Haemorrhoids

Haemorrhoids, also called piles, are swollen veins in your anus and lower rectum, like varicose veins. Haemorrhoids can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids).

Nearly three out of four adults will have haemorrhoids from time to time. Haemorrhoids have several causes, but often the cause is unknown.

Fortunately, effective options are available to treat haemorrhoids. Many people get relief with home treatments and lifestyle changes.

Symptoms

Signs and symptoms of haemorrhoids usually depend on the type of haemorrhoid.

External haemorrhoids

These are under the skin around your anus. Signs and symptoms might include:

Itching or irritation in your anal region

Pain or discomfort

Swelling around your anus

Bleeding

Internal haemorrhoids

Internal haemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:

Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.

A haemorrhoid to push through the anal opening (prolapsed or protruding haemorrhoid), resulting in pain and irritation.

Thrombosed hemorrhoids

If blood pools in an external haemorrhoid and forms a clot (thrombus), it can result in:

Severe pain

Swelling

Inflammation

A hard lump near your anus

When to see a doctor

If you have bleeding during bowel movements or you have haemorrhoids that don't improve after a week of home care, talk to your doctor.

Don't assume rectal bleeding is due to haemorrhoids, especially if you have changes in bowel habits or if your stools change in colour or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

Seek emergency care if you have large amounts of rectal bleeding, light-headedness, dizziness or faintness.

Causes

The veins around your anus tend to stretch under pressure and may bulge or swell. Haemorrhoids can develop from increased pressure in the lower rectum due to:

Straining during bowel movements

Sitting for long periods of time on the toilet

Having chronic diarrhoea or constipation

Being obese

Being pregnant

Having anal intercourse

Eating a low-fibre diet

Regular heavy lifting

Risk factors

As you age, your risk of haemorrhoids increases. That's because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen when you're pregnant, because the baby's weight puts pressure on the anal region.

Complications

Complications of haemorrhoids are rare but include:

Anaemia. Rarely, chronic blood loss from haemorrhoids may cause anaemia, in which you don't have enough healthy red blood cells to carry oxygen to your cells.

Strangulated haemorrhoid. If the blood supply to an internal haemorrhoid is cut off, the haemorrhoid may be "strangulated," which can cause extreme pain.

Blood clot. Occasionally, a clot can form in a haemorrhoid (thrombosed haemorrhoid). Although not dangerous, it can be extremely painful and sometimes needs to be lanced and drained.

Prevention

The best way to prevent haemorrhoids is to keep your stools soft, so they pass easily. To prevent haemorrhoids and reduce symptoms of haemorrhoids, follow these tips:

Eat high-fibre foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause haemorrhoids. Add fibre to your diet slowly to avoid problems with gas.

Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.

Consider fibre supplements. Most people don't get enough of the recommended amount of fibre — 20 to 30 grams a day — in their diet. Studies have shown that over-the-counter fibre supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), improve overall symptoms and bleeding from haemorrhoids.

If you use fibre supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause or worsen constipation.

Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could dry out and be harder to pass.

Exercise. Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that might be contributing to your haemorrhoids.

Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

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