What are haemorrhoids?

Haemorrhoids (also spelt hemorrhoids) or 'piles' are lumps that occur inside and around your anus (back passage). They are very common.

Haemorrhoids are sometimes described as the 'varicose veins' of the anus. They happen when there is a weakness in the side of your anal canal that leads to thickening of the lining. The veins in the lining enlarge to become a haemorrhoid. This causes symptoms such as bleeding, pain and discomfort.

Haemorrhoids may be:

• internal haemorrhoids — just inside your anus
• external haemorrhoids — outside your anus

Large internal haemorrhoids may protrude (stick out) of your anus. This is called a prolapse.

What are the symptoms of haemorrhoids?

If you have haemorrhoids, you may notice:

• bright red blood on the toilet paper or in the toilet when you have a bowel motion (poo)
• itchiness, discomfort or pain around your anus
• sometimes there can be a lump that protrudes out of your anus (prolapse)

Many people experience no symptoms or very mild symptoms that disappear after a couple of days. For others, haemorrhoids are more painful, persistent (do not go away) or recurrent (they go away but come back).

Internal haemorrhoids

Internal haemorrhoids are grouped into 4 types, based on how much they prolapse (stick out) from your anus.

They are:

1. Grade I haemorrhoids — stay inside your anus and are not usually very painful.
2. Grade II haemorrhoids — stick out of your anus when you pass a bowel motion (poo). Once the bowel motion is over, they disappear back inside your anus by themselves.
3. Grade III haemorrhoids — can be physically pushed back inside the anus after passing a bowel motion. They may be painful if they are large.
4. Grade IV haemorrhoids — are larger lumps that protrude out of the anus permanently and cannot be placed back inside.

External haemorrhoids

External haemorrhoids occur as a lump outside your anus. The blood inside these haemorrhoids may thrombose (clot) and the lumps can become very painful.

What causes haemorrhoids?

Haemorrhoids are often caused by constipation (hard bowel motions that are difficult to pass). Constipation causes you to strain (push hard) when you go to the toilet. This puts pressure on the blood vessels in your anus, making them swell.

Other things can increase the chance you will get haemorrhoids:

• ageing — haemorrhoids often occur between the ages of 45 and 65 years
• being overweight
• having diarrhoea
• spending long periods of time on the toilet
• regularly lifting heavy objects

Haemorrhoids are also common during pregnancy. This is because:

• constipation is common in pregnancy
• the growing baby places pressure on your abdomen (tummy)
• there is more blood flowing through your body

Haemorrhoids may also be more common in some families than in others.

When should I see my doctor?

Haemorrhoids often go away without any treatment.

If you notice blood when you have a bowel motion (poo), it is important to get checked by a doctor. This is to make sure your symptoms are not a sign of something more serious. The symptoms of haemorrhoids can be very similar to those of bowel cancer.

Tell your doctor if you have noticed:

• blood or mucus in your stools (poo)
• changes in your bowel habits or movements
• changes in the colour of your stools
• recent weight loss
• abdominal (tummy) pain

How are haemorrhoids diagnosed?

Your doctor will ask about your symptoms and examine your anal passage to look for any swollen blood vessels.

Your doctor may conduct one of the following tests:

• Digital rectal examination — where your doctor puts on gloves and places a lubricated finger inside your back passage (bottom) to gently feel for any abnormalities. This is likely to be uncomfortable but will probably not be painful.
• Proctoscopy — where your doctor examines the inside of your rectum (bottom) using a proctoscope (a hollow tube with a tiny light at the end). They will use this to look for any swelling or other signs. This may be uncomfortable but will probably not be painful.

There is no need to feel embarrassed about these tests. Haemorrhoids are common and your doctor is used to diagnosing and treating them.

In some cases, your doctor may refer you to a surgeon who can assess your haemorrhoids and recommend a treatment.

How are haemorrhoids treated?

Mild symptoms may go away after a few days without any special treatment. If you have constipation, your doctor will suggest things you can do to relieve it.

Medicines

Pain and inflammation (swelling) can often be relieved with over-the-counter haemorrhoid treatments from a pharmacy. These include medicated creams, ointments and suppositories (solid medicines that you put in your anus). Your pharmacist can recommend an option that suits you.

If your inflammation is severe, your doctor may prescribe a corticosteroid cream.

Other treatments

In some cases, other treatments may be needed. Common procedures for internal haemorrhoids are:

• Infrared treatment (photocoagulation) — uses infrared light to shrink haemorrhoids.
• Rubber band ligation (banding) — uses a tight elastic band which is placed around your haemorrhoid to cut off its blood supply. This causes the haemorrhoid to fall off and be passed out of the body.
• Injection (sclerotherapy) — where a chemical is injected into your haemorrhoid. This numbs the pain, stops any bleeding and causes your haemorrhoid to shrink. It is often used when a haemorrhoid is too small to use a rubber band.

Less often, a surgical procedure called haemorrhoidectomy may be needed for more severe haemorrhoids. Here, an operation is carried out under general anaesthetic to remove your haemorrhoids.

What are the complications of haemorrhoids?

Complications of haemorrhoids are rare and can include:

• anaemia — if you lose a lot of blood
• blood clots, also known as thrombosed haemorrhoids

In most cases, haemorrhoids are mild and do not cause any serious problems. Haemorrhoids are not linked with an increased risk of bowel cancer.

Can haemorrhoids be prevented?

The best way to prevent haemorrhoids is to:

• eat a healthy, high-fibre diet
• drink plenty of water
• exercise regularly

Preventing constipation

To help prevent constipation:

• empty your bowels when you need to — try not to 'hang on' to a bowel movement for too long
• try to avoid any medicines that can cause constipation (for example, pain relief medicines containing codeine) — ask your pharmacist for advice on side effects of medicines
• avoid sitting on the toilet for long periods of time

Increasing your fibre intake

You can gradually increase the amount of fibre in your diet by eating foods including:

• fresh fruit and vegetables
• wholegrain breads and cereals
• nuts and seeds
• legumes (peas, beans and lentils)

Fibre supplements are also available and can be useful if you think you are not getting enough of the above foods in your diet.

Increase your fibre intake gradually so your digestive system has time to adapt.

It is also important to increase your fluid intake at the same time. This is because fibre in the stools acts like a sponge, absorbing moisture from the body. Try to drink lots of water.

Maintaining a healthy weight

Being overweight is another factor that may contribute to the development of haemorrhoids.

You can lose weight by:

• exercising regularly
• eating a low-fat diet
• moderating your alcohol intake

Cutting down on sugary drinks will also help you to reduce your calorie intake and that causes weight gain.

Resources and support

• For more information about treatment for haemorrhoids visit the Colorectal Surgical Society of Australia and New Zealand website.
• They also have information about constipation and how to prevent it.
• You can find more information about food and nutrition in our healthy eating section and from the Nutrition Australia website.

If you have other questions about haemorrhoids you can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.