Haemorrhoids (also known as Piles) are cushions of blood vessels and bowel lining tissue that swell and bulge into the back passage. These cushions are located in the anal area and help to ease stool passage. There are two types of haemorrhoids, internal and external. It is possible to have both at any time, and both types may protrude. They often bleed but bleeding from the back passage in not always due to haemorrhoids. Any bleeding should be checked by your doctor. An internal haemorrhoid forms inside the rectum, under the mucous membrane. When internal haemorrhoids enlarge greatly they may prolapse (fall down) and protrude through the anus. An external haemorrhoid forms at the anal opening, and is covered with skin.

Signs and Symptoms

• Bulge or tag of skin around anus
• Bright red blood on toilet paper or around outside
• Itching around anus
• Pain when passing a bowel motion

What causes them?

• Pregnancy and straining during childbirth
• Putting off going to the toilet or straining to pass a bowel
• Constipation or diarrhoea
• Coughing, sneezing, vomiting
• Holding your breath when doing heavy lifting and carrying
• Anything that increases the pressure of blood in blood vessels around the back passage such as:
  • Low fibre diet
  • Wearing tight pants
  • Severe Liver Disease
  • Cancer of the rectum or pelvic area
  • Being overweight
  • Chronic cough

Who is most at risk?

Haemorrhoids are very common in our society, particularly in older people. Up to half the population will suffer from them at some time in their lives. Haemorrhoids are less common in people younger than 40, although they may suffer from anal or rectal discomfort due to other causes. The list of factors that contribute to haemorrhoids (above) indicates the people who are most at risk. Constipation is the biggest factor, and it’s also one that we can do something about. The enormous changes in the body associated with being pregnant and having a child also hasten the development of haemorrhoids.Abdominal strain from coughing or lifting heavy weights may be difficult to avoid, but at least if you use the correct technique for lifting, you will help to reduce the problem.

Internal Haemorrhoids

Internal Haemorrhoids develop from the veins in the lower part of the rectum. Usually they are not painful to start with, although they may cause a vague aching sensation. Often the first sign will be a small amount of bright red blood on the toilet paper or in the toilet bowl after passing a motion, or on the surface of the bowel motion itself. Haemorrhoids tend to grow in size over time. Pain and discomfort also become more likely, particularly if the haemorrhoid becomes inflamed or infected, or if it develops a blood clot inside it. The haemorrhoid may become so large that it’s pushed through the anus when passing a bowel motion (prolapse), and then it may become ‘strangulated’.

External haemorrhoids

Sometimes when an internal haemorrhoid prolapses through the anus it is called ‘external’. However, the phrase ‘external haemorrhoids’ usually refers to changes in the blood vessels lying under the skin around the anus. These veins, too, can become enlarged and cause difficulties. An aching pain is often the first symptom of external haemorrhoids. The biggest problems occur when a blood clot inside the vein causes a blood-blister to form just beneath the skin. Because the skin is rich in nerve endings, this can be very painful. Prevention

• Increasing the fibre content of your diet so that your motions are soft and easy to pass.
• Drinking at least 6-8 large glasses of water each day.
• Learning to lift heavy objects correctly.
• Regular exercise for good muscle tone.
• Don’t strain to pass a motion and do not sit on the toilet longer than 2 minutes trying to pass a motion.
• Avoid using laxatives regularly.

Treatment

External haemorrhoids should clear within a week. Using a haemorrhoid product can help to relieve symptoms, however some products are stronger than others, so ask your pharmacist which one is best for you. If using an applicator, lubricate it before use and wash it well afterwards. For best results use the haemorrhoid product after you pass a motion or have a bath, and also at bedtime.

Examples of Haemorrhoid Product Ingredients

• Adrenaline Narrow blood vessels to reduce swelling and sometimes itching.
• Benzocaine/Lignocaine/Cinchocaine Local anaesthetics – relieve pain – numb the area below the rectum (not needed in the rectum as there are no pain fibres here)
• Hamamelis/Allantoin/Zinc oxide/Sulphate Reduces swelling and relieves itching
• Hydrocortisone/Bufezamac/Prednisolone/Fluocortolone
• Vitamin A/Balsam Peru Wound healers

Applying a cold compress to relieve symptoms can also be of comfort. It shrinks the surrounding blood vessels, therefore relieving the inflamed area. An ideal cold pack for this problem are frozen rubber glove fingers. If you fill a rubber glove with water and place in the freezer, the fingers (cut off the glove) are actually an ideal cold pack for relief within the anal passage. The glove component will pass once the ice has melted.