What are Haemorrhoids?

Haemorrhoids are enlarged veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can cause long lasting discomfort, bleeding and be excruciatingly painful.

Haemorrhoids (also called piles) can be divided into two kinds, internal and external. Internal haemorrhoids lie inside the anus or lower rectum, beneath the anal or rectal lining. External haemorrhoids lie outside the anal opening. Both kinds can be present at the same time.

Haemorrhoids are a very common medical complaint. More than 75% of Americans have haemorrhoids at some point in their lives, typically after age 30. Pregnant women often develop haemorrhoids, but the condition usually clears up after childbirth. Men are more likely than women to suffer from haemorrhoids that require professional medical treatment.

Causes
Precisely why haemorrhoids develop is unknown. Researchers have identified a number of reasons to explain haemorrhoidal swelling, including the simple fact that people’s upright posture places a lot of pressure on the anal and rectal veins. Aging, obesity, pregnancy, chronic constipation or diarrhoea, excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are considered contributing factors. Heredity may also play a part in some cases. There is no reason to believe that haemorrhoids are caused by jobs requiring, for instance, heavy lifting or long hours of sitting, although activities of that kind may make existing haemorrhoids worse.

Symptoms
The commonest symptom of internal haemorrhoids is bright red blood in the toilet bowl or on one’s faeces or toilet paper. When haemorrhoids remain inside the anus they are almost never painful, but they can prolapse (protrude outside the anus) and become irritated and sore. Sometimes, prolapsed haemorrhoids move back into the anal canal on their own or can be pushed back in.

Small external haemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with cleaning the anal area after a bowel movement. When, as sometimes happens, a blood clot forms in an external haemorrhoid (creating what is called a thrombosed haemorrhoid), the skin around the anus becomes inflamed and a very painful lump develops. On rare occasions the clot will begin to bleed after a few days and leave blood on the underwear. A thrombosed haemorrhoid will not cause an embolism.

Prevention
A high-fibre diet and the other lifestyle changes recommended for coping with existing haemorrhoids also help to prevent haemorrhoids. Not straining during bowel movements is essential.

Treatment
Haemorrhoids can often be effectively dealt with by dietary and lifestyle changes. Softening the faeces and avoiding constipation by adding fibre to one’s diet is important, because hard faeces lead to straining during defecation. Fruit, leafy vegetables, and whole-grain breads and cereals are good sources of fibre, as are fibre supplements such as Metamucil or Citrucel. Exercising, losing excess weight, and drinking six to eight glasses a day of water or another liquid (not alcohol) also helps. Soap or toilet paper that is perfumed may irritate the anal area and should be avoided, as should excessive cleaning, rubbing, or wiping of that area. Reading in the bathroom is also considered a bad idea, because it adds to the time one spends on the toilet and may increase the strain placed on the anal and rectal veins. After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation. Sitting often eases haemorrhoid pain, in a tub of warm water for about 10 or 15 minutes two to four times a day (sitz bath). A cool compress or ice pack to reduce swelling is also recommended (the ice pack should be wrapped in a cloth or towel to prevent direct contact with the skin.

The importance of a high-fibre diet is stressed to prevent haemorrhoids by strengthening the veins of the anus, rectum, and colon, blackberries, blueberries, cherries, vitamin C, butcher’s broom (Ruscus aculeatus), and flavonoids (plant pigments found in fruit and fruit products, tea, and soy). Herbal teas, ointments, and suppositories, and other kinds of herbal preparations, are suggested for reducing discomfort and eliminating haemorrhoids. In particular, pilewort (Ranunculusficaria), applied in an ointment or taken as a tea, can reduce the pain of external haemorrhoids. Acupuncture, acupressure , aromatherapy , and homeopathy are also used to treat haemorrhoids.

Haemorrhoids do not cause cancer and are rarely dangerous or life threatening. Most clear up after a few days