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(Tuesday, 21st Apr, 2015)
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Piles (Haemorrhoids)

What are haemorrhoids?

Haemorrhoids are small, blood-filled swellings, caused by dilated (varicose) veins of the rectum or anus, that cause anal bleeding, itching and discomfort. They may be located at the beginning of the anal canal (internal haemorrhoids) or at the anal opening (external haemorrhoids) and may be present for years, but go undetected until bleeding occurs. Haemorrhoids are not dangerous.

Who is affected?

Haemorrhoids are most common in adult men and women.

What causes haemorrhoids?

Constipation and straining during bowel movements may cause haemorrhoids by increasing the pressure in the anal or rectal veins. Other factors that may contribute to haemorrhoids include a low fibre diet, prolonged sitting or standing, obesity, anal intercourse, pregnancy and loss of muscle tone due to old age or rectal surgery.

What are the symptoms of haemorrhoids?

  • Rectal bleeding — bright-red blood may appear as small stains on toilet paper or as a slow trickle for a short time following bowel movements.
  • Pain, itching or mucus discharge following bowel movements.
  • A lump can be felt in the anus.
  • A sensation that the rectum has not emptied completely after a bowel movement — this is only felt if you have large haemorrhoids.

How are haemorrhoids diagnosed?

You will probably suspect that you have haemorrhoids, but you should visit your doctor to rule out any other possible causes of the rectal bleeding. Your doctor will organise investigations, if they are necessary.

How are haemorrhoids treated?

In many cases haemorrhoids can be controlled by simple measures.

  • Change of diet —your doctor may recommend a high fibre diet and more green vegetables, fresh fruit, wholegrain cereals and bran. You will also be encouraged to increase the amount of fluids you drink each day.
  • Over-the-counter or prescription creams are available and will relieve discomfort and itching and reduce swelling in mild cases.
  • Laxative drugs may be prescribed to prevent constipation and soften the stools.

More troublesome haemorrhoids may require additional treatment.

  • Rubber band ligation — this may be recommended in more severe cases. This involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid and the haemorrhoid falls off after a few days. This procedure can be performed at an outpatient clinic and does not require hospital admission. 
  • Sclerotherapy — in severe cases the affected vein can be injected with a substance that makes the blood in the haemorrhoid clot.
  • Surgical removal — this will usually be recommended only for severe cases such as third degree haemorrhoids, which protrude through the back passage. After surgery, small skin tags can develop beside the back passage and may be slightly painful or itchy. These can also be surgically removed by a minor operation.

What can I do?

  • Do not hurry or strain during a bowel movement, especially following treatment, or the haemorrhoids may recur.
  • Clean the anal area gently with soft, moist paper after each bowel movement.
  • Add plenty of fibre to your diet, drink eight to 10 glasses of water every day and exercise regularly.
  • To relieve pain, sit in eight to 10 inches of hot water for 10—20 minutes several times a day.
  • If a haemorrhoid is swollen and painful and protruding from the back passage, stay in bed for a day and apply ice packs to the anal area for 20 minutes an hour for a maximum of three hours a day. Try using a pack of frozen vegetables wrapped in a cloth and never allow the ice to come directly into contact with the skin.

What is the outlook?

Haemorrhoids usually clear up with proper care, although symptoms may flare up again following a bout of constipation.

Avoiding constipation is the best way to prevent recurrence.

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