Piles, or haemorrhoids, are actually enlarged, worn-out veins – varicose veins that may feel rather like soft, spongy grapes. They’re found in and around the lower rectum and anal canal at the very lowest end of the bowel, in a pad of tissue that is not unlike the lips found at the opposite end of the digestive system! Nature intended this soft tissue to be there because, when healthy, it makes a very good seal. But when the veins within it enlarge, becoming piles, a discharge of mucus from the anus can be just one of many distressing symptoms.
Doctors believe that at least half the people in Britain suffer from piles at some time in their life, although many are too embarrassed to seek advice. A susceptibility seems to run in families, perhaps due to an inherited weakness in the wall of the rectal blood vessels. The veins the walls contain, unlike veins elsewhere, do not have valves in them to aid the flow of blood. If anything increases the pressure on these rectal veins, they can become engorged and distended, just like varicose veins in the leg. So there is really no need to be embarrassed about having piles – the chances are that the doctor or pharmacist you consult will have had them too! They really are very common, even more so in men than in women. You are more likely to suffer from piles as you get older (especially if you are overweight), although quite young people can be troubled by them too.
There are many old wives’ tales about the causes of piles. Despite popular belief, you do not get them by sitting on cold walls or hot radiators. Perhaps surprisingly, active sportsmen and women are prone to piles and, like varicose veins, they are a particular hazard of pregnancy. The weight of the developing baby can put pressure on the rectal veins, causing them to enlarge as the normal flow of blood is prevented. Fortunately, these piles usually subside after the baby’s birth and treatment meanwhile can relieve the discomfort.
Some medicines, such as codeine and iron tablets, if taken regularly, can be constipating and so predispose to piles. However, chronic constipation, with the straining and increased pressure on the veins this brings, is one of the most common causes; as is a lack of fibre in the diet over many years.
If you have piles, the first sign you may notice is some bright red blood in the lavatory, or on the loo paper, after a bowel movement. It is always important to check with your doctor that this bleeding is caused by piles and not by some other condition.
Internal’ piles – also known as ‘first degree’ piles – which remain inside the anus are usually painless, but as the normal seal there is affected by the swollen veins, a constant, sometimes blood-stained, discharge may occur. There may also be itching and an uncomfortable aching feeling.
Second degree, ‘external’ piles, which prolapse through the anus, particularly when a motion is passed, tend to become inflamed, itchy and painful from time to time. They usually slip back, or can be gently pushed back, in between bowel movements. It may be easiest to do this while having a bath or using a bidet, when the area is lubricated with soap and your hands are clean.
If second degree piles are not treated, they may protrude permanently – when they are known as third degree piles -and cause considerable discomfort. Occasionally, a protruding pile will be gripped by the tight muscular band (sphincter) at the exit to the anus and become strangulated, which is very painful. If the blood inside the pile then clots, it will, in time, drop off – providing Nature’s cure. Otherwise, rest in bed with the foot of the bed raised and an ice pack applied to the pile should relieve acute symptoms.
Less severe piles can often be cured completely by avoiding constipation and straining. So, if you have ever suffered from piles, or think you are likely to because they run in your family, do all you can to avoid becoming constipated. This means eating plenty of high-fibre foods -fresh fruit and vegetables, wholemeal bread and bran cereals, for instance. Fibre-containing tablets or drinks, such as Fybogel or Regulan, available from your chemist, can be helpful if you find it difficult to eat enough bran-type foods. Try also to cut down on salt and have plenty of watery or fruit drinks. This type of diet should keep your motions regular, well-formed and effortless. Laxatives are usually only advisable as a short-term measure.
If your symptoms persist, you can try some suppositories and/or ointments recommended by your pharmacist and follow their instructions. These mainly contain local anaesthetics such as lignocaine or cinchocaine to ease irritation, and astringents, bismuth subgallate for example, to help dry up piles and relieve inflammation. A suppository is usually inserted after each bowel movement and at night and in the morning. Suppositories should never be taken orally. Some are said to be safe to use in pregnancy, but always check this with your pharmacist. Your doctor may prescribe a short course of suppositories containing cortisone to relieve the inflammation and irritation, with perhaps an anaesthetic cream to ease the soreness. Again, sleeping with the foot end of the bed raised can also help.
If your piles keep recurring and being troublesome, your doctor will probably refer you to a surgeon for further advice. Injection treatment may be recommended for bleeding internal or less severe external piles. This involves injecting a special fluid into the dilated veins which causes them to shrink. You will be treated as an outpatient and, although the procedure may sound unpleasant, it is not painful and is usually very successful. In fact, it’s one of the easiest and quickest forms of treatment.
As an alternative, cryosurgery – ‘freezing’ the veins – may be used, or constricting bands may be placed around the base of the veins. An operation under general anaesthetic, called Tord’s procedure’, can be very effective even for quite advanced piles. It involves a powerful stretching of the tight sphincter muscles around the anus. For severe third degree piles, however, many surgeons will advise removing them completely. This operation may cause discomfort for some time afterwards, but it should then solve the problem once and for all.
Anodesyn, Anusol, Hemocane Sup-positories, Nupercainol, Lasonil, Preparation H Suppositories
Anusol, Preparation H
Heemex, Nelsons Haemorrhoid Cream, Pileabs