Patient information from BMJ

Haemorrhoids

Last published:Aug 03, 2021

If you see bright red blood on the toilet paper after going to the toilet you might have haemorrhoids (piles). They aren't dangerous and they often go away on their own. But if you find them uncomfortable there are treatments that can help.

What are haemorrhoids?

Haemorrhoids are swollen blood vessels around your anus and inside your rectum. They happen when the small blood vessels in the lining of your rectum become wider and swollen with blood. Sometimes the swellings can appear on the outside of your anus. You might be able to push them back in.

You might get haemorrhoids if you often have to strain when you go to the toilet (for example, if you're constipated). Many women get haemorrhoids when they're pregnant, but they often go away after they've given birth.

What are the symptoms?

Small haemorrhoids might cause only mild discomfort or none at all. But large haemorrhoids can be irritating, itchy, or painful. They might also make you feel as if you haven't completely emptied your bowels even when you have.

Many people with haemorrhoids notice bright red blood on the toilet paper or in the toilet bowl. This is usually because their haemorrhoids are bleeding but it can also be a sign of a more serious problem, such as bowel cancer.

If you have bleeding it's important to see your doctor. Your doctor will examine you and order tests if you need them.

What treatments work?

Several treatments can help with haemorrhoids. What treatments your doctor recommends depends on how much your haemorrhoids are bothering you, how large they are, and whether they are inside or outside of your anus.

Doctors often recommend an operation (called a haemorrhoidectomy) to remove haemorrhoids that are outside the anus.

Things you can do for yourself

There are simple treatments you can try yourself. If these work you might not need any other treatment.

Eating plenty of fibre can help prevent and treat constipation, making your stools bulkier and easier to pass without straining. Fruit, vegetables, and wholemeal bread have lots of fibre.

Or you could try a fibre supplement, such as ispaghula husk or methylcellulose. Drinking plenty of water can also soften your stools.

You should go to the toilet as soon as you feel the need. Waiting can mean you get harder stools that are more difficult to pass. Try not to strain and don't sit on the toilet for long periods of time.

To soothe itching or pain you can buy ointments, creams, and suppositories (tablets you put up your rectum) in a pharmacy. Some contain a local anaesthetic or a corticosteroid drug. Corticosteroids are strong anti-inflammatories that help reduce swelling (inflammation).

You can get stronger corticosteroid creams from your doctor. However, you should only use corticosteroid creams for a short time as they can thin your skin with long-term use.

Some people find that a warm bath is soothing.

If these simple treatments don't work you might need other therapies such as banding, injections, infrared treatment, or surgery. You will also probably need other treatments if your haemorrhoids are outside of your anus or are causing more severe symptoms.

Banding

Banding is a simple and effective treatment for haemorrhoids that are inside the anus. It involves putting a rubber band around the base of the haemorrhoid to cut off its blood supply, making it drop off.

It's usually done in hospital. It only takes a few minutes and it isn't usually painful. You might hear it called rubber band ligation. Side effects, such as some bleeding and pain, can affect some people who have this treatment.

Injections

Injections can be used to try to shrink haemorrhoids that are inside the anus. This is called sclerotherapy. It is often used when a haemorrhoid is too small to have a rubber band put around it.

Your doctor injects a chemical into the swollen blood vessel, which causes it to collapse inwards. Some people get pain or bleeding after this treatment.

Infrared treatment

This treatment uses a device that gives off infrared light to burn away haemorrhoids that are inside the anus. You might hear it called infrared photocoagulation.

As with injections, it is often used for haemorrhoids that are too small to have a rubber band put around them. However, unlike injections, it requires multiple treatment sessions.

Stitching closed the blood supply

This is another option for treating haemorrhoids that are inside the anus. It is called haemorrhoidal artery ligation and it involves stitching closed the arteries that supply blood to your haemorrhoids.

This causes the haemorrhoids to shrink. People usually have a general anaesthetic for this procedure, so they are not awake.

Some people get pain, bleeding, and other problems after this treatment. It is less likely to cause problems than other types of surgery for haemorrhoids, such as having an operation to remove your haemorrhoids (haemorrhoidectomy).

Stapling

A newer type of operation uses a circular stapling device to lift your haemorrhoids higher to where they're less likely to cause problems. This also reduces the blood supply to the haemorrhoids and they gradually shrink.

The operation, which is called a stapled haemorrhoidopexy, is done inside your rectum rather than on the sensitive skin around your anus.

You should have less pain and a shorter recovery than if you were to have surgery to remove your haemorrhoids (haemorrhoidectomy). You will probably have a general anaesthetic to make you sleep.

This operation can sometimes lead to serious problems, such as a hole developing in the wall of the rectum. But these problems are rare.

Surgery to remove haemorrhoids

If other treatments haven't helped, or if your haemorrhoids are outside your anus or causing severe symptoms, your doctor might recommend having surgery to remove them.

This is called a haemorrhoidectomy. It's done in hospital. You'll either be given a general anaesthetic to make you sleep or a local anaesthetic to numb the area. Your haemorrhoids will be cut away. The wound will either be closed with stitches or be left to heal naturally.

An operation to remove haemorrhoids can work well. People who have this operation rarely find that their haemorrhoids return. You might get some bleeding and pain afterwards.

Some people get more serious problems, such as an infection or difficulty controlling bowel movements. But the chance of these problems is small.

What will happen to me?

You might find that your haemorrhoids come and go. They can even come back after treatment, but it's rare to get serious problems.