a few days, at-home treatments can help prevent them, and in some cases, medical intervention may be necessary.
Your anus naturally contains blood vessels and spongy tissues called anal cushions, which help keep the anus closed. When these blood vessels become swollen, haemorrhoids can develop, causing discomfort.
Haemorrhoids can affect people of all ages, often leading to symptoms like itching, bleeding, or discomfort during bowel movements. Thankfully, the condition is treatable and manageable through OTC remedies and self-care measures.
How common are piles?
Hemorrhoids are a common condition, affecting 13-36% of the general population. About 50% of adults experience piles at the age of 50; however, it can occur at any age.
Although haemorrhoids are common, they remain undiagnosed as many people manage their symptoms with over-the-counter treatments and self-care.
But if your symptoms persist or become more severe, it is important to consult a professional doctor for better advice.
Types of piles
Haemorrhoids can also be referred to as varicose veins. It can develop inside the rectum (above the dentate line), called internal piles, or under the skin around the anus (below the dentate line), called external hemorrhoids.
The dentate line is the anatomical delineation between the lower and upper anal canal and is 2 cm above the anal verge.
Let’s look at the types of hemorrhoids in detail!
Internal haemorrhoids
Internal piles come out of your anus and hang down. It has four categories:
- First-degree: Small, internal haemorrhoids that don’t prolapse (fall outside the anus). They cause bleeding but do not come out of the anus.
- Second-degree: Internal haemorrhoids that prolapse during bowel movements but retract on their own afterward.
- Third-degree: Internal haemorrhoids that prolapse and require manual retraction. Come out of your anus during poo and go back only if you push them back.
- Grade 4/Fourth-degree Piles: Prolapsed haemorrhoids that cannot be manually pushed back inside and may require surgical intervention.
It hangs down from your anus permanently and can not go back. It also becomes more painful and swollen if the blood inside them clots.
External haemorrhoids
External hemorrhoids are swollen veins that form outside the anus, under the skin around the anal opening. They can cause pain, itching, and occasional bleeding.
In some cases, blood clots can form within the hemorrhoid, leading to a condition known as a thrombosed hemorrhoid, which can be particularly painful. Both internal and external hemorrhoids can occur simultaneously.
Thrombosed haemorrhoids
A thrombosed haemorrhoid is a condition in which the swollen blood vessels in your anal area have developed blood clots called a thrombus. It is an intense and painful form of hemorrhoids, causing symptoms such as:
- Severe pain during walking, sitting, or bowel movements
- A noticeable lump or swelling near the anus
- Bleeding
- Irritation or itching around the anal area
- Purple or bluish discoloration
So, how to treat thrombosed hemorrhoids? The conservative treatment includes OTC painkillers, ice packs, stool softeners, topical ointments, or any hemorrhoids cream.
If managed conservatively, the symptoms may resolve within 10-14 days. If not, minimally invasive procedure (thrombectomy) or surgical interventions (haemorrhoidectomy) is used.
Difference between hemorrhoids and anal fissures
Haemorrhoids and anal fissures are different conditions that affect the anal region; however, they share similar symptoms like bleeding and pain.
Haemorrhoids are swollen veins within the rectum or under the skin around the anus, causing itching, swelling, and bleeding during bowel movements.
While anal fissures are small tears or cracks in the lining of the anal canal, resulting from trauma during bowel movements such as passing hard stools.
Anal fissures cause severe pain during and after bowel movements and sometimes minor bleeding.
Haemorrhoids involve vein-related issues; fissures are an issue with the lining of the anal area. Proper diagnosis and treatment depend on the identification of the specific condition.
Are skin tags the same as hemorrhoids?
Skin tags and piles are not the same things, but skin tags could be a symptom of hemorrhoids.
Skin tags are benign (not serious), small, usually soft, that appear most times around the anal area or other parts of the body. They are not dangerous and are usually painless.
Anal skin tags may appear after a hemorrhoid has healed because the skin is stretched out and remains behind. This occurs due to repeated irritation or swelling in this area.
