Piles or Haemorroids
Bleeding from the bottom is common and natural for most of us - especially younger people - and most diagnoses of ‘piles’ probably aren’t piles at all.
Doctors think it reassures us telling us our bleeding is probably piles - but many people don’t like the thought of having ‘piles’, believing they must have done something wrong (bad diet, bad habits, straining etc) Bleeding affects one in five of us in any year and can continue on and off throughout our lives
The bleeding, usually short bursts after passing a motion or small amounts seen on the toilet paper for a few days at a time, usually comes from ‘cushions’ around the anus - natural spongy bulges of tissue and blood vessels which close the anal canal to hold in gases. Pass a hard motion or strain and they can bleed easily, especially when we’re younger
Bleeding for no reason is less common particularly in older people. It still mostly goes away with no treatment.
Perhaps the word ‘piles’ should be kept for patients whose ‘cushions’ are so large they come through the anal canal and the patient has to push them back (prolapsed piles). These are more likely to happen as we get older and may need surgical treatment.
If you are straining and grape-like little lumps appear around the anus, disappearing when you stop straining, they’re normal too. Occasionally a painful clot can form in one of them - that’s known as a thrombosed pile.
Over 55, any bleeding from the bottom should probably be investigated with a five-minute short colonoscopy called a “flexible signmoidoscopy” – flexi-sig for short. See our Videos for what it involves
What can be done to reduce or stop the bleeding?
• Change your diet to more fibre so that the motions are softer and easier to pass
• Straining a lot is an important cause of bleeding or piles - some straining to start the bowels working is normal but try to avoid excessive straining
• Try buying products at the chemists but, as bleeding tends to come and go, it can be hard to know if the product has worked or the bleeding has stopped by itself
• If bleeding is a nuisance and you are referred to hospital, injections or rubber banding can control it. In some patients this is a permanent cure but as it is impossible to get rid of the ‘cushions’ which are normal structures and in some patients the bleeding can recur and it is possible to repeat the treatments.
In fact some patients get bleeding on and off in early adult life, whatever is done to them. All hospital treatments involve some discomfort but this usually settles down quickly and most are very safe.
Larger piles - banding with a rubber band to shrivel them or injections with phenol is becoming less common. Quick but does not always work
Really large piles which prolapse- usually surgery is the only option but last resort. Recovery can be painful for a couple of weeks, especially when going to the toilet. Laser, infra-red and cryotherapy treatments have been tried in the past but are not usual treatments at the moment. Newer treatments using stapling are less painful but they occasionally have bad complications.