Haemorrhoids & Piles

If you’ve noticed pain and itching around your anus, or bleeding after you’ve passed a stool, you may have piles (haemorrhoids).¹ While it can feel as though you are the only one with piles, they are extremely common.^2,3 In fact, current estimations suggest that between 13–36% of the UK population are affected by piles.^2,3 … Read More See less

Of course, knowing that lots of other people also have piles doesn’t negate the impact they can have on your mental health, as pain and embarrassment can cause some people to withdraw from their social and sexual lives.²Furthermore, many people with piles do not seek medical help until their piles become too severe to live with anymore.²

But piles are nothing to be ashamed of and, with so many people suffering with them, they shouldn’t be difficult to talk about. So, let’s discuss what causes piles, how they’re diagnosed and all the different ways that you can treat them, including the best cream for haemorrhoids. Keep reading to find out more.

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What are haemorrhoids and piles?

Piles are swollen, enlarged blood vessels that form lumps inside and around your bottom (rectum and anus).^1,4

There are four different types of haemorrhoids:⁴

Internal haemorrhoids – first degree swellings inside your rectum. These may cause bleeding, but usually aren’t painful
External haemorrhoids – second degree swellings underneath the skin around your anus. These can be itchy, painful and bleed occasionally. They may pop out of your anus when you go to the toilet, before disappearing inside again
Prolapsed haemorrhoids – third degree lumps that bulge (prolapse) outside of your anus but can be pushed back inside. These may bleed or cause pain
Thrombosed haemorrhoids – fourth degree lumps that hang down from the anus when a blood clot forms in an external haemorrhoid. These types are usually painful, cause a purple/blue lump to form and can’t be pushed back inside (irreducible)

Haemorrhoids and piles symptoms

What many people don’t realise is that we’re all born with haemorrhoids.⁴However, these don’t cause any symptoms until they swell and enlarge.⁵As a result, many people don’t realise they have piles at all.⁵

When symptoms do present, they include:^1,4,6,7

Bleeding when you wipe
Bright red bleeding after passing a stool
An itchy anus
A lump hanging down outside of your anus, which may need to be pushed back in after passing a stool
Mucus in your underwear or on toilet paper after wiping
Soreness, redness and swelling around your anus, especially when you sit
Lumps around your anus
Feeling like you still need to poo after passing a stool
A feeling of fullness in your anus

Causes of haemorrhoids and piles

The exact cause of haemorrhoids is unclear, but there is a link between piles and too much pressure being placed on the blood vessels in and around your anus.^4,6 For example, if you strain a lot when trying to pass a stool, due to constipation.⁶This pressure can cause your blood vessels to swell and become inflamed.^4,6

Other factors that can place strain on your blood vessels and increase your risk of haemorrhoids include:^4,6

Being at a higher weight
Getting older
Being pregnant
Having a family history of haemorrhoids
Regularly straining to lift heavy objects
A persistent cough or repeated vomiting
Sitting on the toilet for long periods of time
Having chronic constipation or diarrhoea
Not eating enough fibre
Having anal sex

How are haemorrhoids and piles diagnosed?

You should go to see your GP about piles if:¹

Your piles are getting worse or haven’t improved after 7 days of treatment at home
You keep getting piles
You notice a change around your anus that is not normal for you

Your GP can diagnose haemorrhoids by examining the outside of your anus for swollen blood vessels.⁵ They may also carry out a digital rectal examination, where they feel for any abnormalities in your anus using a gloved finger and lubricant.^4,5 This shouldn’t hurt but may not be very comfortable.⁵

Occasionally, your GP may decide to conduct a proctoscopy.⁵ This involves inserting a proctoscope (a thin, hollow tube with a light on the end) into your anus so they can see your anal canal (the last part of the large intestine).⁵ However, not all GPs have the training or equipment to carry out this procedure, so you may be referred to a hospital clinic to have this test.⁵

You should tell your GP if:⁵

You’ve recently lost a lot of weight
Your bowel movements have changed
Your stools have become dark or sticky

If you are losing large amounts of blood or feeling lightheaded, dizzy or faint, you should seek emergency care.⁷

How to treat haemorrhoids and piles

There are different treatments recommended for piles, depending on whether this is your first time getting piles or whether you have severe or recurring piles.^6,8

If you have never had piles before, they may clear up on their own after a few days.^6,8However, you can make some lifestyle changes to prevent them from getting worse and help to relieve the symptoms.⁵ You can also use piles creams, ointments and haemorrhoid suppositories (which you insert into your anus) to relieve pain, itching and swelling.^1,6,8

If these treatment approaches don’t produce any improvement in your piles, you may be recommended either surgical or non-surgical haemorrhoids treatments in a hospital.^1,6,8

Lifestyle changes

Lifestyle changes that can help to reduce the strain on your blood vessels include:^1,6,8

Eating plenty of fibre – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
Drinking plenty of fluid – such as water
Cutting down on caffeine and alcohol – such as tea, coffee and cola
Not ignoring the urge to poo – this can make your stools harder and drier, which can lead to more straining
Avoiding medication that causes constipation – such as codeine
Exercising regularly – to prevent constipation
Not wiping too hard after you pass a stool – to avoid putting excess pressure on your anus

Medications

Medications that can be used to treat piles include:^1,6,8

Corticosteroid cream, ointment or suppositories – this is the best haemorrhoid cream to temporarily relieve itching and swelling. However, you shouldn’t use haemorrhoids cream for more than a week at a time, as it can thin the skin around your anus and increase itching
Painkillers – paracetamol and ibuprofen can help to relieve the pain. However, you should not take ibuprofen if you have bleeding haemorrhoids, as this can increase bleeding
Laxatives – to help relieve constipation
Local anaesthetic products – to treat painful haemorrhoids. These should only be used for a few days at a time, as they can make the skin around your anus more sensitive

Non-surgical treatments

Non-surgical treatments include:^1,8

Banding – a tight elastic band is placed around your piles to cut off their blood supply, so they drop off
Sclerotherapy (injections) – a chemical solution is injected into your piles to make them shrink or shrivel up
Electrotherapy (electrocoagulation) – a gentle electric current is passed through a a small metal probe (proctoscope) that’s applied to your piles. This causes the blood supplying the haemorrhoid to coagulate (thicken), which causes the haemorrhoid to shrink
Infrared coagulation – an infrared light is used to cut the blood supply to your piles and make them shrink

You'll be awake for these treatments, but you will have a local anaesthetic to numb the area.^1,8 This means you should be able to go home on the same day.^1,8

Surgical treatments

Around one in ten people with haemorrhoids will eventually need surgery. Surgical treatments include:^1,8,9

Haemorrhoidectomy – your piles are cut out
Stapling (haemorrhoidectomy) – your piles are stapled back inside your anus. This can prevent prolapsing and reduce the blood supply to your haemorrhoids, causing them to gradually shrink
Haemorrhoidal artery ligation – each blood vessel is stitched closed to block the blood supply and cause them to shrink

These treatments are performed under a general anaesthetic, so that you don’t feel any pain.^1,8,9 This may mean that you need to stay in hospital for a day or so, until you are well enough to go home.^1,8,9

Whichever procedure you have, you will be advised to continue implementing lifestyle changes to reduce the risk of your piles coming back.^1,8,9