On the other hand, hemorrhoids are conditions resulting from swollen veins in the rectum or the anus. Unlike skin tags, piles contain blood vessels in their structure and, therefore, may need medical intervention if they are symptomatic.
In case you are not sure whether a lump or growth is a skin tag or due to hemorrhoids, consult a doctor to get the right advice.
Other Conditions That Cause Symptoms Like Haemorrhoids
Different gastrointestinal disorders may cause rectal bleeding and other symptoms similar to hemorrhoids/piles. These include:
- Crohn’s disease
- Colon cancer
- Ulcerative colitis
- Anal cancer
- Inflammatory bowel disease
- Bowel cancer
- Anal fissure (small tear in the lining of the anus)
- Rectum prolapse (rectum protruding through the anus)
- Anal abscess or fistula
- Pruritus ani (itching that is caused by skin conditions, hygiene issues, or infections)
- Colorectal cancer or polyps (tumors in the colon or rectum)
- Perianal warts or skin tags (lumps near the anus)
- Rectal ulcer syndrome (ulceration in the rectum)
So, if you experience unusual or persistent symptoms, consult your doctor for an early and right diagnosis and to access appropriate treatment.
When to see a doctor about piles (Hemorrhoids)
Haemorrhoids/piles can go away without any treatment. However, you must visit your doctor if you notice:
- Blood and mucus in your poo
- Changes in the stool color
- Recent weight loss
- Changes in your bowel movements or habits
- Abdominal pain
- Rectal bleeding
- Dizziness
- Faintness or lightheadedness
Moreover, if your hemorrhoids do not improve after a week at home, consult your doctor immediately, as it may be due to anal cancer and colorectal cancer.
Risk Factors for Hemorrhoids: Who Is Most at Risk?
Haemorrhoids can affect anyone at any age, but certain groups are more prone to this condition due to specific risk factors. Commonly, piles are seen in:
Adults Over 50 Years Old
As people age, the tissues supporting the veins around the anus weaken, making older adults more susceptible to hemorrhoids.
Pregnant women
Haemorrhoids are common in pregnant women due to increased pressure on the pelvic veins and hormonal changes during pregnancy. While they often resolve after childbirth, they can cause discomfort during pregnancy.
People with chronic constipation/diarrhea
Straining during bowel movements, often due to constipation, or frequent diarrhea can irritate and weaken the veins around the anus, leading to hemorrhoids.
Those who sit for long periods
Prolonged sitting, especially on the toilet, can place extra pressure on the anal veins and increase the risk of piles.
Individuals with obesity
Over weight adds strain on the rectal veins, making those who are overweight or obese more likely to develop hemorrhoids.
People with low-fiber diets
Lack of fiber causes constipation, leading to the development of haemorrhoids. One of the main catalysts for hemorrhoid development is constipation and lack of fiber.
People who lift heavy objects
Lifting heavy objects increase abdominal pressure and straining, enhancing the risk of haemorrhoids.
People with chronic cough or sneezing
Conditions that cause frequent coughing or sneezing, such as allergies or respiratory illnesses, can increase pressure on the anal veins, potentially leading to hemorrhoids.
People who got an injury to the rectum or spinal cord
Spinal cord or rectum injuries impair your bowel function, causing straining or constipation and leading to hemorrhoids.
IBD (inflammatory bowel disease)
Conditions such as ulcerative colitis and Crohn’s disease involve chronic constipation or diarrhea, causing hemorrhoids.
Family history of hemorrhoids:
Family history enhances the risk of haemorrhoids because genetic factors can affect the elasticity and strength of the surrounding tissues and vein walls, leading to haemorrhoids.
Haemorrhoids are less common in children and young adults. The risk can be reduced by adopting healthy bowel habits, staying active, and eating a high-fiber diet.
Diagnosis of piles
The diagnosis of hemorrhoids includes a medical history review, physical examination, and, if necessary, additional diagnostic tests. Here is how it is typically done:
1. Medical history
The doctor will ask about the following:
- Symptoms such as bleeding, pain, itching or swelling.
