What Are Piles? Causes and Treatment
Recently I received a call from an old friend who was rather distressed and needed advice on a delicate matter. My friend was obviously embarrassed as she found it difficult to explain the exact cause of her predicament. She used words and phrases like 'down below, ' . . . ' well . . . er . . .you know . . . in my . . . er.' before finally she asked 'well it's cancer, isn't it?'
She had piles, but at that time she did not know it. She went to the toilet and was horrified to find that there was evidence of fresh blood from her back passage after passing stool.
My friend immediately thought the worst. She was surprised to learn that the most obvious and most common cause of rectal bleeding is 'piles,' also known as hemorrhoids (haemorrhoids.)
Piles are often the butt of many jokes (pardon the pun) or well-meaning advice like 'don't sit on cold cement.' However, if you are the individual suffering from piles it is not a joking matter. This condition can be the source of much embarrassment and stress as people imagine the worst case scenario.
I asked my friend a few pertinent questions, and soon I was able to reassure her. I explained that she should contact her doctor for an appointment to confirm the problem and to rule out potentially serious conditions. However, chances are she may be suffering from a small crack or tear in the anus or maybe even bleeding piles.
I received another call from my very relieved friend after her trip to the doctor. informing me that she was indeed suffering from piles.
This article will cover the following topics:
- What Are Piles/Hemorrhoids
- Types of Piles
- Causes and Symptoms of Piles
- Prevention of Piles
- Treatment of Piles
- Over-the-Counter Treatment Options
- Home Remedies for Piles
What Are Piles or Haemorrhoids
Haemorrhoids comes from the Greek word haimorrhois meaning 'liable to discharge blood.' They are caused by the abnormal swelling of tissue containing veins and tiny arteries within the lining of the anus and lower rectum.
These vessels can become dilated and engorged with an excess of blood quite like varicose veins. The engorged vessels and surrounding tissue can develop into small swellings known as haemorrhoids or piles.
It is estimated that 50% of people in the UK and around 10.4 million people in the US suffers from piles. 50% of us will develop piles by the age of 50, there are 1 million new cases of piles each year in the US, but only a small proportion will seek treatment.
The reason we get piles is not exactly clear. In some cases it occurs for no apparent reason, but the general consensus is that the condition occurs when there is an increased intra-abdominal pressure exerting force in and around the anus.
In many cases the piles are mild and are present without any sign of other symptoms. However, in severe cases symptoms can include:
Bleeding of bright red blood after passing stool
Itching around the anus
Mucous discharge after passing stool
Inflammation and soreness around the anus
Feeling like the bowels remains full and still need to be emptied
Types of Piles or Haemorrhoids
There are two types of piles: internal and external.
Internal piles often remain along the anal wall with no obvious symptoms; people with internal piles are normally unaware of their presence unless it breaks through the anal wall. When this occurs, the swelling needs to be pushed back after passing stool, also known as protruded or prolapsed haemorrhoids or piles. Internal piles are not usually painful but can be associated with other conditions such as fissure.
Fissure is a tear in the lining of the anal canal which can be further extended when stool is passed during a bowel movement; it can be painful, bleeds and itches.
External piles consists of small soft pads along the opening of the anus, normally the same colour as the skin. When external haemorrhoids form a blood clot, it can appear blue, accompanied by severe pain, itching, and inflammation.
Piles can become strangulated and bulge outside of the anus; the anal muscles tighten around the pile causing it to become hard and painful.
Perianal haematoma is associated with external blood clots under the skin.
Thrombosed external haemorrhoid is a hard lump consisting of blood clots that develop around the anus and can be painful.
How Do You Get Piles? Causes and Symptoms
Certain factors are thought to increase the chances of developing piles; they include:
Chronic Constipation passing large hard stool can cause straining that increases the pressure in and around the anus to form piles.
Pregnancy and childbirth: Piles are a common occurrence in pregnancy, this is probably due to the pressure of the baby lying above the rectum and anus. Hormonal changes during pregnancy can also affect the veins in the anus to cause piles
Age: The tissue lining the anus, can become less supportive with age, increasing the risk of piles
Hereditary: Some people may inherit a weakness in the wall of the anal region.
Other factors include chronic diarrhea, prolonged sitting or standing, heavy lifting and obesity.
How to Prevent Piles
The best management of piles is prevention, ways to avoid piles includes:
Diet: A high fibre diet with plenty of fruits, vegetables and grain, will increase bulk and soften the stool to reduce straining.
Hydration: Drink more fluids.
Fibre: Consider taking fibre supplements, but remember to drink 8 to 10 glasses of water while taking them, or they can cause constipation.
Exercise: Staying active help reduce pressure on the veins caused by long periods of standing or sitting; it can also help to reduce weight and obesity.
Go to the Toilet: Go as soon as you feel the urge because holding back causes the stool to become drier and harder to pass.
Don't Sit on the Toilet for too Long: Sitting for too long so will increase the pressure on the anus and can exacerbate the problem.
Additional Tips for Preventing Hemorrhoids
- Eat more wholemeal or multi-grain bread instead of white loaf.
- Try brown rice and wholemeal pasta.
