Haemorrhoids Treatments
Haemorrhoids, also known as piles, can be an embarrassing condition to seek treatment for and people may hesitate to speak to a healthcare professional about it. However, there are many treatments that are available to treat this condition. Fill out the health questionnaires below and one of our prescribers will make sure that you receive the most suitable treatment for your condition.
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Haemorrhoids Key Information
Haemorrhoids/piles
Haemorrhoids (or piles) exist in healthy individuals maintaining continence and acting as ‘cushions’. In some patients, haemorrhoids develop into swollen blood vessels or lumps inside the rectum or around the anus, which can be internal (inside the anal canal) or external (around the opening of the anus).
They are very common, affecting up to 8 million people in the UK ( community-based studies in the UK reported that haemorrhoids affect 13-36%). Haemorrhoids may be present for years without being detected, often becoming noticeable when they bleed.
Symptoms can include pain, rectal bleeding, and anal itching. While they usually resolve within a few days, at-home treatments can help prevent them, and in some cases, medical intervention may be necessary.
Your anus naturally contains blood vessels and spongy tissues called anal cushions, which help keep the anus closed. When these blood vessels become swollen, haemorrhoids can develop, causing discomfort.
Haemorrhoids can affect people of all ages, often leading to symptoms like itching, bleeding, or discomfort during bowel movements. Thankfully, the condition is treatable and manageable through OTC remedies and self-care measures.
How common are piles?
Hemorrhoids are a common condition, affecting 13-36% of the general population. About 50% of adults experience piles by the age of 50; however, it can occur at any age.
Although haemorrhoids are common, they remain undiagnosed as many people manage their symptoms with over-the-counter treatments and self-care.
But if your symptoms persist or become more severe, it is important to consult a healthcare professional for expert advice.
Types of piles
Haemorrhoids can also be referred to as varicose veins of the anus. Haemorrhoids can develop inside the rectum (above the dentate line), called internal piles, or under the skin around the anus (below the dentate line), called external hemorrhoids.
The dentate line is the anatomical delineation between the lower and upper anal canal and is 2 cm above the anal verge.
Let’s look at the types of hemorrhoids in detail!
Internal haemorrhoids
Internal piles have four categories based on the degree of prolapse (how much they stick out):
- First-degree: Small, internal haemorrhoids that don’t prolapse. They cause bleeding but do not come out of the anus.
- Second-degree: Internal haemorrhoids that prolapse during bowel movements but retract on their own afterward.
- Third-degree: Internal haemorrhoids that prolapse and require manual retraction. Come out of your anus during straining and go back only if you push them back.
- Grade 4/Fourth-degree Piles: Prolapsed haemorrhoids that cannot be manually pushed back inside and may require surgical intervention.
External haemorrhoids
External hemorrhoids are swollen veins that form outside the anus, under the skin around the anal opening. They can cause pain, itching, and occasional bleeding.
In some cases, blood clots can form within the haemorrhoid, leading to a condition known as a thrombosed haemorrhoid, which can be particularly painful. Both internal and external hemorrhoids can occur simultaneously.
Thrombosed haemorrhoids
A thrombosed haemorrhoid is a condition in which the swollen blood vessels in your anal area have developed blood clots called a thrombus. It is an intense and painful form of hemorrhoids, causing symptoms such as:
- Severe pain during walking, sitting, or bowel movements
- A noticeable lump or swelling near the anus
- Bleeding
- Irritation or itching around the anal area
- Purple or bluish discoloration
So, how to treat thrombosed haemorrhoids? The conservative treatment includes OTC painkillers, ice packs, stool softeners, topical ointments, or any hemorrhoids cream.
If managed conservatively, the symptoms may resolve within 10-14 days. If not, minimally invasive procedure (thrombectomy) or surgical interventions (haemorrhoidectomy) is used.
Difference between hemorrhoids and anal fissures
Haemorrhoids involve vein-related issues; fissures are an issue with the lining of the anal area. Proper diagnosis and treatment depend on the identification of the specific condition.
| Haemorrhoids/piles | Anal fissures |
| Haemorrhoids and anal fissures are different conditions that affect the anal region; however, they share similar symptoms like bleeding and pain. | Anal fissures cause severe pain during and after bowel movements and sometimes minor bleeding. |
| Haemorrhoids are swollen veins within the rectum or under the skin around the anus, causing itching, swelling, and bleeding during bowel movements. | While anal fissures are small tears or cracks in the lining of the anal canal, resulting from trauma during bowel movements such as passing hard stools. |
Are skin tags the same as hemorrhoids?
