Haemorrhoids

What are the symptoms of this condition?

Symptoms will vary depending upon the location of the haemorrhoids (they may be either internal, located inside the rectum or external, located in the area of the anus). Generally, the symptoms include pain, itching, aching and bleeding. Pain and itching may be felt in and around the rectal area with blood often being found either on the motions or on the toilet paper after opening the bowels. The blood will be fresh and red in appearance.

Sometimes a lump may be noticed in the area round the anus due to the presence of an external haemorrhoid, or a prolapsed internal haemorrhoid.

What is the cause of the condition?

Haemorrhoids are caused by swollen veins in the rectum or anus. To better understand why haemorrhoids develop, it is necessary to look at the structure of the veins and the purpose they serve in the circulatory system.

While arteries are responsible for taking blood from the heart, it is the veins which return the blood to the heart. These two systems are separate and behave in very different ways. One of the main differences is that the arterial system has to cope with the high pressures generated by the beating of the heart; veins, by contrast, carry blood at a much lower pressure.

Veins handle the slow but steady low pressure flow with the help of an internal valve system and elastic walls.

Valves are situated within the veins to prevent the blood flowing backwards. The valves consist of small flaps of material which will close off the vein as soon as the blood flow ceases.

Vein walls are thinner and weaker than those of arteries because they do not have to withstand such high pressures. They also incorporate elastic material to provide flexibility and allow for expansion.

A haemorrhoid can occur when one of the valves in a lower rectal vein fails, allowing blood to flow backwards. This causes a section of the vein to become over-filled with blood. Because the walls of the veins are relatively thin and designed to expand, that part of the vein will distend or start to balloon out. Over time this ballooning becomes larger and will be made worse by straining to pass motions or when lifting heavy objects. Increased pressure within the abdomen during pregnancy may also make the swelling worse. Ultimately this part of the vein may burst, causing bleeding, or the vein and some of the surrounding muscle and fat may pass through the rectum as a prolapsed internal haemorrhoid.

External haemorrhoids have the same underlying causes as internal haemorrhoids and are more easily recognised, because of the lump that they form around the anus. The weak vein or veins are situated in and around the anus, rather than the rectum, and are easier to detect. They may also cause more pain and irritation than internal haemorrhoids.

What complications might occur?

Blood loss with haemorrhoids is not uncommon. Fresh, bright red blood on the toilet paper is probably the result of bleeding from the piles, however, any blood loss from the back passage, no matter what the apparent cause, ought to be reported to your doctor. Other conditions, apart from haemorrhoids, may cause bleeding; these include anal fissures (tears of the skin lining the anus), or infections of either bacterial or fungal origin. It is also possible that the blood is coming from higher up in the bowel especially if the blood is associated with mucus and pain.

A health professional ought to investigate the blood loss. This is even more important if the bleeding is associated with a change in the bowel habit, any unexplained weight loss or anaemia. There is always the remote chance that the bleeding might be an early indicator of cancer. The good news is that this form of bowel cancer is often easily treatable provided that it is diagnosed early enough. Hence the importance of seeking prompt advice should any bleeding occur.

Complications directly affecting the haemorrhoids may arise if a haemorrhoid prolapses from the rectum and then becomes 'strangulated', i.e. the blood supply to the haemorrhoid and its associated muscle and fat are cut off. This will be extremely painful and requires the urgent attention of a doctor.

What can I do to treat myself?

There are a number of actions that will assist in keeping haemorrhoids under control. These can be placed under two main headings: hygiene, and reducing straining.

Hygiene
It is important to keep the area around the anus clean and free from mucus or faecal debris. For example, a bath after each bowel motion will ease any pain and discomfort resulting from the motion, as well as maintaining general cleanliness. Take care when washing round the anus to avoid scratching or damaging the skin and any external or prolapsed haemorrhoids that may be present.

As it is not always possible to bathe immediately after a motion, a good quality soft toilet paper should be used. Soft toilet papers wipe more effectively than hard papers and are not as abrasive, so causing less damage to the anal area.

Straining
As mentioned above, straining - either because of constipation or heavy lifting - is going to make the haemorrhoids worse.

Constipation may be eased by paying attention to diet and fluid intake.

A normal stool consists of non-digestible fibrous material derived from fruit, vegetables and other foodstuffs, plus water, bacteria and discarded cells from the digestive tract. Keeping the stool soft and easy to pass depends largely upon the fibre and water content. A diet that is low in fibre provides less 'bulk' to make up the stool and in turn less stimulus to the bowel itself. Failing to drink sufficient water compounds the problem, as fluid is reabsorbed from the stool as it moves through the colon toward the rectum.

The end result is a slow moving, relatively dry stool which is difficult to expel from the rectum. Straining is the inevitable result.

