Are you sitting comfortably? If you've got haemorrhoids (piles), chances are, you're not. Around half of us will experience the nuisance and discomfort of haemorrhoids at some point in our lives. So what are they, what causes them and how can they be treated?
Haemorrhoids are swellings in the lining of the anus and back passage which occur when small veins become engorged with more blood than usual.
The problem can range from mild and barely noticeable to severe and extremely painful, depending on the number and size of haemorrhoids that a patient develops. Due to their location, they can make life very uncomfortable for the sufferer, and cause problems with hygiene.
What causes them?
Piles can have a number of different causes, some preventable and others not.
"Preventable causes include excess straining when passing faeces," explains GP Dr Jeff Foster.
However, haemorrhoids have other causes including: "obstruction of venous blood, which may occur during pregnancy or in patients with portal hypertension (a condition usually seen in severe liver disease)." Effectively this means that any physical obstruction which makes it harder for blood to get back to the heart from the further reaches of the body can lead to pressure damming up in veins like those around the anus.
Finally, haemorrhoids may occur in patients who have unusually tight anal sphincter muscles. These muscles may be tight because of: "spasm due to anal fissures, due to anatomy (natural body design in some people) or neurology (nerve signals causing the muscles to tighten) and can also be seen in conditions such as irritable bowel syndrome."
What are the symptoms?
Whilst swellings can often be seen or felt, some haemorrhoids may not be as large or obvious as others, or may occur within the rectum. However, there are other symptoms that may suggest you have this condition.
"Typical symptoms of haemorrhoids include blood after opening your bowels - which is bright red on the paper or in the pan, rather than mixed in with the stool; a mucous discharge; itching and occasionally pain - which may be severe if the pile has a starved blood supply," explains Foster.
Importantly, however, these symptoms may also point to a different diagnosis so if you suspect you have haemorrhoids it's important to confirm with your GP.
"Other conditions that may have similar symptoms include peri-anal haematoma (a collection of blood under the skin around the anus, usually due to a burst blood vessel), rectal prolapse, inflammatory bowel disease (such as Crohn's disease or ulcerative colitis) and occasionally rectal cancer, so it's important to get properly diagnosed," explains Foster.
How are they treated?
Depending on the cause and severity of the haemorrhoids, a number of different treatments are available.
"Usually treatment is conservative," explains Foster. "The condition needs to be tackled in two ways - treating the symptoms and the cause." These recommendations don't 'cure' piles, but they can relieve symptoms and reduce future problems.
The soreness and irritation of piles may be reduced by washing and drying the area round the bottom thoroughly after a bowel movement - although over-vigorous rubbing can make matters worse. Doctors may also: "use topical creams with steroids to reduce the size and itch of the haemorrhoid."
Other treatments may include: "pushing back the haemorrhoid," which can make patients feel better, or “using nitroglycerine ointments or even botulinum toxin (Botox) injection to reduce spasm of the internal anal sphincter," he adds.
Dietary improvement (centred around increasing fibre intake), short-term laxative use and avoidance of overstraining may also be recommended.
In some patients, where other treatment fails to correct the problem, surgical intervention may be required, including sclerotherapy (where medicine is injected into the pile, making it shrink), rubber band ligation (where internal piles are tied off with rubber bands), cryotherapy (freezing), anal dilatation under general anaesthetic or haemorrhoidectomy (surgical removal).
A different approach
New thinking around the problem of haemorrhoids may result in a different treatment in the future. Research has suggested that the issue may eventually be treated by looking at the entire venous system, rather than focusing on the rectal area.
"In many countries, haemorrhoids are starting to be treated by phlebologists (specialist vein doctors) because it's a problem of the venous system, and the same as having varicose veins of your testicles, vulva or vagina," explains Professor Mark Whiteley, founder of The Whiteley Clinic.
A new treatment currently undergoing National Institute for Health and Care Excellence (NICE) approval and available from some private clinics may also become more accessible in the future.
"This treatment uses radiofrequency to destroy the blood vessel and surrounding tissue", Whiteley explains.
As the procedure takes place under local anaesthetic and is a walk-in rather than day-patient procedure, Whiteley has hopes that this will provide an improved solution for patients.
Recurrence of the problem
Unfortunately, haemorrhoids often recur after treatment and ongoing preventative measures are recommended.
"As the British population is getting more obese and more sedentary, the prevalence of haemorrhoids is going to increase," explains Foster. "Whilst not all piles are preventable, in many cases changing diet and lifestyle can decrease the risk of recurrence."
So if you suspect you have haemorrhoids don't suffer in silence - speak with your GP and follow advice to minimise or eliminate the problem.