- Dietary habits such as fiber and fluid intake
- Bowel habits such as constipation, diarrhea, or straining.
- Family history of hemorrhoids or related conditions.
2. Physical examination
- External Examination: The doctor examines the anus and rectum visually to look for external hemorrhoids, swelling, irritation, or prolapsed internal hemorrhoids.
- Digital Rectal Examination(DRE): A gloved, lubricated finger is inserted into the rectum to examine internal hemorrhoids, lumps, or abnormalities.
3. Anoscopy
An instrument called an anoscope (a small, lighted tube) is used to look into the anus and lower rectum to see if there are internal hemorrhoids or other abnormalities.
4. Additional tests (if needed)
These may be done to rule out other conditions causing similar symptoms, such as colorectal cancer, polyps, or inflammatory bowel disease:
- Proctoscopy: An examination of the rectum with a small instrument (a hollow tube with a tiny light at the end).
- Sigmoidoscopy: To examine your lower colon and rectum with a lighted tube with a camera. The procedure may include rigid sigmoidoscopy and flexible sigmoidoscopy.
- Colonoscopy: To check if there is significant rectal bleeding and/or a concern for cancer or other serious conditions.
Early diagnosis and effective treatment provide relief from symptoms and prevent complications; so do not feel embarrassed about these tests.
Complications of piles
Haemorrhoids rarely cause serious complications such as:
Anemia (iron deficiency): Ongoing bleeding from hemorrhoids may cause anemia, resulting in dizziness, pale skin, or weakness. If anemia is diagnosed, iron supplements are recommended.
Strangulated piles: If a blood clot is formed in an internal hemorrhoid, it cuts off its blood supply and makes it painful and strangulated. It involves surgical interventions.
Infection: Sometimes, the haemorrhoids become rupture and develop an infection, making them more prone to rupture. If infection is diagnosed, antibiotics are recommended.
Skin tags: When your hemorrhoids shrink back and skin remains, skin tags can develop and make the overlying skin stretch and enlarge.
Prognosis of hemorrhoids: Are hemorrhoids dangerous?
Hemorrhoids tend to have a good prognosis when treated properly, particularly with lifestyle modifications and effective hemorrhoid treatment options.
Even though they can be uncomfortable and inconvenient, they are usually not life-threatening, and often go away or become manageable with proper care.
Prognosis factors
- Mild symptoms respond well to conservative treatments such as topical ointments, sitz baths, and dietary changes.
- Adhering to medical advice or recommendations causes fewer recurrences and better outcomes.
- Haemorrhoids in pregnancy resolve after delivery.
- Only 10% of people need surgery.
- Timely medical interventions or surgical treatment offer positive outcomes and prevent complications.
Long-term outcomes
- Acute hemorrhoids can resolve completely with treatment.
- The symptoms of chronic haemorrhoids can be managed effectively.
- Surgical procedures offer long-term success.
- Preventive measures such as dietary changes and lifestyle modifications lower the risk of recurrence.
Author
| Name | Mr Suhail Jamil |
| Role | Superintendent Pharmacist |
| GPHc NUM | 2069518 |
Resources
https://www.bupa.co.uk/health-information/digestive-gut-health/haemorrhoids
Causes
Haemorrhoids arise from recurring pressure in the veins of the rectum and anus. They may also be caused by constipation and straining to empty bowels.
Diarrhoea also causes stress on the bowels and may lead to haemorrhoids. Other factors that may cause haemorrhoids are sitting for long periods, obesity, losing muscle tone due to age, anal intercourse, anal infection, rectal surgery and inflammatory bowel disease.
Treatments
Treatment of piles: How to treat painful hemorrhoids
If your symptoms of piles do not go away, you may need access to treatment options to relieve your symptoms. The treatment options depend on the severity of the symptoms and degree of prolapse, including:
Piles Treatments
The medications for piles include:
- Paracetamol (do not use codeine analgesia)
- OTC (over-the-counter) medications, creams, suppositories, or ointments such as witch hazel, lidocaine, or hydrocortisone.