- Cut down on on animal fat, sugary and processed or refined foods.
- Add nuts and seeds to breakfast cereals and sprinkle on your salads.
- Eat five portions of fresh fruit and vegetables per day.
- Eat more pulses such as baked beans, lentils, beans, kidney beans and chickpeas.
- Try to avoid medication that causes constipation, such as painkillers containing codeine.
- Reduce alcohol intake because alcohol causes dehydration and can harden the stool to cause constipation.
See Your Doctor
Don't die of embarrassment. Contact your doctor if you find blood in you stool—do not assume the worst. A trip to the doctor's can put your mind at ease. If the problem proves to be something more serious, the earlier the intervention, the better.
Piles are little more than a nuisance, but if ignored it can be painful and could require more invasive management. Prevention is always the best cure, and squatting is better than sitting.
Treatment Options for Alleviating Piles
As mentioned about, a mild case of piles can be relieved by good management. The condition will quite often settle down after a few days without treatment, however; treatment is available to relieve the symptoms in more severe cases, and to remove or shrink piles where necessary.
- Creams, ointments and suppositories are available over-the-counter from various pharmacies. They can be used to relieve the symptoms of swelling and inflammation, but should only be used for five to seven days at a time; any longer can cause irritation of the sensitive skin around the anus.
- Painkillers such as paracetamol and local anesthetics can help to relieve pain.
- Laxatives may be recommended the doctor for relieving constipation and can also help to form bulk in stool.
- Banding is a procedure that can be used to treat second and third-degree haemorrhoids. This procedure involves the placing of a tight elastic band around the base of the piles to effectively cut off the blood supply. Piles should fall off within seven days of having the procedure.
- Injection (sclerotherapy) is often used for internal piles as an alternative to banding. A chemical solution is injected into blood vessels in the anus to deaden the sensory nerve endings, relieve pain and harden to form scar tissue. The piles should reduce in size and shrivel up in about four to six weeks.
- Infrared coagulation can also be used in the treatment of piles.
- Haemorrhoidectomy surgery is sometime necessary to treat large, internal piles or those that are graded three or four.
- Cold compress may be used when piles are extended outside of the anal canal and can help to relieve swelling
- Avoid foods that may worsen the condition such as nuts, coffee, alcohol and spicy foods.
- Use wet wipes or moist toilet paper after passing stool.
- Using Epsom Salt in warm water and sitting for approximately 15 minutes at a time can help to relieve symptoms and reduce inflammation.
- Clean the anal area by gently cleansing with warm water; soap may aggravate the condition.
- Prolapsed piles may be pushed back very gently into the anal canal.
- Surgical rings or donut cushion and pillows can help to relieve pressure and maintain comfort.
Over-the-Counter Treatment Options for Piles
shark liver oil
Anusol Ointment / Suppositories
shark liver oil
Daflon / Cyclo-3 Fort Oral Tablets
Always get advice from your primary health provider, and read all instruction before taking medication.
Care should be taken when using over-the-counter medication containing vasoconstrictors in people with any of the the following conditions: diabetes, heart disease, high blood pressure, thyroid problems, difficulties passing urine, those taking anti-depressant medications.
Home Remedies for Treating Piles
Apple Cider Vinegar is apparently one of the most popular natural treatments for piles. Soak a cotton ball with apple cider vinegar and apply it to the piles. Repeat this process until the inflammation and symptoms are gone. Alternatively, half a cup of apple cider vinegar can also be added to a sitz bath.
Rutin is a health-promoting compound that has been credited with properties that strengthen blood vessels. Rutin is found in buckwheat, oranges, grapefruits, asparagus lemons, and cranberries. It is often used to treat piles and can be taken as s supplements.
Coconut oil should be applied to haemorrhoids, rinsed and repeated. This will help to relieve the symptoms of piles which should disappear within a few days.
Witch hazel is one of the oldest known natural remedies for piles. Use by soaking a cotton ball with witch hazel and applying it to the affected area.
Aloe vera should be applied to the affected area to relieve symptoms.
Sitz baths require soaking the area a few times per day in warm water for 10 to 15 minutes to relieve symptoms.
- Squatting (rather than sitting) is the conventional position we assume when using the toilet. This may be one of the reasons why piles are so common in developed countries. In many of the less developed parts of the globe squatting is the preferred position when using the loo. Sitting down while having a bowel movement puts excess strain on the rectum. On the other hand, squatting helps to straighten the rectum and relaxes the puborectalis muscle.
Additional Piles Related Tidbits
Oncologists have observed that 80% of colon cancers occur in the caecum and sigmoid colon. These areas that are not fully emptied when we use the sitting position to empty the bowel. This causes residual fecal matter to stagnate, and this may well be the reason colon cancer is the second leading cause of deaths in developed countries.
In cultures where squatting on the loo is the norm such as Asia and Africa, colon cancer is very rare. However, I believe that a less refined diet, high in grain fresh fruits and vegetables may have something to do with the statistics. The old way of our ancestors' 'squatting' may yet prove to be the healthier position. People in the US and Europe are beginning to warm to the idea as new products begin to emerge in the marketplace to facilitate squatting.
Reduce the Strain by Squatting
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.