Haemorrhoids - Causes, Symptoms & Treatment

 

Haemorrhoids, also known as piles, are a common condition that affect the anal area. They occur when the blood vessels in the rectum or anus become swollen and inflamed.

The exact cause of haemorrhoids is not fully understood, but several things are thought to cause them. This includes straining during bowel movements, chronic constipation or diarrhoea, sitting for prolonged periods, genetics, obesity, pregnancy and ageing.

Symptoms of haemorrhoids can vary depending on their type and severity. Internal haemorrhoids are often painless and may go unnoticed until they bleed during a bowel movement.

On the other hand, external haemorrhoids can be more painful and cause itching, swelling, and discomfort.

Treatment for haemorrhoids usually involves lifestyle changes and self-care measures. Increasing fibre intake, drinking plenty of fluids and avoiding straining during bowel movements can help alleviate symptoms and prevent them from coming back.

Symptoms

Haemorrhoid symptoms can vary. One of the most common symptoms is bleeding in the rectum, and it’s usually painless. The blood may be bright red and occur during or after a bowel movement.

They can also cause itching and irritation, leading to a persistent urge to scratch. External haemorrhoids can be painful and cause discomfort, possibly resulting in a lump or swelling around the anus.

This may be sensitive to touch or when pressure is applied. Sitting, walking or having a bowel movement may increase pain. Haemorrhoids can sometimes produce excess mucus, too, which can contribute to itching and irritation.

It’s important to note that the symptoms of haemorrhoids can also be caused by other conditions, such as anal fissures or inflammatory bowel disease (IBD). If you’re displaying any of these symptoms, always speak to your GP to be officially diagnosed with haemorrhoids.

Causes

The exact cause of haemorrhoids is not fully understood, but several factors can contribute to their development. 

One of the primary causes of haemorrhoids is excessive straining during bowel movements. Straining while passing stool puts increased pressure on the blood vessels in the rectum and anus, leading to swelling and inflammation. This can be because of chronic constipation.

Both chronic constipation and chronic diarrhoea can increase the risk of developing haemorrhoids. Constipation causes hard and dry stools that require straining, while diarrhoea can lead to frequent bowel movements and irritation.

Sitting for prolonged periods of time, especially on hard surfaces, can increase the risk of developing haemorrhoids. 

Putting pressure on this area slows down blood circulation, leading to their formation. Being overweight or obese also puts extra pressure on the rectal area. Heavy lifting is also a known cause.

As you age, the tissues supporting the veins in the rectum and anus weaken, making you more susceptible to haemorrhoids. If you have a family history of haemorrhoids, you may be at an increased risk of developing them yourself.

Piles during pregnancy

Piles are common during pregnancy. The hormonal changes and increased pressure on the pelvic area are thought to contribute to their development.

The main cause of piles during pregnancy is due to the increased pressure on the rectal veins. The growing baby puts pressure on the pelvic veins and the inferior vena cava, which can slow down blood flow and cause the veins to swell and become inflamed.

Hormonal changes during pregnancy can also contribute to the development of haemorrhoids by relaxing the walls of blood vessels.

Diagnosis

Diagnosing haemorrhoids typically involves a medical evaluation performed by your GP. They may visually inspect the area and use a gloved, lubricated finger to conduct a digital rectal examination to feel for growths or anything unusual.

As internal haemorrhoids are typically too soft to be felt during a rectal exam, your GP may examine the anal canal or lower rectum with an anoscope, a short, tube-like instrument with a light source.

When to see your GP

You should see your GP if: 

• Your haemorrhoids are getting worse or there isn’t any improvement after 7 days.
• Your haemorrhoids keep coming back.
• You notice any unusual changes around your anus that aren’t typical for you.

During your appointment, your GP may prescribe stronger medicines for haemorrhoids or constipation, and evaluate whether your symptoms may be the cause of an underlying medical condition.

