When to seek medical advice
See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked out, so your doctor can rule out more potentially serious causes.
The symptoms of haemorrhoids often clear up on their own or with simple treatments that can be bought from a pharmacy without a prescription (see below). However, speak to your GP if your symptoms don't get better or if you experience pain or bleeding.
Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.
Some people with haemorrhoids are reluctant to see their GP. However, there’s no need to be embarrassed, because GPs are very used to diagnosing
What causes haemorrhoids?
The exact cause of haemorrhoids is unclear, but they're associated with increased pressure in the blood vessels in and around your anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed.
Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation – this is often due to a lack of fibre in a person's diet. Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.
Other factors that might increase your risk of developing haemorrhoids include:
- being overweight or obese
- age – as you get older, your body's supporting tissues get weaker, increasing your risk of haemorrhoids
- being pregnant – which can place increased pressure on your pelvic blood vessels, causing them to enlarge (read more about common pregnancy problem
- having a family history of haemorrhoids
- regularly lifting heavy objects
- a persistent cough or repeated vomiting
- sitting down for long periods of time
Preventing and treating haemorrhoids
Haemorrhoid symptoms often settle down after a few days, without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.
However, making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended. These can include:
- gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
- drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
- not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
- avoiding medication that causes constipation – such as painkillers that contain codeine
- loosing weight (if you're overweight)
- exercise regulary – can help prevent constipation, reduce your blood pressure and help you lose weight
These measures can also reduce the risk of haemorrhoids returning, or even developing in the first place.
Medication that you apply directly to your back passage (known as topical treatments) or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools.
There are various treatment options for more severe haemorrhoids. One of these options is banding, which is a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off after about a week.
Surgery carried out under general anathetics (where you're unconscious) is sometimes used to remove or shrink large or external haemorrhoids.
Diagnosing haemorrhoids
Your GP can diagnose haemorrhoids (piles) by examining your back passage to check for swollen blood vessels.
Some people with haemorrhoids are reluctant to see their GP. However, there’s no need to be embarrassed – all GPs are used to diagnosing and treating piles.
It's important to tell your GP about all of your symptoms – for example, tell them if you've recently lost a lot of weight, if your bowel movements have changed, or if your stools have become dark or sticky.
Rectal examination
Your GP may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called a digital rectal examination (DRE).
During a DRE, your GP will wear gloves and use lubricant. Using their finger, they'll feel for any abnormalities in your back passage. A DRE shouldn't be painful, but you may feel some slight discomfort.
Proctoscopy
In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin hollow tube with a light on the end that's inserted into your anus.
This allows your doctor to see your entire anal canal (the last section of the large intestine).
GPs are sometimes able to carry out a proctoscopy. However, not all GPs have the correct training or access to the right equipment, so you may need to go to a hospital clinic to have the procedure.
Types of haemorrhoids
After you've had a rectal examination or proctoscopy, your doctor will be able to determine what type of haemorrhoids you have.
Haemorrhoids can develop internally or externally. Internal haemorrhoids develop in the upper two-thirds of your anal canal and external haemorrhoids in the lower third (closest to your anus). The nerves in the lower part can transmit pain messages, while the nerves in the upper part can't.
Haemorrhoids can be further classified, depending on their size and severity. They can be:
- first degree – small swellings that develop on the inside lining of the anus and aren't visible from outside the anus
- second degree – larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again
- third degree – one or more small soft lumps that hang down from the anus and can be pushed back inside (prolapsing and reducible)
- fourth degree – larger lumps that hang down from the anus and can't be pushed back inside (irreducible)
It's useful for doctors to know what type and size of haemorrhoid you have, as they can then decide on the best treatment.
Treating haemorrhoids
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.
Creams, ointments and suppositories (which you insert into your bottom) are available from pharmacies without a prescription. 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. In these cases, haemorrhoid surgerywill usually be recommended.
The various treatments for haemorrhoids are outlined below.
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
Read more aboutpreventing constipation
Medication
Over-the-counter topical treatments
Various creams, ointments and suppositories (which are inserted into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.
