Piles (haemorrhoids): symptoms, self-care and treatment, a review

Piles, also called haemorrhoids, can be uncomfortable, but they often improve on their own and simple changes can help. This article explains what piles are, what makes them more likely, how to ease symptoms and which medical treatments are available. It uses information from the NHS, NIDDK and MedlinePlus.

1. Introduction

NIDDK describes haemorrhoids, or piles, as swollen and inflamed veins around the anus (the opening of the back passage) or in the lower rectum (the last part of the bowel) ^[2]. External piles form under the skin around the anus, and internal piles form in the lining of the anus and lower rectum ^{[2, 3]}. The NHS says piles are lumps inside and around the anus and often get better on their own after a few days ^[1].

2. Causes and risk factors

The NHS says the exact cause is not clear, but these things are linked to piles ^[1]:

• Constipation, meaning hard stools that are difficult to pass
• Straining when passing stool
• Heavy lifting
• Pregnancy
• Getting older
• Being overweight

MedlinePlus explains that extra pressure on the veins around the anus, from straining, sitting on the toilet for a long time, long-lasting constipation or diarrhoea, a low-fibre diet or frequent heavy lifting, can lead to piles. Weakening of the supporting tissues with ageing and pregnancy also plays a part ^[3]. NIDDK also lists certain toilet habits, constipation and a low-fibre diet ^[2].

3. Signs and symptoms

The NHS lists these symptoms ^[1]:

• Bright red blood after passing stool
• An itchy anus
• A feeling that you still need to go after using the toilet
• Mucus in your underwear or on the toilet paper
• Lumps or pain around the anus

Lumps can be as small as a pea or as large as a grape, and pink or purple ^[1]. MedlinePlus says internal piles are usually painless unless they prolapse, which means they push out through the anal opening. External piles can cause itching, hard tender lumps and pain, especially when sitting ^[3]. Too much straining, rubbing or cleaning can make symptoms worse ^[3].

4. Diagnosis

Piles are usually diagnosed from your medical history and a physical examination. External piles can often be seen, and the doctor may do a digital rectal examination to check for internal piles or use procedures such as anoscopy to look inside the anus and rectum ^{[2, 3]}. The NHS says a GP may also check that something else is not causing your symptoms ^[1].

5. Self-care and prevention

The NHS suggests these steps for symptoms ^[1]:

• Drink plenty of fluid and eat fibre to keep stools soft
• Take a warm bath to ease itching and pain
• Use an ice pack wrapped in a towel
• Keep the area clean and dry, patting rather than rubbing
• Cut down on alcohol and caffeine
• Gently push a pile back in if you can

The NHS advises not ignoring the urge to go, not pushing hard on the toilet and not spending longer than needed on the toilet ^[1]. MedlinePlus says a high-fibre diet, enough fluids and avoiding straining and long periods on the toilet help both treat and prevent piles, and NIDDK says high-fibre foods and drinking fluids help treat and prevent them ^{[2, 3]}. A pharmacist can suggest creams for pain, itching and swelling and laxatives to soften stools ^[1]. Ask the pharmacist what suits you, including which painkillers are suitable.

6. Medical treatment

The NHS says that if home treatment does not work, hospital treatments that do not need surgery may be used. They include ^[1]:

• Rubber band ligation, where a band is placed around a pile so it drops off
• Sclerotherapy, where a liquid is injected to shrink the pile
• Electrotherapy, where a gentle electric current shrinks the pile
• Infrared coagulation, where infrared light cuts off the blood supply

You are awake for these, the area may be numbed and you can usually go home the same day, but piles can come back ^[1]. Surgery is for piles that are large or do not respond. Options include removing the piles, stapling them back inside the anus or tying off their blood supply with stitches, usually under anaesthetic ^[1]. MedlinePlus says severe cases may need surgery ^[3].

7. Pregnancy and older age

The NHS notes that piles are more likely during pregnancy ^[1]. MedlinePlus says pregnancy and ageing can weaken the supporting tissues around the anus ^[3].

8. When to see a doctor

MedlinePlus advises seeing a health professional if symptoms last after a week of home treatment, and for any rectal bleeding, because other conditions can cause it, including Crohn's disease, ulcerative colitis and cancers of the bowel or anus ^[3]. The NHS suggests a non-urgent GP visit if symptoms get worse, keep coming back or you notice an unusual change around the anus ^[1]. It advises urgent advice for painless bleeding, pus leaking from the piles, or a very high temperature with feeling unwell ^[1]. Go to hospital for bleeding that will not stop, a lot of blood or large clots, or severe pain, and do not drive yourself ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Piles often settle with softer stools, good toilet habits and simple self-care. Do not assume that all bleeding is from piles. See a doctor to be sure, especially if symptoms continue or bleeding is heavy.