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Haemorrhoids are sometimes called ‘piles’. They can be internal (inside the anal canal) or external (outside the anal canal). They are common, particularly after the age of 40 and during pregnancy.
External haemorrhoids are small, painful swellings around the anus.
Internal haemorrhoids are usually painless but may bleed. They occur when the inside of the anal canal becomes damaged or weak. Increasing age and passing hard stools (constipation) can make this more likely.
Internal haemorrhoids can prolapse or pop out through the anus, at first when there is a bowel motion and later, at any time. Some pop back in by themselves, but more severe ones need to be pushed back in with your finger. Some cannot be put back in, which can lead to complications.
Causes of haemorrhoids include increasing age, pregnancy, varicose veins, chronic constipation, straining when you go to the toilet, heavy lifting, obesity, prolonged sitting, chronic diarrhoea, and bowel or pelvic tumours.
Symptoms of haemorrhoids
- bleeding from the rectal area, especially when you go to the toilet; this may be visible as bright red blood on toilet tissue, in the toilet bowl, or on the outside of your stools
- itching around your anus
- burning or dull pain in the rectal area, especially when you go to the toilet
- straining when you go to the toilet
See Your Pharmacist or Medical Professional
- if it is the first time you have had haemorrhoids
- if the person with the haemorrhoids is a child
- if the blood appears to be mixed in with your stools, not just on the outside
- if the blood is profuse or persistent or is dark in colour
- if you have sore, hard lumps or severe pain or itching around the rectal area
- if the haemorrhoids have to be pushed back in after you have been to the toilet
- if you notice seeping faeces, mucus, pus or any other discharge
- if you strain when you have a bowel motion and you feel like you cannot completely empty your bowel
- if you have significant pain when you have a bowel motion
- if you have had symptoms for more than three weeks, if the haemorrhoids do not improve after a week, or if the haemorrhoids return
- if you have chronic constipation, diarrhoea or your bowel habits have changed
- if you have other symptoms, such as fever, abdominal pain, vomiting, nausea or if you have no appetite
- if you have unexplained weight loss or tiredness
- if your haemorrhoids seem to be getting worse even though you are treating them
- if you are pregnant or breastfeeding; some medicines may not be suitable
- if there is a family history of colon cancer or inflammatory bowel disease
- if you have other medical conditions or take other medicines
- if you have allergies to any medicines or have just started taking a new medicine
- apply a cold compress to the area for relief
- a warm salt bath may help painful haemorrhoids, especially after passing a motion
- use baby wipes instead of toilet paper
- avoid scratching the area
- wear cotton underwear to minimise discomfort
- treat any constipation or diarrhoea
- eat a high-fibre diet and drink plenty of fluids
- if your diet is not already high in fibre, introduce it gradually
- exercise regularly
- avoid straining when having a bowel motion
- lift heavy items using a safe technique to prevent straining
- avoid long periods of standing or sitting if possible
- always go to the toilet as soon as you feel the need to go as 'holding on' can make haemorrhoids worse
- treatment generally relieves symptoms such as itching, pain and swelling
- the choice of treatment can depend on how bad your symptoms are
- it can take one week for external haemorrhoids to disappear or improve
- some haemorrhoid products (e.g. those with hydrocortisone) are only for short-term use; check the manufacturer’s directions
- for best results use haemorrhoid products morning and night and after each bowel motion
- always remove foils or plastic wrap from suppositories, then insert the rounded end first
- the dosage may change over days or weeks; always follow product instructions
- haemorrhoid products are well tolerated by most people but occasionally may cause skin irritation or sensitivity
- local anaesthetics are more effective if applied around the anus and the beginning of the anal canal
- some people may require surgical therapy to relieve painful or persistent haemorrhoids
e.g. Metamucil, Normafibe, Benefiber, Fybogel
- these products can improve symptoms and help with constipation
Ointments or suppositories
e.g. zinc oxide, Peruvian balsam, benzyl benzoate (Anusol ointment and suppositories)
e.g. cinchocaine, hydrocortisone (Proctosedyl Ointment, Proctosedyl Suppositories); cincochaine + zinc oxide (Rectinol ointment); lignocaine + allantoin + hamamelis + zinc oxide (Hemocane ointment); lignocaine + hydrocortisone + aluminium acetate + zinc oxide (Xyloproct ointment)
e.g. glyceryl trinitrate (Rectogesic ointment)
e.g. cinchocaine + prednisolone (Scheriproct ointment and suppositories)
- ointments and suppositories include a number of ingredients that relieve symptoms:
- corticosteroids (such as hydrocortisone and prednisolone): reduce redness, swelling, itching and pain
- local anaesthetics (such as cinchocaine and lignocaine): reduce pain and itching
- protectants (such as zinc oxide and mineral oils): soften and soothe skin
- astringents (such as zinc oxide, witchhazel (hamamelis), aloe and Peru balsam): provide a protective coating over damaged tissue
- antipruritics (such as resorcinol, benzyl benzoate): reduce itching
- glyceryl trinitrate ointment may relieve pain and discomfort associated with post-haemorrhoidectomy
- a product containing an astringent and local anaesthetic may be enough if haemorrhoids are not severe
- products containing corticosteroids and anaesthetics should be limited to 7 days’ use unless otherwise advised by your health care professional
- ointments can be used for internal and external haemorrhoids, especially if they are sore
- suppositories may be more effective for internal haemorrhoids
- most products come with a special applicator
- use ointments or suppositories after bowel motions; follow the manufacturer’s directions
- some haemorrhoid preparations can be used in pregnancy; check with your pharmacist
Availability of medicines
- GENERAL SALE available through pharmacies and possibly other retail outlets.
- PHARMACY ONLY available for sale through pharmacies only.
- PHARMACIST ONLY may only be sold by a pharmacist.
- PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.
Last Reviewed: 30/11/2009
Video: Haemorrhoids - Dr Naseem
Haemorrhoids, also known as piles, are one of the oldest afflictions described in surgical history. The term refers to the blood vessels lining the innermost layer of the canal leading to the anus.
Haemorrhoids are enlarged, congested veins just under the surface tissue of your rectum or anus. About 50 per cent of adults have had them by the time they turn 50.
Preventing constipation is the best way to avoid existing haemorrhoids becoming irritated and new ones forming. Avoid excessive straining and sitting on the toilet for any longer than a few minutes.
Constipation is when your bowel motions take more effort than usual and your stools can be small and hard. Find out what products are available for constipation.
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