Piles (haemorrhoids)

What are piles?

They are swellings of the lining of the anus. They can cause bleeding, lumps or pain. Despite these unpleasant symptoms, they are not dangerous.

How are they confirmed?

Other conditions can cause anal symptoms, so a careful examination is necessary to confirm piles. It is uncomfortable but should not hurt. First the anus is inspected with a strong light. Next the inside of the anus is examined with a finger lubricated with jelly. Then a lighted tube is passed into the anus to inspect the last part of the bowel. Lastly, a shorter tube is passed into the anus to look for internal piles. This all takes two or three minutes.

What symptoms do piles cause?

Bleeding
Internal piles bleed easily because they form in the upper anus where the bowel lining is delicate. External piles occur in the lower anus and are covered by skin which is sensitive but relatively tough, so they seldom bleed much.

Lumps
Internal piles may be felt outside after a bowel action, then may slip back in on their own. Big internal piles sometimes have to be pushed back.
External piles can be felt at the anus.

Pain

Piles seldom hurt unless the blood vessels in them clot. These clots make the surrounding area inflamed, causing painful lumps which last for days.

How are piles treated?

The simplest treatment which helps your symptoms is the right one. The table over the page lists the conventional options. Below that is a more detailed explanation.

Summary of treatments

Main symptom Suitable treatments What treatment involves

Only bleeding. Nothing slips out of anus.

Take daily dose of “bulk” laxative, or Banding

Banding is done in surgeon’s rooms

Piles come out, then go back on their own

Banding, usually with local anaesthetic

Takes 1⁄2 hr in surgeon’s rooms. Anal ache for a few hours. Maybe take afternoon off.

Piles come out; you push them back

Banding may work but surgery mostly gives best result

For a week after surgery, stools hurt. Typically 10-14 days off work.

Piles are permanently outside

Surgery gives best result

Avoiding hard motions

If piles only bleed when you push hard to pass a motion, they may stop bleeding if your motions are softer and pass more easily. Eating more fruit or vegetables or taking a “bulk” laxative can make your motions softer.

Banding piles

For larger piles, tiny elastic bands can be slipped over them to block their blood supply. The piles then die. They and the bands usually fall off a week later into the toilet without the patient noticing. Injecting local anaesthetic beforehand usually makes the banding procedure almost painless. The lump caused by the pile may be felt inside the anus for a day or so.

Surgery

Internal piles usually need surgery if they are large enough to slip out and have to be pushed back, or are associated with large external piles. External piles are covered by sensitive skin, so treatment needs a local or a general anaesthetic because the piles are excised surgically. For some time afterwards bowel motions hurt, so surgery is only worthwhile if external piles cause quite severe symptoms, or when they are combined with large and troublesome internal piles.

Other treatments

You may have heard of coagulation of piles with an infra-red probe, cryotherapy (freezing), stretching the anus under anaesthesia, an operation which uses a stapling instrument, and tying off anal arteries using a Döppler instrument. Comparisons have shown that these produce less predictable or less satisfactory results, so they are not widely used.