- Corticosteroids such as Proctosedyl ointment or Uniroid-HC ointment
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Bulk-forming laxatives such as sterculia, ispaghulahusk, or lactulose.
Non-surgical
In some cases, other treatments are required, such as:
- Rubber band ligation (banding): In this, a tight elastic band is placed around your hemorrhoids to cut off their blood supply. It causes the haemorrhoids to fall off and pass out of the body within a few days.
- Photocoagulation (infrared treatment): This procedure uses infrared light to burn away your haemorrhoids.
- Sclerotherapy (injection): In this, a chemical is injected into your haemorrhoids, stopping bleeding, numbing pain, and shrinking your haemorrhoids (too small to use a rubber band).
- Bipolar diathermy & direct current electrotherapy: This treatment uses electric current or heat to destroy the pile.
Before using any procedure, your doctor will tell you the pros and cons of each treatment according to your health and current condition.
Surgery
If the above treatment options do not work, surgical interventions are used to remove the hemorrhoids. Its different types include:
- Haemorrhoidectomy: Sever pile removal surgery under general anesthetic.
- Stapled haemorrhoidopexy: Best for symptomatic internal haemorrhoids. In this specialised circular stapling gun is used that staples back your piles inside your anus.
- Haemorrhoidal artery ligation operation (HALO): In this process, stitches cut off the blood supply to your piles (haemorrhoids) and let them shrink.
Symptoms
How do I know if I have haemorrhoids?
You can determine if you have hemorrhoids by observing symptoms such as pain, itching, bright red blood during bowel movements, or swelling around the anal area. Consult a doctor for a proper examination and confirmation of the diagnosis.
Symptoms of haemorrhoids (piles)
Some people with haemorrhoids remain asymptomatic, some show mild symptoms that go away within a few days, and others have severe signs that need medical supervision. The symptoms of hemorrhoids include:
- Bleeding when you poop (you will find blood on the surface of your poop or the toilet paper)
- Lump in or around the anus
- The feeling of fullness and discomfort in your anus
- Sore or itchy skin around your anus
- Discharge of mucus from your anus (straining your underwear)
- Sensation of incomplete evacuation
- Discomfort and pain after you go to the toilet
FAQ
Should I be concerned about bleeding from Haemorrhoids?
Bleeding from Haemorrhoids is not of a serious nature, however all anal bleeding should be checked out by your doctor as it may indicate something more serious.
How can I prevent Haemorrhoids?
You can reduce the risk of getting haemorrhoids by increasing fluid intake, increasing dietary fibre intake, using fibre supplements, regular exercise and maintaining a healthy body weight.
You should also only go to the toilet when you need to and avoid forceful wiping after a bowel movement.
Prevention of piles: What is the best home remedy for hemorrhoids
If you want to prevent hemorrhoid or improve your piles' symptoms, try the following things:
1. Improve bowel habits
- Avoid strain during bowel movements.
- Do not delay bowel movements and go when needed.
- Limit toilet time and do not sit on the toilet for an extended time.
2. Adopt a high-fiber diet
- Increase fiber intake by consuming fruits, vegetables, whole grains, and legumes.
- Stay well-hydrated to soften stools.
- Use fiber supplements, such as psyllium, if dietary fiber is deficient.
3. Dietary changes
- Avoid too much alcohol
- Do not drink too much caffeinated drinks such as tea, coffee, and cola.
4. Relieve discomfort
- Soak the anal area in warm water for 10–15 minutes 2–3 times per day (Warm Sitz Baths).
- Reduce pain and swelling of swollen areas with ice packs (cold compression).
5. Practice good hygiene
- Wipe the anal area with warm water after bowel movements. Avoid harsh soaps.
- Instead of toilet paper, use alcohol-free wipes to minimize irritation.
Prevent recurrence
- Exercise regularly to promote regular bowel movements.
