Piles or Haemorrhoids

Haemorrhoids, commonly called Piles are lumps or swellings containing engorged blood vessels found just inside or around your back passage (rectum and anus).

Piles can cause the following symptoms:

1. Bright red bleeding either on toilet paper or dripping in the toilet pan.
2. Itchy bottom (called pruritis ani).
3. Slime or mucous discharge from back passage.
4. Lumps prolapsing from back passage which may need pushing back.

However, Piles may cause no symptoms at all and only those that cause symptoms need treating.

How can you avoid Piles developing in the first place?

1. Avoid constipation with high fibre diet and drink plenty of fluids
2. Avoid straining excessively while opening your bowels.
3. Avoid constipating medication like codeine, tramadol, morphine, pethidine. If you cannot avoid taking such medication, counter the constipating effect with fibre, fluids and if needed laxatives.
4. Losing weight if you are overweight and exercising regularly.

There are some factors that predispose you to developing Piles. These are being overweight, over the age of 45, pregnancy and a family history of Piles.

What are your treatment options?

Piles need treatment only if they are causing you significant symptoms. However, any rectal bleeding invariably needs investigating to confirm the presence of Piles and more importantly exclude any other cause for the bleeding.

Flexible sigmoidoscopy or a camera test is the first investigation you will be offered. This is done as a day case procedure with or without sedation and usually treatment for Piles in the form of banding is done at the same time if appropriate.

Treatment for Piles depends on the grade or severity of the Piles. They range from Grade 1 (small piles) to Grade 4 (large Piles that remain prolapsed outside the anus at all times). Treatment options are as follows:

1. Grade 1 and some Grade 2 Piles: Increased dietary fibre and fluid intake with avoidance of straining.
2. Grade 2 and 3 Piles: Banding or a sclerosant injection. Banding cuts off the blood supply to piles and they drop off. Sclerosant injection causes scarring and therefore shrinkage of Piles
3. Grade 2,3 and 4 Piles: If the above measures fail or if the Piles are too large then surgery may be the only option left. Surgery can be of the following types:

(a) Conventional surgery to cut away or excise the Piles leaving a wound.

(b) Stapling technique where a circular segment of the lining (or mucosa) of the rectum is taken away.

(c) The relatively less painful HALO (Haemorrhoidal Artery Ligation Operation) procedure. This is usually combined with Anopexy to treat prolapsing Piles.