What are haemorrhoids/Piles?

Haemorrhoids develop when the veins in your anus and lower rectum become inflamed and swollen. In some cases, haemorrhoids develop internally, inside the rectum, or externally under the skin around your anus. You may also have internal haemorrhoids that push through the anal opening, causing a condition known as a protruding or prolapsed haemorrhoid.

A common condition, haemorrhoids can result when you strain during a bowel movement or due to excess pressure on the veins during pregnancy. You may also develop haemorrhoids for no apparent reason.

What are the symptoms of haemorrhoids/Piles?

Haemorrhoids may cause no symptoms at all, but many people experience discomfort, pain, and a variety of other symptoms that interfere with your usual routine.

In addition to pain, you may experience symptoms affecting your anus, such as:

• Itching
• Swelling
• Persistent irritation

Piles is classified into four grades:

• Grade I: There are small inflammations, usually inside the lining of the anus. They are not visible.
• Grade II: Grade II piles are larger than grade I piles, but also remain inside the anus. They may get pushed out during the passing of stool, but they will return unaided.
• Grade III: These are also known as prolapsed haemorrhoids, and appear outside the anus. The individual may feel them hanging from the rectum, but they can be easily re-inserted.
• Grade IV: These cannot be pushed back in and need treatment. They are large and remain outside of the anus.

You may also have small amounts of blood appear in the toilet bowl or on toilet paper after a bowel movement.

If blood pools in an external haemorrhoid, it can form a thrombosis, or blood clot, which causes a thrombosed haemorrhoid, a condition that causes severe pain and the development of a lump near your anus.

If you can’t tolerate pain or notice bleeding when using the bathroom, you should schedule a medical evaluation at Piles Clinic UK.

How are Haemorrhoids/Piles diagnosed?

The doctor will examine the anus and rectum to determine whether a person has haemorrhoids. Haemorrhoid symptoms are similar to the symptoms of other anorectal problems, such as fissures, abscesses, warts, and polyps. The doctor will perform a physical exam to look for visible haemorrhoids. A digital rectal exam with a gloved, lubricated finger and an anoscope—a hollow, lighted tube—may be performed to view the rectum.

A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool. Bleeding may be a symptom of other digestive diseases, including colorectal cancer.

Additional exams may be done to rule out other causes of bleeding, especially in people age 40 or older:

• Colonoscopy, A flexible, lighted tube called a colonoscope is inserted through the anus, the rectum, and the upper part of the large intestine, called the colon. The colonoscope transmits images of the inside of the rectum and the entire colon.
• Sigmoidoscopy. This procedure is similar to colonoscopy, but it uses a shorter tube called a sigmoidoscope and transmits images of the rectum and the sigmoid colon, the lower portion of the colon that empties into the rectum.

Haemorrhoids During Pregnancy

What causes haemorrhoids when you are pregnant?

Unfortunately, haemorrhoids are a common complaint during pregnancy — especially during the third trimester and immediately after childbirth. They’re the result of the tremendous strain on the veins around the anus from carrying a baby and giving birth, as well as hormonal changes that cause these veins to expand and bulge.

Haemorrhoids are also related to constipation. Constipation combined with increased pressure on the rectum and perineum is the primary reason that women experience these.  Prolonged standing may also be a factor contributing to haemorrhoids.

The most common symptoms of haemorrhoids during pregnancy are:

• Blood coating the stool.
• Blood on toilet paper.
• Itching in the anal canal.
• A small swollen (often blue of bright red coloured) mound of skin protruding from the anus (for external haemorrhoids).
• Pain in the anus.

What are the treatments for haemorrhoids during pregnancy?

The good news is that the problem usually improves after the baby is born. In the meantime, there are a number of things you can do to treat haemorrhoids.

• Take a warm bath to reduce swelling
• Use witch hazel to reduce swelling or bleeding
• Avoid sitting for long periods
• Analgesics: Ointment or cream can be used for external haemorrhoids, if it involves pain and irritation.

