What are haemorrhoids?

Haemorrhoids are enlarged veins just under the surface tissue of your rectum (the last part of your bowel) or your anus (the opening of your bowel). Haemorrhoids that occur in your rectum are called internal haemorrhoids, and those that occur around your anus are called external haemorrhoids. Haemorrhoids are common — about 50 per cent of adults have them by the time they turn 50 — and are also called ‘piles’.

Symptoms

Haemorrhoids can become swollen, painful and inflamed (‘flare up’) and bleed when irritated, while at other times, when they are not swollen or irritated, they may cause no symptoms.

Internal haemorrhoids usually can’t be seen from the outside, but they can cause a feeling of pressure in the rectum and can bleed, especially when you pass a stool. You might notice streaks of bright blood on the outside of a stool or on the toilet paper when you wipe your bottom, or splashes of blood in the toilet bowl.

Internal haemorrhoids can cause mucus to leak from the rectum onto the anal skin. This moisture encourages secondary skin infections, and results in the itchiness that often accompanies haemorrhoids.

Internal haemorrhoids are not usually painful, but if one becomes very large, it can hang out of the anus (called a ‘protruding haemorrhoid’), causing pain and increased swelling.

External haemorrhoids can be seen on the outside of the anus. They look like one or more firm grape-like swellings. External haemorrhoids can become painful and irritated, and can bleed or itch. Blood pooling in an external haemorrhoid can lead to a blood clot forming in the haemorrhoid. This results in a firm, bluish swelling on the edge of the anus that is very painful. This pain usually intensifies over about 3 days then settles as the clot resolves.

When a swollen haemorrhoid subsides, the area of anal skin that overlies it can hang a bit loose, because it was stretched when the haemorrhoid was swollen. This small area of loose skin is called a ‘skin tag’. Several skin tags can give the anus a ruffled rather than a smooth appearance. Skin tags do not usually cause discomfort but they can make cleaning your bottom after passing a motion more difficult. It is best to wash the area or use a moist disposable wipe, rather than dry toilet paper.

What causes haemorrhoids?

Increased pressure in the veins around the anus is thought to be the cause of haemorrhoids. This increased pressure can be caused by:

• straining to pass a bowel motion because of hard, dry stools (as in constipation);
• diarrhoea;
• heavy lifting;
• being very overweight;
• sitting on the toilet for a long time; and
• sitting or standing for long periods.

In women, probably the single most common cause of haemorrhoids is pregnancy, as the weight of the baby and childbirth itself both increase the pressure in the anal veins.

Failure to pass a stool when needed, eating a diet low in fibre, not exercising regularly, and not drinking enough fluids can lead to constipation, which increases your likelihood of developing haemorrhoids.

Original material provided by myDr, 9/3/2004.