- Skin tags and piles are not the same things, but skin tags could be a symptom of hemorrhoids.
- Skin tags are benign (not serious), small, usually soft, that appear most times around the anal area or other parts of the body. They are not dangerous and are usually painless.
- Anal skin tags may appear after a hemorrhoid has healed because the skin is stretched out and remains behind. This occurs due to repeated irritation or swelling in this area.
- On the other hand, haemorrhoids are conditions resulting from swollen veins in the rectum or the anus. Unlike skin tags, piles contain blood vessels in their structure and, therefore, may need medical intervention if they are symptomatic.
In case you are not sure whether a lump or growth is a skin tag or due to haemorrhoids, consult a doctor to get the right advice.
When You Should See a Doctor About Piles (Haemorrhoids)
Haemorrhoids/piles can go away without any treatment. However, you must visit your doctor if you notice:
- Blood and mucus in your poo
- Changes in the stool colour
- Very high temperature or you feel hot and shivery
- Recent or unexplained weight loss
- Changes in your bowel movements or habits
- Abdominal pain
- Rectal bleeding
- Dizziness
- Faintness or lightheadedness
Moreover, if your haemorrhoids do not improve after a week of treatment at home, consult your doctor immediately, as it may be due to anal cancer and/or colorectal cancer.
Risk Factors for Hemorrhoids: Who Is Most at Risk?
Haemorrhoids can affect anyone at any age, but certain groups are more prone to this condition due to specific risk factors. Commonly, piles are seen in:
Adults Over 50 Years Old
As people age, the tissues supporting the veins around the anus weaken, making older adults more susceptible to haemorrhoids.
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Pregnant women
Haemorrhoids are common in pregnant women due to increased pressure on the pelvic veins and hormonal changes during pregnancy. While they often resolve after childbirth, they can cause discomfort during pregnancy.
People with chronic constipation/diarrhoea
Straining during bowel movements, often due to constipation, or frequent diarrhoea can irritate and weaken the veins around the anus, leading to haemorrhoids.
Those who sit for long periods
Prolonged sitting, especially on the toilet, can place extra pressure on the anal veins and increase the risk of piles.
Individuals with obesity
Excess weight in the abdomen adds strain on the rectal veins, making those who are overweight or obese more likely to develop haemorrhoids.
People with low-fiber diets
Lack of fiber causes constipation, leading to the development of haemorrhoids. One of the main reasons for haemorrhoid development is constipation and lack of fiber.
People who lift heavy objects
Lifting heavy objects increases abdominal pressure and straining, enhancing the risk of haemorrhoids.
People with chronic cough or sneezing
Conditions that cause frequent coughing or sneezing, such as allergies or respiratory conditions, can increase pressure on the anal veins, potentially leading to hemorrhoids.
People who got an injury to the rectum or spinal cord
Spinal cord or rectum injuries impair your bowel function, causing straining or constipation and leading to haemorrhoids.
IBD (inflammatory bowel disease)
Conditions such as ulcerative colitis and Crohn’s disease involve chronic constipation or diarrhoea, causing haemorrhoids.
Family history of haemorrhoids:
Family history enhances the risk of haemorrhoids because genetic factors can affect the elasticity and strength of the surrounding tissues and vein walls, leading to haemorrhoids.
Haemorrhoids are less common in children and young adults. The risk can be reduced by adopting healthy bowel habits, staying active, and eating a high-fiber diet.
What Happens If Hemorrhoids Are Left Untreated?
If haemorrhoids are ignored, they may worsen, leading to pain, bleeding, thrombosis, or other complications. [see the Symptoms and Complications sections for more details).
Helpfull Resources
https://www.bupa.co.uk/health-information/digestive-gut-health/haemorrhoids
https://patient.info/doctor/haemorrhoids-piles-pro
https://pharmaceutical-journal.com/article/ld/case-based-learning-haemorrhoids
What can cause haemorrhoids?
Haemorrhoids arise from recurring pressure in the veins of the rectum and anus. They may also be caused by constipation and straining to empty bowels.
Diarrhoea also causes stress on the bowels and may lead to haemorrhoids. Other factors that may cause haemorrhoids are sitting for long periods, obesity, losing muscle tone due to age, anal intercourse, anal infection, rectal surgery and inflammatory bowel conditions.
