What Are the Symptoms of Piles?
The symptoms of piles can come and go. There are five main symptoms:
bleeding, with bright red blood
itching and irritation
aching pain and discomfort
a lump, which may be tender
soiling of underwear with slime or poo (‘skid marks’).
Itching and irritation probably occur because the lumpy piles stop acting as soft pads to keep the mucus in; instead, a little mucus leaks out and irritates the area around the a***. Pain and discomfort comes from swelling around the pile, and from scratching of the lining of the a*** canal by poo as it passes over the lumpy area. The scratching also causes bleeding, which is a fresh bright red colour and may be seen on the poo or toilet paper or dripping into the toilet. A pile that has been pushed down (grade 2–4 piles) may be felt as a lump at the a***.
How You Can Help Yourself
Most piles get better in a few days without any treatment, but there are several ways of relieving the discomfort.
Wash the area gently with warm, salty water, to get rid of irritant mucus that has leaked out. Dry carefully with cotton wool and apply petroleum jelly (available from pharmacies) or nappy rash cream to protect your skin if more mucus or moisture leaks out.
Use soft toilet paper, and dab rather than wipe; also consider unscented wet wipe toilet paper or use a bidet to gently clean the area.
Wear loose underwear and clothing (i.e. not tight trousers), so that nothing will rub the pile.
Do not scratch. For more information on dealing with itch, look at the section on a*** itching.
Avoid constipation by eating lots of fresh fruit and vegetables and soluble fibre. Aim for poo that is soft enough to change their shape as you push them out.
Drink plenty of fluids.
After you have had a poo, do not strain to finish. People with piles often think there is more to come, but this is a false sensation caused by the swollen spongy pads in the piles themselves. Do not read on the toilet. Aim to be off the toilet within a minute.
If you can feel a lump, try pushing it gently upwards; try to relax your a*** as you do so.
If you have a lot of discomfort, buy a haemorrhoid cream or gel. A pharmacist will be able to help you choose one that is suitable for you. A haemorrhoid cream or gel does not cure the pile, but will usually relieve the discomfort effectively until the pile goes away of its own accord. Do not use it for longer than a week or two.
To stop piles returning, continue the high-fibre diet to keep your stools soft and do not put off opening your bowels, and avoid straining.
When to See Your Doctor
See your doctor if the symptoms last longer than a week. You should also see your doctor if you have bleeding to ensure that there is not a more serious cause. Your doctor will examine your a***, feel inside the a*** canal and may also insert a small plastic or metal tube, called a proctoscope, an inch or two into the a*** canal to give a better view. For more information, look at the section on seeing your doctor about an a*** problem.
What Your Doctor Can Do
First- and second-degree piles usually go away on their own if constipation is avoided, but your doctor may prescribe a short course of haemorrhoid cream to relieve symptoms. Third-degree piles may also go away on their own, but if they persist, they may need treatment.
Only a few people need an operation; most are treated by banding or phenol injections. There is usually no need for a general anaesthetic or to stay in hospital overnight for these procedures.
‘Venotonic’ drugs are popular treatments for piles in Europe (especially France) and in the Far East. The most common are the so-called ‘flavonoid’ chemicals such as diosmin, hidrosmin, hesperidin and rutosides. Researchers have looked at all the evidence on these drugs, and have concluded that it is not possible to say whether they are effective because most of the research studies have been flawed in one way or another (British Journal of Surgery 2006;93:909–920).
Banding involves placing a small rubber band at the base of the pile, so that it pinches the lining of the a*** canal. This ‘strangles’ the pile, so it dies and falls off. It causes some scarring. It is more effective than some other treatments but has some drawbacks, such as severe bleeding in a few cases. Therefore you need to tell the surgeon if you are on blood-thinning (anticoagulant) medication. Some people feel faint and nauseous just after the bands are put on, and they can be quite painful for the following 48 hours. According to an article in the British Medical Journal (2003;327:8847-521), the success rate for banding is:
79% of piles are cured
18% of piles return so that repeat banding is needed
for 2% of piles, it does not work at all.
How to ‘shrink’ piles/haemorrhoids
Injection of phenol in almond oil is a method of causing scarring in the area, but produces a permanent cure in only about 25% of cases. It is less commonly used now, because the results are not as good as with banding.
Banding and injection are not suitable for larger grade 3 piles or for grade 4 piles.
How to ‘shrink’ piles/haemorrhoids
Direct-current electrotherapy (eXroid) is a new non-surgical treatment that uses a probe to apply a very low current to the base of the pile for up to 10 minutes. It is usually painless and has the best safety record of all available treatments. More than 120,000 patients have been successfully treated worldwide, and it is the only treatment approved in the USA for all grades of piles.
Cryosurgery freezes the pile to destroy it. It is not used much because it causes a watery discharge afterwards.
Infrared coagulation uses infrared light to destroy the pile. This method is not commonly used in the UK because it is not as effective as other methods.
Surgery. There are several different operations for piles.
In the usual operation, the swollen spongy pad that forms the pile is cut away. It is painful for 7–10 days afterwards.
A newer operation, called ‘stapling’, involves cutting away a 2 cm strip of the lining of the r***** and joining the cut edges with a special stapler. People seem to recover quicker from ‘stapling’ than from the ordinary operation. It is not yet a common operation in the UK, but it is popular in the rest of Europe. Although it is less painful than the ordinary operation, it seems to be less effective in the long-term and about 12% of people have a recurrence of the piles within 16 months (Surgery 2006;24:148–150). However, more research is needed.
Another type of operation uses ultrasound to locate the arteries that feed blood into the pile. These arteries are then closed off using stitches. Bleeding from the pile decreases over the following few weeks. This treatment is becoming more popular, partly because it does not involve any cutting and is almost painless. More research is needed to see if it is effective in the long-term.
First published on: embarrassingproblems.***
Reviewed and edited by: Dr Kevin Barrett
Last updated: October 2020