These medicines should only be used for five to seven days at a time. If you use them for longer, they may irritate the sensitive skin around your anus. Any medication should be combined with the diet and self-care advice discussed above.
There's no evidence to suggest that one method is more effective than another. Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it.
Don't use more than one product at once.
Corticosteroid cream
If you have severe inflammation in and around your back passage, your GP may prescribe corticisteroid cream, which contains steroids.
You shouldn't use corticosteroid cream for more than a week at a time, because it can make the skin around your anus thinner and the irritation worse.
Painkillers
Common painkilling medication, such as paracetamoll, can help relieve the pain of haemorrhoids.
However, if you have excessive bleeding, avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofin, because it can make rectal bleeding worse. You should also avoid using codeine painkillers, because they can cause constipation.
Your GP may prescribe products that contain local anastheiticc to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days, because they can make the skin around your back passage more sensitive.
Laxatives
If you're constipated, your GP may prescribe a laxatives. Laxatives are a type of medicine that can help you empty your bowels.
Non-surgical treatments
If dietary changes and medication don't improve your symptoms, your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.
If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended.
Banding
Banding involves placing a very tight elastic band around the base of your haemorrhoids to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.
Banding is usually a day procedure that doesn't need an anaesthetic, and most people can get back to their normal activities the next day. You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger, if needed.
You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet. If you notice some mucus discharge within a week of the procedure, it usually means that the haemorrhoids have fallen off.
Directly after the procedure, you may notice blood on the toilet paper after going to the toilet. This is normal, but there shouldn't be a lot of bleeding. If you pass a lot of bright red blood or blood clots (solid lumps of blood), go to your nearest accident and emergency (A&E) department immediately.
Ulcers (open sores) can occur at the site of the banding, although these usually heal without needing further treatment.
Injections (sclerotherapy)
A treatment called sclerotherapy may be used as an alternative to banding.
During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about 4 to 6 weeks, the haemorrhoid should decrease in size or shrivel up.
After the injection, you should avoid strenuous exercise for the rest of the day. You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.
Electrotherapy
Electrotherapy, also known as electrocoagulation, is another alternative to banding for people with smaller haemorrhoids.
During the procedure, a device called a proctoscope is inserted into the anus to locate the haemorrhoid. An electric current is then passed through a small metal probe that's placed at the base of the haemorrhoid, above the dentate line. The specialist can control the electric current using controls attached to the probe.
The aim of electrotherapy is to cause the blood supplying the haemorrhoid to coagulate (thicken), which causes the haemorrhoid to shrink. If necessary, more than one haemorrhoid can be treated during each session.
Electrotherapy can either be carried out on outpatient basis using a low electric current, or a higher dose can be given while the person is under a general an asthetics or spinal anaesthetic.
You may experience some mild pain during or after electrotherapy, but in most cases this doesn't last long. Rectal bleeding is another possible side effect of the procedure, but this is usually short-lived.
Electrotherapy is recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids. It can also be used as an alternative to surgery for treating larger haemorrhoids, but there's less evidence of its effectiveness.
Surgery
Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery.
Surgery is particularly useful for haemorrhoids that have developed below the dentate line because, unlike non-surgical treatments, anaesthetic is used to ensure you don’t feel any pain.
There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.
reating bowel incontinence
Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms.
Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended.
Medication and surgery are usually only considered if other treatments haven't worked.
The various treatments for bowel incontinence are outlined below.
Continence products
You may find it helpful to use continence products until your bowel incontinence is better controlled. Most continence products are available for free on the NHS.
Anal plugs are one way to prevent involuntary soiling. An anal plug is made of foam and designed to be inserted into your bottom. However, they can be uncomfortable and they're not really a long term solution.
If the plug comes into contact with moisture from the bowel, it expands and prevents leakage or soiling. Anal plugs can be worn for up to 12 hours, after which time they are removed using an attached string.