When to call 111/an emergency doctor

You should either ask for an urgent GP appointment, contact an emergency doctor or get help from NHS 111 if:

• You have haemorrhoids and your temperature is very high or you feel hot and shivery, along with a general sense of being unwell. These symptoms could indicate a potential infection.
• You notice pus leaking from your haemorrhoids, as it may suggest an infection. 

When to go to A&E/call emergency services 

You must go to A&E or call 999 if you have haemorrhoids and:

• Your haemorrhoids are bleeding non-stop
• You notice a significant amount of blood, such as the toilet water turning red or if you notice large blood clots.
• You are in severe pain with your haemorrhoids.

Treatment

Haemorrhoid treatments may vary depending on the type and severity of the haemorrhoids. In general, treatment options include topical medications and suppositories, home treatments, hospital treatments, and, in severe cases, surgical procedures. 

Medications (creams, ointments and suppositories)

There are several topical medications (creams and ointments) available for the treatment of haemorrhoids. These medications are applied directly to the affected area and can help alleviate symptoms, shrink the size of the haemorrhoids and promote healing.

Products containing lidocaine can provide pain relief by numbing the area; these are known as analgesics or local anaesthetic. Examples commonly used in the UK include Anodesyn and Germoloids, which are both available without prescription.

Topical protectants create a barrier on the skin, helping to reduce irritation and quicken the healing process. Some products contain ingredients like zinc oxide, hamamelis water or cod liver oil. 

Regular Anusol and Germoloids products contain protectants, in addition to Germoloids infusing a local anaesthetic, too, for added pain relief.

Corticosteroid products may be prescribed by a healthcare professional to reduce inflammation and itching. Hydrocortisone-based products, such as Anusol Plus HC, are ideal.

If creams and ointments aren’t for you, there are also haemorrhoid suppositories which contain the same active ingredients as the products listed above. They’re inserted into the back passage, usually after every bowel movement. But always read the instructions before use.

Xyloproct is an ointment that contains both lidocaine and hydrocortisone. It’s very effective at relieving discomfort caused by piles, in addition to reducing inflammation. 

Scheriproct is an ointment that uses two active ingredients, prednisolone, that’s included to help reduce swelling and inflammation, and a local anaesthetic called cinchocaine, which helps to ease pain and itching.

However, for these two products, you will need a prescription from one of our prescribing pharmacists who will check whether it’s suitable for you.

Constipation relief 

Laxatives are a type of medication that can be used to help regulate bowel movements, helpful if you’re struggling with a bout of constipation as the result of haemorrhoids.

There are several types of laxatives available, and the specific one offered to you will depend on your symptoms and needs. 

It's important to follow the instructions provided by your healthcare provider when taking laxatives, as they should only be used for a short period of time.

The first type is a bulk-forming laxative (Fybogel) that works by increasing the weight of your stool, helping to stimulate a bowel movement. These take around 2 to 3 days to work.

Stimulant laxatives (bisacodyl, also known by the brand name Dulcolax; senna, also called Senokot) stimulate the muscles that line your gut, helping to shift the stool to your back passage. These are faster-acting laxatives that take around 6 to 12 hours to work.

There are also osmotic laxatives like lactulose (Duphalac and Lactugal). Macrogol is another osmotic laxative that’s known by the brand names Movicol and Laxido. These draw in water from the rest of your body to soften the stool and make it easier to pass. Again, these take around 2 to 3 days to work.

Finally, there are stool-softener laxatives that allow water into the stool to soften it, making it easier and more comfortable to pass. These include docusate, also known by Dulcoease.

Home treatments (cold packs and symptom relief)

There are simple treatments you can adopt at home to provide relief against haemorrhoids, but they’re better used alongside other treatment options, like a medicated cream or ointment.

Soaking in a warm, shallow bath, known as a sitz bath, can help relieve itching, pain and inflammation associated with haemorrhoids. Fill a small tub or basin with warm water and sit in it for about 10 to 15 minutes, two to three times a day. Make sure to gently pat the area dry afterward.