- Avoid heavy lifting, as straining can worsen haemorrhoids.
- If you are obese, lose weight to reduce pressure on rectal veins.
Self-help strategies alleviate haemorrhoid symptoms; however, if symptoms persist, consult your doctor to access effective treatment options.
How to cure hemorrhoids permanently?/Do hemorrhoids ever fully go away?
To cure hemorrhoids permanently, adopt healthy lifestyles such as staying well-hydrated, eating a high-fiber diet, and avoiding straining during bowel movements.
Surgical interventions can be used for long-term success in recurrent or severe cases.
Will hemorrhoids go away?/How long does it take to get rid of haemorrhoids?
Mild haemorrhoids go away on their own within a few days with lifestyle changes and conservative treatments. However, for chronic haemorrhoids, medical interventions are used.
What are female hemorrhoids?
Female haemorrhoids are swollen blood vessels in the anal or rectal area caused by increased pelvic pressure and hormonal changes during pregnancy.
It results in itching, bleeding, discomfort, and pain but is manageable via medical care and lifestyle changes.
How to shrink a hemorrhoid fast?
To shrink haemorrhoids fastly, use ice packs to reduce swelling, warm sitz baths to promote healing, and OTC treatments such as Proctosedyl ointment or Uniroid-HC ointment to soothe the pain.
What are stage 3 hemorrhoids?
Stage 3 haemorrhoids involve internal haemorrhoids that prolapse or bulge out of the anus during bowel movements and do not go back on their own. It requires manual pushing and may cause itching, pain, or bleeding.
Should I push my hemorrhoid back in?
You can push your hemorrhoid back in if it is not too painful, offering relief and preventing irritation. For this, use clear hands and lubrication. However, if it is painful and prolapsing, consult your doctor for evaluation.
Can haemorrhoids cause stomach pain?
Haemorrhoids do not cause stomach pain. It causes discomfort in the rectal area. However, severe constipation or straining associated with hemorrhoids can lead to abdominal/stomach discomfort.
Persistent stomach may be an indication of underlying health disease, so consult your doctor for evaluation.
What are the causes of piles in females?
Piles in females are caused by straining bowel movements, chronic constipation, hormonal changes, and pregnancy, increasing pressure on rectal veins.
Moreover, obesity, low-fiber diet, and prolonged sitting can also cause piles in females.
Can stress cause haemorrhoids?
Stress does not cause haemorrhoids. However, stress can worsen the existing haemorrhoids by enhancing inflammation and tension.
Do haemorrhoids smell?
Haemorrhoids do not smell. But if they bleed, accompanied by poor hygiene, or become infected, an unpleasant odor may occur. So, maintain cleanliness and seek medical advice to prevent smell or further complications.
Why do haemorrhoids hurt so much?/Why are haemorrhoids itchy?
Haemorrhoids hurt or cause itchiness during bowel movements when the swollen veins in the anus or rectum become irritated, compressed, or inflamed. It also leads to sharp pain or burning sensation due to nerve-rich tissue in the area.
How to ease the pain of haemorrhoids?
To ease the pain of haemorrhoids, use warm sitz baths, OTC creams, and ointments, keeping the area clean and soothing. Also, enhance water intake and a fiber-rich diet to prevent straining during bowel movements.
Can haemorrhoids cause back pain?
Haemorrhoids do not cause back pain directly. However, straining, severe discomfort, or referred pain from the pelvic area sometimes may feel like back pain.
Persistent back pain may be due to some other underlying health disease, so consult your doctor for evaluation.
What foods to avoid with piles?
In haemorrhoids, avoid alcohol, caffeinated beverages, low-fiber food, processed or spicy snacks, dairy products, and fast foods. These foods can worsen hemorrhoids, inflame them, and irritate your digestive system.
What to eat when you have haemorrhoids?
When you have haemorrhoids, eat fiber-rich foods, vegetables, fruits, legumes, and whole grains to prevent straining and soften stool. Drink plenty of water and avoid processed foods to prevent irritation.