Disposable body pads are contoured pads that soak up liquid stools and protect your skin. They can be used in cases of mild bowel incontinence.
Single-use silicone inserts, which form a seal around the rectum until your next bowel movement, are also being investigated as a treatment option for moderate to severe bowel incontinence.
Your local NHS continence service can offer help and advice about continence products, and you don't usually need a referral from your GP to make an appointment. These clinics are staffed by nurses who specialise in continence treatment.
When you're out
- Wear trousers or skirts that are easy to undo and have elasticated waistbands rather than buttons.
- disability right Ukoffers access to 9,000 disabled toilets around the UK with a rader nks. The key costs £4.50 and is only sold to people who require use of toilet facilities due to a disability or health condition.
Dietary changes
Bowel incontinence associated with diarrhoea or constipation can often be controlled by making changes to your diet.
It may be beneficial to keep a food diary to record the effect of your diet on your symptoms.
Diarrhoea
The National Institute for Health and Care Excellence (NICE) has published dietary advice for managing diarrhoea in cases of irritable bowel syndrome. These guidelines can also be applied to people with diarrhoea associated with bowel incontinence.
The advice from NICE includes the following:
- limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds)
- avoid skin, pips and pith from fruit and vegetables
- limit fresh and dried fruit to 3 portions a day and fruit juice to 1 small glass a day (make up the recommended ‘5 a day’ with vegetables)
- limit how often you have fizzy drinks and drinks containing caffeine
- avoid foods high in fat, such as chips, fast foods and burgers
Constipation
A high-fibre diet is usually recommended for most people with constipation-associated bowel incontinence. Your GP can tell you if a high-fibre diet is suitable for you.
Fibre can soften stools, making them easier to pass. Foods that are high in fibre include:
- fruit and vegetables
- beans
- wholegrain rice
- wholewheat pasta
- wholemeal bread
- seeds, nuts and oats
Drink plenty of fluids because this can help to soften your stools and make them easier to pass.
Pelvic floor muscle training
Pelvic floor muscle training is a type of exercise programme used to treat cases of bowel incontinence caused by weakness in the pelvic floor muscles.
A therapist, usually a physiotherapist or specialist nurse, will teach you a range of exercises. The goal of pelvic floor muscle training is to strengthen any muscles that may have been stretched and weakened.
You'll probably be required to carry out the exercises 3 times a day, for 6 to 8 weeks. After this time, you should notice an improvement in your symptoms.
Exercises to try
Check with your health professional before trying these at home.
First, pretend you're trying to hold in a bowel movement. You should feel the muscles around your anus tighten.
Next, sit, stand, or lie in a comfortable position with your legs slightly apart.
- Squeeze your pelvic floor muscles for as long as you can, then relax. Repeat 5 times.
- Squeeze the muscles as hard as you can, then relax. Repeat 5 times.
- Squeeze the muscles quickly, then relax. Repeat 5 times.
If you find these exercises too difficult, try fewer repetitions at first and build them up. If they get too easy, try doing more repetitions. You can do the exercises without anyone knowing about them, so they should be easy to fit into your daily routine.
Bowel retraining
Bowel retraining is a type of treatment for people with reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation.
There are 3 goals in bowel retraining:
- to improve the consistency of your stools
- to establish a regular time for you to empty your bowels
- to find ways of stimulating your bowels to empty themselves
Changes to your diet usually improve stool consistency (see above).
Establishing a regular time to empty your bowels means finding the most convenient time when you can go to the toilet without being rushed.
Ways to stimulate bowel movements can differ from person to person. Some people find a hot drink and meal can help. Others may need to stimulate their anus using their finger.
Biofeedback
Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom.
The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer.
You're then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that you are performing the exercises in the right way.
Medication
Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence.
Loperamide is a medicine widely used to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time.
laxactives are used to treat constipation. They're a type of medicine that helps you to pass stools. Bulk-forming laxatives are usually recommended. These help your stools to retain fluid. This means they're less likely to dry out, which can lead to faecal impaction.
Enemas or rectal irrigation
Rectal irrigation or enemas are used when bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool from the rectum.