Other Conditions That Cause Symptoms Like Haemorrhoids
Different gastrointestinal conditions may cause rectal bleeding and other symptoms similar to haemorrhoids/piles. These include:
- Crohn’s disease
- Colon cancer
- Ulcerative colitis
- Anal cancer
- Inflammatory bowel disease
- Bowel cancer
- Anal fissure (small tear in the lining of the anus)
- Rectum prolapse (rectum protruding through the anus)
- Anal abscess or fistula
- Pruritus ani (itching that is caused by skin conditions, hygiene issues, or infections)
- Colorectal cancer or polyps (tumors in the colon or rectum)
- Perianal warts or skin tags (lumps near the anus)
- Rectal ulcer syndrome (ulceration in the rectum)
So, if you experience unusual or persistent symptoms, consult your doctor for an early and right diagnosis and to access appropriate treatment.
Diagnosis and Treatments
The diagnosis of haemorrhoids includes a medical history review, physical examination, and, if necessary, additional diagnostic tests. Here is how it is typically done:
1. Medical history
The doctor will ask about the following:
- Symptoms such as bleeding, pain, itching or swelling.
- Dietary habits such as fiber and fluid intake.
- Bowel habits such as constipation, diarrhoea, or straining.
- Family history of haemorrhoids or related conditions.
2. Physical examination
External Examination: The doctor examines the anus and rectum visually to look for external haemorrhoids, swelling, irritation, or prolapsed internal haemorrhoids.
Digital Rectal Examination(DRE): A gloved, lubricated finger is inserted into the rectum to examine internal haemorrhoids, lumps, or abnormalities.
3. Anoscopy
An instrument called an anoscope (a small, lighted tube) is used to look into the anus and lower rectum to see if there are internal haemorrhoids or other abnormalities.
4. Additional tests (if needed)
These may be done to rule out other conditions causing similar symptoms, such as colorectal cancer, polyps, or inflammatory bowel disease:
- Proctoscopy: An examination of the rectum with a small instrument (a hollow tube with a tiny light at the end).
- Sigmoidoscopy: To examine your lower colon and rectum with a lighted tube with a camera. The procedure may include rigid sigmoidoscopy and flexible sigmoidoscopy.
- Colonoscopy: To check if there is significant rectal bleeding and/or a concern for cancer or other serious conditions.
Early diagnosis and effective treatment provide relief from symptoms and prevent complications; so do not feel embarrassed about these tests.
Treatment of piles: How to treat painful hemorrhoids
If your symptoms of piles do not go away, you may need access to treatment options to relieve your symptoms. The treatment options depend on the severity of the symptoms and degree of prolapse, including:
Piles Treatments
The medications for piles include:
- Paracetamol (do not use codeine analgesia)
- OTC (over-the-counter) medications, creams, suppositories, or ointments such as witch hazel, lidocaine, or hydrocortisone.
- Corticosteroids such as Proctosedyl ointment or Uniroid-HC ointment
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Bulk-forming laxatives such as sterculia, ispaghula husk, or lactulose.
Non-surgical
In some cases, other treatments are required, such as:
- Rubber band ligation (banding): In this, a tight elastic band is placed around your hemorrhoids to cut off their blood supply. It causes the haemorrhoids to fall off and pass out of the body within a few days.
- Photocoagulation (infrared treatment): This procedure uses infrared light to burn away your haemorrhoids.
- Sclerotherapy (injection): In this, a chemical is injected into your haemorrhoids, stopping bleeding, numbing pain, and shrinking your haemorrhoids (too small to use a rubber band).
- Bipolar diathermy & direct current electrotherapy: This treatment uses electric current or heat to destroy the pile.
Before using any procedure, your doctor will tell you the pros and cons of each treatment according to your health and current condition.
Surgery
If the above treatment options do not work, surgical interventions are used to remove the hemorrhoids. Its different types include:
- Haemorrhoidectomy: Sever pile removal surgery under general anesthetic.
- Stapled haemorrhoidopexy: Best for symptomatic internal haemorrhoids. In this specialised circular stapling gun is used that staples back your piles inside your anus.
- Haemorrhoidal artery ligation operation (HALO): In this process, stitches cut off the blood supply to your piles (haemorrhoids) and let them shrink.
Written and reviewed by our qualified team — Mr Suhail Jamil, Superintendent Pharmacist (GPhC 2069518).