Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels that are found inside or around the bottom (the rectum and anus).
In many cases, haemorrhoids don’t cause symptoms, and some people don’t even realise they have them. However, when symptoms do occur, they may include:
- bleeding after passing a stool (the blood is usually bright red)
- itchy bottom
- a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
- a mucus discharge after passing a stool
- soreness, redness and swelling around your anus
Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.
When to seek medical advice
See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked out, so your doctor can rule out more potentially serious causes.
The symptoms of haemorrhoids often clear up on their own or with simple treatments that can be bought from a pharmacy without a prescription (see below). However, speak to your GP if your symptoms don’t get better or if you experience pain or bleeding.
Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.
Some people with haemorrhoids are reluctant to see their GP. However, there’s no need to be embarrassed, because GPs are very used to diagnosing and treating haemorrhoids.
Read more about diagnosing haemorrhoids.
What causes haemorrhoids?
The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed.
Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation – this is often due to a lack of fibre in a person’s diet. Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.
Other factors that might increase your risk of developing haemorrhoids include:
- being overweight or obese
- age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
- being pregnant – which can place increased pressure on your pelvic blood vessels, causing them to enlarge (read more about common pregnancy problems)
- having a family history of haemorrhoids
- regularly lifting heavy objects
- a persistent cough or repeated vomiting
- sitting down for long periods of time
Preventing and treating haemorrhoids
Haemorrhoid symptoms often settle down after a few days, without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.
However, making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended. These can include:
- gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
- drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
- not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
- avoiding medication that causes constipation – such as painkillers that contain codeine
- losing weight (if you’re overweight)
- exercising regularly – can help prevent constipation, reduce your blood pressure and help you lose weight
These measures can also reduce the risk of haemorrhoids returning, or even developing in the first place.
Medication that you apply directly to your back passage (known as topical treatments) or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools.
There are various treatment options for more severe haemorrhoids. One of these options is banding, which is a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off after about a week.
Surgery carried out under general anaesthetic (where you’re unconscious) is sometimes used to remove or shrink large or external haemorrhoids.