A diet which includes plenty of fibre and a reasonable amount of fluid will help to resolve the problem. Fibre is present in fruit and vegetables and to a lesser extent in certain other food stuffs. It is present only in small quantities in convenience and fast foods and confectionery. The simple solution is to make fruit and vegetables a regular part of your diet, and to drink around one litre of water a day (not necessarily all at once!).

Finally, establish a regular bowel pattern and don't ignore the urge to open your bowels; doing so will only cause your stools to become more dehydrated and difficult to pass.

What treatments are available for me to purchase?

The self-help actions in the section above will prevent the situation worsening and should be undertaken regardless of any other treatments that are tried. However, they may not be totally effective. Pharmacy2U provides a wide range of medications designed to assist you in treating your haemorrhoids. To help you decide which is the most appropriate treatment, here is a list of the ingredients usually encountered:

Local anaesthetics
Anaesthetics are used to numb the area and relieve the pain and itching. Two of the more common local anaesthetics are benzocaine and lidocaine. Occasionally these can cause local sensitivity reactions or a skin rash. If this occurs you should stop using the product. Medications which contain local anaesthetics are not designed for long term use. If you find your symptoms persist for more than a week you should consult either a Pharmacy2U pharmacist or your family doctor. Products which have anaesthetic properties include Anodesyn and Germoloids suppositories.

Antiseptics
Antiseptics are used to kill or remove bacteria from the skin surface. They aid in reducing the risk of infection. Balsam Peru is an example of an antiseptic and can be found in certain suppositories and creams, e.g. Anusol cream. Normally antiseptics are safe to use but occasionally skin rashes occur. If this happens you should stop using the product.

Astringents
Astringents are substances that reduce inflammation and swelling. They occur in many products designed for haemorrhoids. Zinc oxide is an example of an astringent and is included in Anusol and Germoloid cream.

Anti-inflammatories
Reducing inflammation helps to control pain, swelling and associated discomfort. There are several anti-inflammatory agents available, of which the steroid preparation, hydrocortisone, is one of the most effective. Anusol HC suppositories are an example of a product containing hydrocortisone. As with local anaesthetics, these are not designed for long term use except under medical supervision. If after one week your symptoms have not improved, stop using the product and consult a Pharmacy2U pharmacist.

Many haemorrhoid products include more than one of these ingredients to improve effectiveness.

To see the full range of haemorrhoid products available from Pharmacy2U please click here.

Haemorrhoids are sometimes associated with constipation. If this is the case, and the dietary measures suggested above are not helping, then a laxative may be needed. Laxatives are used to help restore a normal frequency of bowel movements. Laxatives which contain ispaghula husk (e.g. Fybogel Sachets) increase the bulk of the stools, and are a good option to try first; they may be used regularly. Lactulose solution works in a similar way, and may also be used regularly. More powerful stimulant laxatives, such as Senna Tablets, should only be used for occasional relief.

To see the full range of laxatives available from Pharmacy2U please click here.

What treatments are available from my doctor?

Your family doctor can supply on prescription a larger range of medicines to treat haemorrhoids.

These products include ointments, creams and suppositories which incorporate more potent steroid anti-inflammatory and local anaesthetic ingredients. These medicines are not designed for long term use. They are intended to relieve acute symptoms after which detailed investigations of the causes and severity of the problem can be undertaken.

If other treatment options are not satisfactory, then surgery may be an option. There are a number of operations which can be carried out to treat haemorrhoids; some of these can be performed in an Out-Patient Clinic, others will require a short stay in hospital. However, most haemorrhoids sufferers will be able to manage their condition without needing surgery.

What additional investigations might be needed?

If you are worried about your haemorrhoids you should consult either a Pharmacy2U pharmacist or your family doctor. This is especially important if bleeding is taking place. The GP may need to examine your back passage with a finger (this is known as a digital examination) to try and identify where the problem lies. Depending on the history of the problem, treatment with suppositories may be tried; however, if prescription medicines are not adequate to relieve the discomfort, the symptoms may require referral to a specialist. The specialist may perform a sigmoidoscopy (a direct viewing of the inside the rectum with a special viewing tube) or possibly a barium enema (an x-ray of the bowel after it has been coated with an opaque liquid) to assess the state of your bowel. These investigations are designed to exclude any other possible causes for the symptoms. If the results of the investigations are negative, and the problem is definitely haemorrhoids, the treatment options available include injection of the piles, freezing or surgical removal. The treatment recommended will depend upon the severity of the problem.

Any other information I should have?

Finally, remember that piles are not life threatening. They can however be painful and extremely inconvenient. If you have any doubts or worries about your piles you should seek advice and guidance from a pharmacist or other health professional.