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What is a haemorrhoid?

Haemorrhoids, also called ‘piles’ are swollen blood vessels in the back passage/ anal canal. They are similar to varicose veins and are very common. They may occur inside you body, in the anal canal, or sometimes be felt outside your anus. In this case they are called prolapsed haemorrhoids. As many as one in three of us will experience haemorrhoids at some stage in our lives.

How do I know if I have haemorrhoids?

Haemorrhoids is a distressing condition which, at its least, can cause itching and discomfort around the back passage and, at its worst, become a severe condition involving pain and bleeding. You may feel an uncomfortable ‘weight’ around your anus, or experience discomfort or pain when opening your bowels. You may find blood on your stools or on your underwear after opening your bowels, and, if your haemorrhoid is prolapsed, you will be able to feel it when wiping after opening yours bowels. These are usually painless.

How do you get them?

The most usual cause is constipation-pushing hard to open your bowels. This puts strain on the veins in the anal canal/ back passage and they will eventually enlarge and become haemorrhoids. They are more common in women during pregnancy and after childbirth. There is some evidence to suggest that haemorrhoids run in families.

Obesity, straining during bowel movements, sitting too long on the toilet, or standing or lifting too much can make hemorrhoids worse.

Is there a way of preventing them in the first place?

The most important thing is to avoid straining to open your bowels so a careful look at what you eat is important. Try to increase the amount of fibre in your diet, that is eat more cereals, fruit and vegetables, preferably with the skin still on, and drink plenty of liquids. The fibre and liquid will add bulk to your stools which helps the waste move through the intestines and results in soft stools which are quick and easy to pass. Eating 5 – portions of fruit and vegetables a day, drinking plenty of water and doing regular exercise are recommended.

You are also more likely to suffer from haemorrhoids (just as you are from varicose veins) if you are overweight.

Internal haemorrhoids

Internal haemorrhoids can be classified into grades, from 1 to 4. Small haemorrhoids (grade 1) are common, develop on the inside lining of the back passage, and cannot be seen or felt from outside the anus. Grade 2 haemorrhoids are larger, and are sometimes pushed out (prolapse) from the anus when you go to the toilet. However, afterwards, they return inside.

If you have grade 3 haemorrhoids, you may be able to feel one or more small lumps hanging from your anus. You will be able to push them back inside using your finger. Grade 4 haemorrhoids can become quite large, and permanently protrude (hang down) form the anus. They cannot be pushed back inside.

Protruding haemorrhoids can cause itching and discomfort, and there may be a mucus discharge from the irritated mucous membrane (skin around the anus). Sometimes, haemorrhoids can become inflamed and swollen, but are rarely very painful, unless associated with an actual splitting of the anus (anal fissure). However, if haemorrhoids are causing you pain and discomfort, you should see your doctor.

I’ve heard that surgery for piles isn’t very pleasant?

Surgery is an option that doctors have historically hesitated to recommend. It is an unfortunate fact that many patients suffered some post operative pain and had to take considerable time away from work.

Treatment Options

1st Degree - Dietary modification and general advise

2nd Degree - Sclerotherapy, banding

3rd Degree - Banding, Haemorrhoidectomy, PPH

4th Degree -Haemorrhoidectomy

A new procedure is available – PPH - Procedure for Prolapsed Haemorrhoids!

However, a new procedure has been under evaluation by surgeons in a number of hospitals around the country. Many thousands of patients in Europe have had their haemorrhoids successfully removed using this procedure, but it has only been introduced in the UK recently.

Called Procedure for Prolapsed Haemorrhoids (PPH) this operation can also be performed as day surgery under a very light general anaesthetic (even under a regional anaesthetic under certain conditions) and you may go home the same day. Patients who have undergone this operation report that their post-operative pain levels are low, and say they feel able to resume normal activities within a very few days of going home.

How long will I have to stay in hospital?

This is your surgeon’s decision but it is possible that you may be admitted as a day case and be able to go home on the day of your operation. However, this varies from place to place.

What to expect after the operation?

Whether you have the new PPH operation or a more conventional procedure you might experience certain post-operative symptoms. One of these is some bleeding from the rectum, this is not unusual. If the bleeding becomes heavy and troublesome; you need to return to the hospital where your surgery was performed.

Preventing the return of piles

Having got rid of your piles there is a lot you can do to help prevent their recurrence. Do make sure you stick to a high fibre diet and drink lots of liquid – every day

Do not rely on convenience foods/ fast foods.

When you open your bowels, don’t strain. The correct diet should ensure that you pass stools quickly and without discomfort.

Drink plenty of water and exercise in moderation.