Swollen veins, popularly known as piles, are the most common cause of bleeding from the back passage.

Causes of Hemorrhoids

There are two types, internal and external piles. The causes are the same. External piles are visible as swellings around the back passage and can be felt. They are veins that have become dilated and varicose, similar to varicose veins on the legs. Internal piles are a little more complicated. They are pillars of cushioning tissue supporting the rectum and cannot usually be felt unless they prolapse (drop) through the anus.

Anything that increases the pressure of blood within the abdomen increases the chances of piles, for example spending much time standing, pregnancy (see Pregnancy problems) and chronic constipation with accompanying straining.

Piles are more often a nuisance than anything else, unless they prolapse. When this happens to internal piles the piles become trapped by the muscles of the anus and remain as large painful swellings that cannot be pushed back inside. External piles can thrombose – meaning that the blood inside them clots.

Symptoms of Hemorrhoids

Often there is slight discomfort around the back passage, itching and occasional bleeding after defecation. Prolapsed piles are felt and seen as large tender swellings at the anus.

Treatment of Hemorrhoids

Mild piles are common and cause little by way of symptoms. Even though they occasionally prolapse they are easily pushed back inside. No treatment is needed apart from avoiding constipation and straining, by increasing fibre and fluid intake. It may be possible to spend less time standing. Piles appearing during pregnancy will go after birth.

If the pile has prolapsed and is tender, treatment is with painkillers and creams containing a local anaesthetic rubbed into the pile. It will shrink over a few days. Occasionally, a pile causes so much pain that a surgeon will need to cut it open to let out the blood, but this does prolong the healing process.

Various treatments for piles that give recurrent problems all cause the blood to clot inside the pile, which will then shrink away. Piles can be burnt, gripped with tough rubber bands, frozen or injected. Whatever is done, piles tend to recur after a few years and hemorrhoidectomy, offering a good chance
of permanent cure, may be necessary. This involves cutting a portion of the rectal lining, taking the pile with it. The operation has a reputation for being painful, as has the first opening of the bowels afterwards. Good anaesthetic technique avoids this by blocking the pain nerves at the time of surgery.

QUESTIONS

Should I worry that I often get bleeding from piles?

It is tempting to ascribe rectal bleeding to piles. While this is safe in young people with obvious piles, older people should have further checks to exclude other causes of bleeding.

Are piles dangerous?

Theoretically there is a risk of anaemia through constant blood loss but this is very unusual unless significant bleeding is neglected.

Is there any harm in self-treatment?

If you know you have piles and if the symptoms are familiar, there is little harm. The older you are the more seriously you should take any change in the amount or pattern of bleeding or discomfort.

Complementary Treatment

Homeopathy – Paeonia ointment for external piles, or Paeonia suppositories for internal piles. Chakra balancing aids pain control and healing; the relaxation effect eases defecation. Aromatherapy – try a daily sitz bath with one of the following oils (six drops); cypress, chamomile, lavender. A nutritional therapist would suggest boosting your fibre intake. Ayurveda -oral preparations are given, plus dietary advice. Yoga is especially helpful, together with pelvic floor exercises. Other therapies to try: shiatsu-do.