Piles, or haemorrhoids, are areas in the anal canal where the tissue has become swollen. They are very common at any age.
Piles are round swellings on the inside of the anal canal - the short, muscular tube that connects your rectum (back passage) with your anus - in areas known as the anal cushions.
Many people with piles don't consult a doctor so it's difficult to know exactly how many people in Hong Kong get them.
Although piles develop from inside your anal canal, they can hang down out of your rectum. They are graded as follows.
- First degree piles are swellings on the inside lining of your anal canal. They may bleed but can't be seen from outside the anus.
- Second degree piles are larger and stick out (prolapse) from the anus when you have a bowel movement, but return on their own afterwards.
- Third degree piles are similar, but hang out from your anus and only return inside when pushed back in.
- Fourth degree piles permanently hang down from your anus and you can't push them back inside. They may become extremely swollen and painful if the blood in them clots.
- External piles are swellings that develop from below the anal cushions. They can be more painful than the other types of piles.
Other causes of lumps around the anus can include a sentinel pile, which is the painless skin tag that develops when a crack in the anus (an anal fissure) heals up.
The exact cause of piles is not known. One theory is that piles are a result of a weakness of the tissue that connects the anal cushions to the muscle layers underneath. In combination with frequently straining while passing hard bowel movements, this can cause the anal cushions to slide out of their usual place and down the rectum.
You are more likely to develop piles:
- if you eat a low-fibre diet
- if you strain to empty your bowels (for example, if you have constipation)
- as you age because the support structures in your rectum weaken
- if you're pregnant
- if you're born with a weakness in your rectum or have a family history of piles
Common symptoms of piles include:
- painless bleeding from your anus, which you may notice in the toilet bowl or when you use toilet paper, or from soiled underwear
- a lump on your anus
- a slimy discharge of mucus
- a feeling that your bowels have not emptied completely
- itchy skin around your anus
- swelling around your anus
- pain and discomfort after a bowel movement if you have external piles
These symptoms may be caused by problems other than piles. You should visit your doctor for advice.
Visit your doctor if you notice any signs of bleeding from your rectum.
Your doctor will ask about your symptoms and examine you. This may involve a rectal examination, where he or she will gently insert a gloved finger into your rectum. Your doctor may also ask you about your medical history.
Your doctor may use a proctoscope to look inside your rectum. A proctoscope is a narrow, tube-like telescopic camera. Air can be blown through the tube to open up the bowel so it can be seen more clearly. This test can help to rule out problems in your rectum.
Alternatively, your doctor may refer you for a flexible sigmoidoscopy or colonoscopy test that will need to be done in hospital. This allows your doctor to look inside your large bowel. These tests are sometimes done to check that your condition isn't caused by something more serious.
- If you're passing hard or infrequent faeces, you could try a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxatives such as lactulose, which will soften your faeces. Don't use laxatives that stimulate the bowel, such as senna, unless your doctor advises you to.
- Soothing creams, ointments and suppositories may ease any pain and itchiness. There are many different products available. Some contain a local anaesthetic such as lidocaine.
- Products containing corticosteroids, such as Anugesic-HC and Proctosedyl, may reduce inflammation and pain.
- infrared coagulation or laser, where infrared light is used to seal the veins above the pile causing it to shrink
- cryosurgery, which destroys the pile by freezing it - the pile will later shrink and fall off
- bipolar diathermy and direct current electrotherapy, where an electrical current is used to burn the pile off
You can reduce your risk of developing piles. If you have daily bowel movements that are solid but soft, and you don't need to strain, faeces will pass easily and won't put pressure on the blood vessels in your anal area.
To keep your bowel movements soft try to:
- eat plenty of fibre-rich foods such as fruit, vegetables and wholegrain cereals (for example, brown rice, wholemeal bread and wholemeal pasta)
- drink plenty of fluids
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