Haemorrhoids (Piles)

Haemorrhoids are associated with increased pressure in the blood vessels in and around the anus. The pressure can cause the blood vessels in your back passage to become swollen and inflamed.

Most cases are thought to be caused by too much straining when going to the toilet. This is usually a result of prolonged constipation, which is frequently caused by a lack of fibre in a person’s diet.

Chronic diarrhoea can also make you more vulnerable to getting haemorrhoids.

Risk factors

Factors that may increase your risk of developing haemorrhoids include:

• Overweight or obesity
• Family history of haemorrhoids
• Lifting heavy objects on a regular basis
• Persistent coughing or repeated vomiting
• Sitting down for long periods of time
• Age – as we age our body’s supporting tissues get weaker
  pregnancy – Pregnancy increases pressure on your pelvic blood vessels, causing them to enlarge. You can read more about piles in pregnancy

If symptoms do occur, they may include the following:

• Pain on passing stool
• Bleeding after passing a stool
• Itchy bottom
• Feeling a lump when wiping your bottom
• A lump hanging down, outside the anus, which may need to be pushed back in after passing a stool.
• A temporary, acutely painful/tender anal swelling that will usually settle within 7-14 days, often leaving a small, painless anal skin tag.

The symptoms of haemorrhoids will often clear up on their own, or by using treatments that can be bought from a pharmacy without prescription.

You should visit your GP if you are having persistent or severe discomfort or any bleeding/mucus discharge from your back passage.

Your GP will often diagnose haemorrhoids using a simple internal examination of your back passage.

Some people with haemorrhoids are hesitant to see their GP but there is no need to be embarrassed – all GPs are used to diagnosing and treating haemorrhoids.

You should always get any rectal bleeding/discharge checked so that your doctor can rule out a more serious cause.

Depending on the severity of your haemorrhoids, your GP may refer you to see a colorectal specialist for treatment.

If you are referred for treatment this is subject to NHS referral criteria which will need to be met. Haemorrhoid operations are not often necessary. Your GP will be aware of what criteria will need to be met.

In some circumstances your referral may be returned to your GP.

If your referral meets criteria and you are referred for possible surgery, you can find out more here.

The removal of anal skin tags is not routinely commissioned in Devon.

It is crucial to tell your GP about all of your symptoms – for example, if you have recently lost a lot of weight, if your bowel movements have changed, or if your stools have become dark or sticky.

Read in more detail the different methods of diagnosis.

After you have had a rectal examination, your GP will be able to determine what type of haemorrhoids you have. Haemorrhoids can develop internally or externally. Haemorrhoids can be further classified, depending on size and severity:

• First degree – Small swellings that develop on the inside lining of the anus and aren’t visible from the outside
• Second degree – Larger swellings that could come out of your anus when you go to the toilet, before disappearing inside again
• Third degree – One or more small, soft lumps that hang down from the anus and can be pushed back inside
• Fourth degree – Larger lumps that hang down from the anus and cannot be pushed back inside

Haemorrhoids often settle down after a few days without needing treatment.

Making lifestyle changes can reduce the strain on the blood vessels in and around your anus.

These can include:

• gradually increasing the amount of fibre in your diet
• drinking plenty of fluids. Avoiding or cutting down on caffeine and alcohol
• not delaying going to the toilet
• avoiding medication that causes constipation
• losing weight
• exercising more frequently
• Washing around your anus after each bowel action

These measures can reduce the risk of haemorrhoids returning or even developing in the first instance.

Depending on how severe your haemorrhoids are, you may use medication that you apply directly to your back passage or tablets (pessaries) bought from a pharmacy or prescribed by your GP. These may ease symptoms and make it easier for you to pass stools. To read more on treatments available for Haemorrhoids click here.