What can you do to prevent haemorrhoids during pregnancy?

The best thing to do to prevent haemorrhoids during pregnancy is to avoid getting constipated. If you are constipated, avoid straining during bowel movements.

Try the following to prevent constipation:

• Eat a high fibre diet
• Drink plenty of fluids
• Drink prune juice
• Do not delay going to the bathroom
• Eat plenty of fruits and vegetables

ALWAYS check with your health care provider before taking any medication for haemorrhoids.

How can you prevent haemorrhoids during pregnancy?

You can try to reduce haemorrhoids or prevent them from developing in several ways.

PREVENTION TIPS

• Eat a diet full of fibre-rich foods, like vegetables and fruits.
• Drink plenty of water to help keep your stools soft and your bowel movements regular.
• Avoid straining when using the toilet.
• Avoid sitting on the toilet for long periods of time.
• Pass a bowel movement as soon as you feel it coming — not holding it in or delaying.
• Move around as much as you can by exercising and avoid long periods of sitting.
• Talk with your doctor about adding a supplement to your diet that helps avoid constipation.

When to contact a doctor?

If you’re pregnant and think you have haemorrhoids, be sure to talk with your doctor about the symptoms you’re having.

Contact a doctor if you have:

• haemorrhoid symptoms that fail to improve after receiving treatment
• recurring haemorrhoids
• fever or chills
• pus oozing from your haemorrhoid
• severe bleeding or bleeding that won’t stop
• severe pain

Do haemorrhoids go away after pregnancy?

Your haemorrhoids may disappear completely after pregnancy and delivery without any treatment as your hormone levels, blood volume, and intra-abdominal pressure decrease after delivery.

The most common times haemorrhoids develop during pregnancy is in your third trimester and during and immediately after childbirth. You may develop haemorrhoids from childbirth if you experience extended straining during the second stage of labour.

What are the treatment options for Piles?

You can try many home remedies and lifestyle modifications to reduce haemorrhoids. It’s best not to ignore them, though. Untreated haemorrhoids may get worse with time and cause complications such as increased pain or, in rare cases, anaemia from bleeding.

You may need to reach out to a healthcare professional to diagnose and treat your haemorrhoids. Since haemorrhoids are not the only cause of bleeding near your anus, it’s always a good idea to speak with a doctor if you notice new bleeding when you wipe or in your stool.

Home remedies for haemorrhoids

There are many steps you can take at home to relieve and prevent haemorrhoids. Here are some ideas.

• drinking six to eight 8-ounce glasses of water or other non-alcoholic fluids each day
• Use gentle, flushable wipes when you have a bowel movement.
• Use a sitz bath or soak in clean warm water for 10 minutes at a time a few times a day.
• Take Epsom salt baths in warm water that’s not too hot.
• Hold an ice pack on the area for a few minutes several times a day.
• Move around frequently and try not to sit for too long to avoid extra pressure on your anus.
• Drink lots of water and eat foods high in fibre to help keep stools soft.
• Avoid straining while having a bowel movement or sitting on the toilet for long periods of time.

You may want to speak with a doctor before treating haemorrhoids at home. This will ensure you get a proper diagnosis and understand the treatment options available to you.

Medical treatment for haemorrhoids

Topical over-the-counter or prescription treatments may help haemorrhoids. These medications often include pain-relieving or anti-inflammatory ingredients.

Creams or ointments that contain hydrocortisone can be especially effective for reducing pain, inflammation, and itching caused by haemorrhoids. But these ingredients may not be safe for pregnancy. During pregnancy, always talk with your doctor before taking any medication, including those you apply to your skin (topical). This will ensure treatments do not pose a risk to your baby Make sure to discuss them with a doctor.

The doctor may also be able to recommend a safe laxative or a suppository to relieve constipation.

For Surgical treatment -Please see ADVANCED PILES TREATMENT section on the Pilesclinic UK website.