These procedures involve a small tube that is placed into your anus. A special solution is then used to wash out your rectum.
Surgery
Surgery is usually only recommended after all other treatment options have been tried.
The main surgical treatments used on the NHS are sphincteroplasty and sacral nerve stimulation. Other treatments – such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery – can also be used, but their availability on the NHS is limited.
An operation called acolostomy is more widely available on the NHS, but it's only used if other treatments are unsuccessful.
These treatments are outlined in more detail below.
Sphincteroplasty
A sphincteroplasty is an operation to repair damaged sphincter muscles. The surgeon removes some of the muscle tissue and the muscle edges are overlapped and sewn back together. This provides extra support to the muscles, which makes them stronger.
Sacral nerve stimulation
Sacral nerve stimulation is a treatment used for people with weakened sphincter muscles.
Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves, which causes the sphincter and pelvic floor muscles to work more effectively.
At first, the pulse generator is located outside your body. If the treatment is effective, the pulse generator will be implanted deep under the skin in your back.
The most commonly reported complications of the procedure are infection at the site of surgery and technical problems with the pulse generator, which require additional surgery to correct.
See the NICE guidelines on sacral nrves stimulation for fecal incotitience
Tibial nerve stimulation
Tibial nerve stimulation is a fairly new treatment for bowel incontinence.
A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot. A mild electric current is passed through the needle to stimulate the tibial nerve. It's not known exactly how this treatment works, but it's thought to work in a similar way to sacral nerve stimulation.
NICE concludes that the procedure appears to be safe, although there are still uncertainties about how well it works.
See the NICE guidelines on treating fecal incotitience by stimulating tibia nerves.
Injectable bulking agents
Bulking agents, such as collagen or silicone, can be injected into the muscles of the sphincter and rectum to strengthen them.
The use of bulking agents in this way is a fairly new technique, so there's little information about their long-term effectiveness and safety.
You should discuss the possible advantages and disadvantages of this type of treatment in full with your treatment team before deciding whether to proceed.
See the NICE guidelines on trating fecal incontience with injectable bulking agent.
Endoscopic heat therapy
Endoscopic radiofrequency (heat) therapy is a fairly new treatment for bowel incontinence.
Heat energy is applied to the sphincter muscles through a thin probe, to encourage scarring of the tissue. This helps tighten the muscles and helps to control bowel movements.
The National Institute for Health and Care Excellence (NICE) recently produced guidelines on this procedure. NICE concluded that the procedure appears to be safe, although there are still uncertainties about how well it works.
As well as the uncertainties surrounding this procedure, it is also expensive. Therefore, it is usually only used on the NHS during clinical trials.
See the NICE guidelines ontreating feacal incotitienceu usind radioscope endoradience therapy.
Artificial sphincter
An artificial sphincter may be implanted if you have bowel incontinence caused by a problem with your sphincter muscles.
This operation involves placing a circular cuff under the skin around the anus. The cuff is filled with fluid and sits tightly around the anus, keeping it closed.
A tube is placed under the skin from the cuff to a control pump. In men, the pump is placed near the testicles, in women it’s placed near the vagina. A special balloon is placed into the tummy, and this is connected to the control pump by tubing that runs under the skin.
The pump is activated by pressing a button located under the skin. This drains the fluid from the cuff into the balloon, so your anus opens and you can pass stools. When you are finished, the fluid slowly refills the cuff and the anus closes.
The use of an artificial sphincter is a relatively new procedure, so there isn't much good-quality information about its long-term effectiveness and safety.
Possible problems include infection, injury during surgery and the cuff becoming dislodged. In some cases, further surgery is required to correct problems.
See the NICE guidelines on trearing fecal incotitience with artificial sphinter without cut abdomen
Colostomy
A colonostomy is usually only recommended if other surgical treatments are unsuccessful.
A colostomy is a surgical procedure in which your colon (lower bowel) is cut and brought through the wall of your stomach to create an artificial opening. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening.
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