Often the subject of jokes and a cause of great embarrassment, haemorrhoids, also known as 'piles'¹, can be extremely uncomfortable and are no laughing matter for the sufferer. Over half the UK population will suffer from haemorrhoids at some time in their life.

What are Haemorrhoids?

A very common ailment, haemorrhoids are swollen veins or blood vessels inside or just outside the anus². There are therefore two distinct varieties of haemorrhoid, external and internal, each with differing symptoms. It is possible to have both types at the same time. Internal haemorrhoids are often painless as they are from blood vessels on the 'dentate line' where the lining of the anus joins with the nerve rich skin. External haemorrhoids lie exclusively under the skin and can cause a lot of pain.

Doctors classify internal haemorrhoids according to their size and position in the passage:

• First Degree (Grade 1): Small swellings on the inside of the anal canal. They cannot be seen or felt from outside the passage.

• Second Degree (Grade 2): Larger in size than in first degree and may move down (prolapse) during a bowel movement but usually return into the canal after.

• Third Degree (Grade 3): Similar to grade 2, but hang out permanently unless pushed back inside with a finger.

• Fourth Degree (Grade 4): Hang down as in grade 3 but cannot be pushed back inside.

External haemorrhoids or perianal haematomae³ are small pink or bluish lumps that develop on the outside edge of the anal opening. They are not as common as internal haemorrhoids.

The Symptoms

Please always consult a doctor if these symptoms occur as some of them, such as bleeding, can also be signs of more serious conditions such as bowel cancer.

• Discomfort including itching and irritation around the anus after a bowel movement.

• Pain or a burning sensation during or after bowel movement.

• Excess mucus which you may notice on going to the toilet.

• Changes in bowel habits including a need to go even when there is nothing to pass, and a feeling that you have not emptied fully.

• Bleeding which may be apparent either on your toilet paper or in the toilet itself after bowel movement.

Haemorrhoids can occasionally develop complications. These should be seen by a doctor and can include infection, where an external haemorrhoid develops a painful abscess and thrombosis, where a prolapsed internal haemorrhoid becomes clotted causing a hard tender swelling.

What Causes Haemorrhoids?

There is still a lot of debate as to how haemorrhoids are formed. The causes listed below are some of the most common possibilities acknowledged by doctors.

• Low-fibre diets - these lead to less bulky faeces which require greater contractions and straining to pass.

• Straining - especially when associated with constipation, straining on the toilet puts excess pressure on the blood vessels.

• Pregnancy - the weight of the baby on the abdomen, extra blood flow in the body and the strain of pushing in labour might all contribute to haemorrhoids.

• Genetics - some doctors believe the tendency to develop haemorrhoids may be hereditary.

• Cancer - tumours and growths in the bowel or pelvis can exert similar pressure to pregnancy.

• Liver disease - this may cause the liver to block the venous return from the bowels, contributing to engorgement of the rectal veins.

Contrary to old wives' tales you will not get haemorrhoids from sitting on a cold surface or from standing for long periods.

Treatment

When you visit your doctor they will listen to your symptoms and will probably need to gently examine you with a gloved finger inserted into the back passage. This examination may not feel lesser degree haemorrhoids but can prove useful to the doctor in excluding other conditions. Depending on the findings your doctor may wish you to have further tests either with them or a colorectal specialist. This will probably include examination with a small telescope-like device called a 'proctoscope'.

To ease symptoms your doctor may prescribe a corticosteroid cream which will slowly shrink the haemorrhoids. Other measures include bathing and/or washing with warm water to ease the itching and irritation, applying ice to external swellings⁴ and over-the-counter creams, such as 'germoloids', to ease inflammation which may include a local anaesthetic.

It is also advisable to eat more fibre, drink plenty of water and avoid straining on the toilet. If the above treatments prove ineffective there are several other options available including:

• Banding - An elastic band is placed around the base of the haemorrhoid, cutting off its blood supply causing it to shrink and fall off. Up to three haemorrhoids may be treated at once.

• Schelerotherapy - a chemical is injected into the haemorrhoids causing them to shrink. A series of injections may be required.

• Cryosurgery - the haemorrhoids are surgically frozen causing them to shrink and fall away.

• Haemorrhoidectomy - surgical removal of the haemorrhoids, usually reserved for grade 4 cases or if all other treatment fails.