‘Piles can be managed’

• Mr Fahuwa

Haemorrhoids also called piles (Yoruba, jedijedi) are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. Haemorrhoids (piles) often clear up by themselves after a few days.

However, there are many treatments that can reduce itching and discomfort. Making simple dietary changes and not straining on the toilet are often recommended first. Haemorrhoids (Piles) are swellings that can occur inside and around the back passage (anus) and the anal canal.

To understand Haemorrhoids one needs to know that there is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged with more blood than usual. The engorged veins and the overlying tissue may then form into one or more small swellings called piles. The anal canal is the last part of the large intestine and is about 4cm long. At the lower end of the anal canal is the opening to the outside (usually referred to as the anus), through which faeces pass. At the upper end, the anal canal connects with the rectum (also part of the large intestine).

Creams, ointments and suppositories (which you insert into your bottom) are available and they can be used to relieve any swelling and discomfort. If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canal – the lower third (closest to your anus) or the upper two-thirds. The lower third contain nerves which can transmit pain, while the upper two-thirds do not. Non-surgical treatments for haemorrhoids in the lower part of the canal are likely to be very painful, because the nerves in this area can detect pain. There are also herbal preparations that can address this problem.

Different types of piles (haemorrhoids)

Internal piles (haemorrhoids) are those that form above a point two to three cm inside the back passage (anus) in the upper part of the anal canal. Internal piles are usually painless because the upper anal canal has no pain nerve fibres. External piles are those that form below that point, in the lower part of the anal canal. External piles may be painful because the lower part of the anal canal has lots of pain nerve fibres.

The terminology can be a little confusing – you would have thought that external piles would mean outside of the anal canal (and so outside of the anus) but this is not always the case. There are external piles that are actually inside the anus. Internal piles can also enlarge and drop down (prolapse), so that they hang outside of the anus. Some people develop internal and external piles at the same time. Internal piles can be classified into grades one to four according to their severity and size:

• Grade 1 are small swellings on the inside lining of the anal canal. They cannot be seen or felt from outside the anus. Grade 1 piles are common. In some people they enlarge further to grade two or more.
• Grade 2 are larger. They may be partly pushed out from the anus when you go to the toilet, but quickly spring back inside again.
• Grade 3 hang out from the anus when you go to the toilet. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
• Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

Certain situations increase the chance of piles developing

• Constipation, passing large stools (faeces), and straining at the toilet. These increase the pressure in and around the veins in the anus and seem to be a common reason for piles to develop.
• Pregnancy. Piles are common during pregnancy. This is probably due to pressure effects of the baby lying above the rectum and anus, and the effect that the change in hormones during pregnancy can have on the veins.
• Ageing. The tissues in the lining of the anus may become less supportive as we get older.
• Hereditary factors. Some people may inherit a weakness of the wall of the veins in the anal region.

Dietary changes and self care

If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular, so that you don’t strain when passing stools.

You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables. You should also drink plenty of water and avoid caffeine (found in tea, coffee and cola). When going to the toilet, you should:

• Avoid straining to pass stools, because it may make your haemorrhoids worse
• Use moist toilet paper, rather than dry toilet paper, or baby wipes to clean your bottom after passing a stool
• Pat the area around your bottom, rather than rubbing it

Avoid constipation and straining at the toilet

Keep the stools (faeces) soft, and don’t strain on the toilet. You can do this by the following:

Eat plenty of fibre, such as fruit, vegetables, cereals, and wholegrain bread

Have lots to drink. Adults should aim to drink at least two litres (six-eight glasses) per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens faeces. Most sorts of drink will do, but alcoholic drinks can cause the body to lose fluids (they are dehydrating) and may not be so good. Too much caffeine should also be avoided.

Fibre supplements. If a high-fibre diet is not helping, you can take fibre supplements (bulking agentsas they also help to soften faeces directly which makes them easier to pass.

Avoid painkillers that contain codeine such asco-codamol, as they are a common cause of constipation.

Toileting. Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later. This may result in bigger and harder faeces forming which are then more difficult to pass. Do not strain on the toilet. Piles may cause a feeling of fullness in the rectum and it is tempting to strain at the end to try to empty the rectum further. Resist this. Do not spend too long on the toilet, which may encourage you to strain. (For example, do not read whilst on the toilet.)