What are piles and how do you treat them?

Piles, also called haemorrhoids, are swellings that develop in and around your bottom (anus). Piles are very common and nothing to be embarrassed about — up to a third of the UK population have piles.

They often get better without medical treatment but with simple lifestyle changes. Although if they don’t resolve with lifestyle changes, there are treatments available as well as things you can do after treatment to reduce your risk of developing piles again. 

Piles symptoms

In some cases, piles are small enough that they cause no symptoms at all.

If you do get symptoms, the most common one is bleeding. You may notice bright red blood on your stools or when you wipe your bottom.

Other symptoms include:

• A lump in or around your anus
• Anal discharge or a jelly-like discharge after passing a stool
• Bowel incontinence if you have severe piles
• Constipation or difficulty passing stools
• Itchy, sore skin around your anus
• Pain around your anus or when passing a stool

What causes piles?

Piles occur when pressure builds up in the blood vessels in one or several of your anal cushions (tissues that help hold in your stools to prevent incontinence). The pressure causes the anal cushions and their blood vessels to enlarge. 

It isn’t always clear why pressure builds up in the blood vessels, but piles are more common if you are:

• Aged 45 and over
• Overweight or obese
• Pregnant, or you have recently given birth

Activities, lifestyle choices and conditions that put pressure on your rectum also increase your chances of getting piles. These include:

• Chronic diarrhoea or constipation
• Frequent heavy lifting that causes you to strain
• Having anal sex
• Not eating enough fibre
• Sitting down, especially on the toilet, for long periods of time
• Straining when passing stools

How are piles diagnosed?

If you notice bleeding from your bottom, you should see your doctor. They can tell you if you have piles, or another condition with similar symptoms, such as an anal fissure or bowel polyps.

Your doctor will ask you about your symptoms and examine your bottom. This may include gently inserting a lubricated finger inside your bottom to feel for any lumps.

Your doctor might also arrange for a proctoscopy for you. During a proctoscopy, a doctor will examine the inside of your bottom using a proctoscope (a short, straight hollow tube that usually has a small light bulb on the end). 

How are piles treated?

Piles can often get better on their own, but where treatment is needed there are both surgical and non-surgical options. The right option for you will usually depend on how large your piles are and how much discomfort they’re causing.

Over-the-counter creams can help, including corticosteroid creams that reduce inflammation and haemorrhoid creams that relieve itching and pain. Some people also find over-the-counter painkillers help manage their symptoms. However, painkillers containing codeine can make you more constipated which can worsen your symptoms, so try to avoid these.

If you have constipation, easing it with medication eg laxatives or changes to your diet can help.

If these options don’t work, there are a number of other treatments that have a high success rate.

Non-surgical piles treatments

The three non-surgical treatments typically used to treat piles are banding, sclerotherapy and coagulation.

Banding involves fitting a tight band around the base of the piles to cut off their blood supply. Without blood, the piles shrivel up and fall off, usually in about a week.

Banding can sometimes be uncomfortable and cause bleeding, but it is nonetheless an effective treatment.

Sclerotherapy involves injecting a chemical solution into the piles which causes them to dry and shrivel up. It is typically less painful than banding but isn’t always as effective.

Coagulation uses infrared or laser energy to shrivel up the piles. It causes minimum discomfort.

Surgical treatments

Around one in 10 people will need surgery for piles. The surgery can either shrink the piles by cutting off their blood supply or remove the piles completely.

Surgeries to shrink piles include:

• HALO, haemorrhoid artery ligation operation
• Rafaelo® procedure, radiofrequency treatment under local anaesthetic
• Stapling, circular stapled haemorrhoidectomy 
• THD, transanal haemorrhoidal de-arterialisation

The operation to surgically remove piles is called a haemorrhoidectomy. You will be given either a local or a general anaesthetic to make sure you feel no pain during the surgery. It’s the most effective way to treat piles if they are large or keep coming back.

Recovering from a haemorrhoidectomy is painful but taking warm baths with salt can help. 

How can I reduce my chances of getting piles?

The best way to reduce your chances of getting piles is to minimise any straining around your anus. You can do this by keeping your stools soft, so you don’t need to push too hard when passing them. Eating foods that are high in fibre, such as vegetables, fruits and whole grains, and drinking plenty of fluids will help your stools pass easily.

Other tips to minimise strain around your rectum include:

• Avoid sitting down for long periods of time — this can lead to extra pressure in the veins inside your bottom
• Be careful not to strain too much when lifting heavy objects; get help if you need and make sure you bend your knees and let your legs take the strain
• Don’t hold onto your stools — you should go to the toilet as soon as you feel the need to; if you wait, your stools can dry out and they’ll be harder to pass
• Make dietary changes to improve any diarrhoea or constipation you may have 
• Take regular exercise — this reduces your chances of constipation, helps you lose weight and reduces the time you spend sitting down