Haemorrhoids (piles) explained: causes, relief and treatment

What haemorrhoids are

Haemorrhoids are swollen and enlarged blood vessels in and around the anus and lower rectum — the end of the back passage. Everyone has cushions of blood vessels in this area normally; piles develop when these become swollen. They are described as internal, when they form higher up inside and cannot usually be seen or felt, or external, when they form under the skin around the anus and can feel like lumps. Piles are very common and often come and go. They are not dangerous in themselves and are not a form of cancer, but their most common symptom — bleeding — can look the same as more serious conditions, which is why any new or persistent bleeding should always be checked.

Causes and symptoms

Piles are usually linked to increased pressure in the blood vessels around the back passage. Common triggers include constipation and straining to pass hard stools, long periods of sitting, pregnancy, being overweight, ageing, and persistent coughing or heavy lifting. Symptoms vary. Many people notice bright red blood, often on the toilet paper or in the pan after passing a stool. Others feel itching, soreness or a lump around the anus, a feeling of not having fully emptied the bowels, or mucus. Internal piles are often painless, while external ones can be sore, especially if a blood clot forms in one, causing a tender lump. Some people have piles with no symptoms at all.

Easing symptoms at home

Most piles improve with simple self-care aimed at softening stools and reducing straining. Eating more fibre — plenty of fruit, vegetables and wholegrains — and drinking enough fluid helps keep stools soft and easy to pass. It helps to avoid straining on the toilet, not to delay when you need to go, and not to sit for too long. Keeping the area clean and gently patting dry, and using a cool pack or a warm bath, can ease soreness. Pharmacies stock creams, ointments and suppositories that soothe symptoms for a short time, and a pharmacist can advise. These measures often settle piles within a week or two, especially if constipation is tackled.

When to see a clinician and treatments

You should see a clinician if piles do not improve with self-care, keep coming back, are very painful, or if there is bleeding — particularly to make sure the bleeding is not coming from something more serious. A clinician can confirm the diagnosis, sometimes with a simple internal examination. If self-care is not enough, several treatments can help. Non-surgical procedures done in a clinic include banding, where a small band is placed around an internal pile to make it drop off, and injections that shrink piles. For larger or persistent piles, surgical options to remove or reduce them are available. The right choice depends on the type and severity of the piles.

Red flags: always get bleeding checked

Although bleeding from piles is common and usually harmless, bleeding from the back passage should never be assumed to be "just piles" without being checked, because it can also be a sign of more serious conditions, including bowel cancer. See a clinician promptly if you have bleeding from your bottom, a change in your normal bowel habit lasting three weeks or more, darker or tarry stools, blood mixed in with the stool, unexplained weight loss, tiredness that could be from anaemia, or a lump. These warning signs do not mean something serious is definitely wrong, but they always need assessment. Getting checked provides reassurance or allows any problem to be found early.