What are piles?
Who gets piles?
What are the symptoms of piles?
- bleeding, with bright red blood
- itching and irritation
- aching pain and discomfort
- a lump, which may be tender
- soiling of underwear with slime or faeces (‘skid marks’).
How you can help yourself
- Wash the area gently with warm, salty water, to get rid of irritant mucus that has leaked out. Dry carefully with cotton wool and apply petroleum jelly (available from pharmacies) or nappy rash cream to protect your skin if more mucus or moisture leaks out.
- Use soft toilet paper, and dab rather than wipe; also consider wet wipe toilet paper or use a bidet to gently clean the area.
- Wear loose underwear and clothing (i.e. not tight trousers), so that nothing will rub the pile.
- Do not scratch. For more information on dealing with itch, look at the section on anal itching.
- Avoid constipation by eating lots of fresh fruit and vegetables and bran cereal. Aim for faeces that are soft enough to change their shape as you push them out.
- Drink plenty of fluids.
- After you have passed the faeces, do not strain to finish. People with piles often think there is more to come, but this is a false sensation caused by the swollen spongy pads in the piles themselves. Do not read on the toilet and aim to be out of the toilet within a minute.
- If you can feel a lump, try pushing it gently upwards; try to relax your anus as you do so.
- If you have a lot of discomfort, buy a haemorrhoid cream or gel. A pharmacist will be able to help you choose one that is suitable for you. A haemorrhoid cream or gel does not cure the pile, but will usually relieve the discomfort effectively until the pile goes away of its own accord. Do not use it for longer than a week or two.
To stop piles returning, continue the high-fibre diet to keep your stools soft and do not put off opening your bowels, and avoid straining.
When to see your doctor
What your doctor can do
- 79% of piles are cured
- 18% of piles return so that repeat banding is needed
- for 2% of piles, it does not work at all.
Injection of phenol in almond oil is a method of causing scarring in the area, but produces a permanent cure in only about 25% of cases. It is less commonly used now, because the results are not as good as with banding.
Banding and injection are not suitable for larger grade 3 piles or for grade 4 piles.
Direct-current electrotherapy (Ultroid) is a new non-surgical treatment that uses a probe to apply a very low current to the base of the pile for up to 10 minutes. It is usually painless and has the best safety record of all available treatments. More than 120,000 patients have been successfully treated worldwide, and it is the only treatment approved in the USA for all grades of piles.
- In the usual operation, the swollen spongy pad that forms the pile is cut away. It is painful for 7–10 days afterwards.
- A newer operation, called ‘stapling’, involves cutting away a 2 cm strip of the lining of the rectum and joining the cut edges with a special stapler. People seem to recover quicker from ‘stapling’ than from the ordinary operation. It is not yet a common operation in the UK, but it is popular in the rest of Europe. Although it is less painful than the ordinary operation, it seems to be less effective in the long-term and about 12% of people have a recurrence of the piles within 16 months (Surgery 2006;24(4):148–50). However, more research is needed.
- Another type of operation uses ultrasound to locate the arteries that feed blood into the pile. These arteries are then closed off using stitches. Bleeding from the pile decreases over the following few weeks. This treatment is becoming more popular, partly because it does not involve any cutting and is almost painless. More research is needed to see if it is effective in the long-term.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Monday, March 30th 2015
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