Applying cold compresses or ice packs to the affected area can help reduce swelling and discomfort. 

Wrap a few ice cubes in a clean cloth or use a cold pack and gently apply it to the haemorrhoids for about 10 to 15 minutes at a time. Remember to always wrap the ice pack in a cloth to protect the skin.

Hospital treatments (without surgery)

There are a number of hospital treatments you can get for haemorrhoids that don’t involve surgery. 

Rubber band ligation involves placing a small rubber band around the base of the haemorrhoid to cut off its blood supply. Overtime, the haemorrhoid will shrink and fall off.

Sclerotherapy is a chemical solution that’s injected into the haemorrhoid, causing it to shrink and eventually disappear. Electrotherapy involves applying a gentle electric current to the haemorrhoid, which helps to shrink it down.

Infrared coagulation is an infrared light that’s used to cut off the blood supply to the haemorrhoid, leading to it shrinking.

These treatments are typically performed on an outpatient basis, and you will be awake during the procedure, although the area will be numbed to minimise discomfort. After the treatment, you should be able to go home on the same day.

Surgery 

If non-surgical treatments haven’t been effective, the last option you have would be surgery. Surgical treatments for haemorrhoids include haemorrhoidectomy, which involves surgically removing the haemorrhoid tissue. 

Haemorrhoidectomy is often recommended for severe or recurring haemorrhoids.

Stapled haemorrhoidopexy involves stapling back the piles inside the anus. This helps to reduce the blood flow to the haemorrhoids and promote their shrinkage. 

Haemorrhoidal artery ligation (HAL) involves the use of stitches or sutures to cut off the blood supply to the haemorrhoids. By reducing the blood flow, the haemorrhoids shrink.

All of these surgical procedures involve general anaesthetic, and you may need to stay in hospital overnight until you recover.

Preventon

Preventing haemorrhoids involves adopting certain lifestyle habits and making dietary changes to promote regular bowel movements and minimise strain on the anal area. Here are some effective measures for haemorrhoid prevention:

• Maintaining a high-fibre diet: Include plenty of fibre-rich foods in your daily meals, such as fruits, vegetables, whole grains, legumes and nuts. Fibre adds bulk to the stool, making it easier to pass, and helps prevent constipation.

• Staying hydrated: Drink an adequate amount of water throughout the day to keep yourself hydrated. Sufficient hydration helps maintain soft and easy-to-pass stools.

• Avoid straining: Straining during bowel movements puts extra pressure on the anal area and increases the risk of haemorrhoids. Take your time, avoid pushing forcefully and respond to the natural urge to have a bowel movement.

• Establish regular bowel habits: Try to maintain a consistent schedule for bowel movements. Responding to the urge when it arises can help prevent constipation and reduce the likelihood of developing haemorrhoids.

• Engage in regular physical activity: Regular exercise, such as walking, jogging, or swimming, promotes healthy bowel movements and reduces the risk of constipation. Aim for at least 30 minutes of moderate exercise most days of the week.

• Practice good bathroom habits: Avoid sitting on the toilet for prolonged periods, as it can increase pressure on the anal area. Also, consider using a squatting position or placing your feet on a small step or stool to align the rectum for easier elimination.

• Maintain a healthy weight: Excess weight and obesity can contribute to the development of haemorrhoids. Maintain a healthy weight through a balanced diet and regular exercise.

• Avoid straining during lifting: When lifting heavy objects, remember to use proper lifting techniques and avoid straining excessively. Straining can increase abdominal pressure and strain the veins in the rectal area.

• Manage chronic diarrhoea or constipation: If you experience chronic diarrhoea or constipation, seek medical advice. Chronic bowel issues can increase the risk of haemorrhoids.

• Practice good anal hygiene: After bowel movements, gently clean the anal area with mild, unscented soap and water. Avoid using harsh or irritating toilet paper. Pat the area dry rather than rubbing.