Consultant surgeon

Haemorrhoids / Piles

An area of bowel lining at the junction of the anus and rectum sits slightly proud at usually three points of the surrounding area due to dilated blood vessels under the surface. Its function is to provide a tight seal when the muscles of the anus close after passing a stool. Commonly this area can swell and, if it causes symptoms, we call these points haemorrhoids or piles.

Symptoms can be mild and require little or no treatment but progressive swelling can cause persistent and distressing problems:

Bleeding. Usually bright red in character and found on the toilet tissue or dripping into the toilet bowl.

Burning/anal itching. This can be intense and is often a problem during the night.

Pain. Not usually thought to be a symptom of piles but is not uncommon. The pain is different in character from that of an anal fissure. It comes on after passing a stool, rather than during, and lasts up to about an hour. It is caused by a pile prolapsing into the anal canal and getting nipped when the anal muscles contract.

Prolapse/mucus/anal leakage. Bigger piles can prolapse out of the anus causing difficulty with hygiene. They may go back up spontaneously or they may have to be reduced manually.

Strangulation. Prolapsing piles can kink their own blood supply and lead to excruciating anal swelling which needs urgent treatment.


The large number of available treatments for piles indicates just how common a condition it is as well as the fact that not everything works for everybody.

Many people will self medicate often on the advice of their local pharmacy. However, I believe it is important to discuss any anal symptoms with your GP. The majority can then be reassured, given advice and prescribed treatment if necessary.

Most bleeding and minor degrees of prolapse will respond to a high fibre diet. Itching or soreness can be treated with topical creams or suppositories although different formulations work for different people and it may be a case of trial and error before finding what works best.

Persisting symptoms will usually result in a referral to a bowel specialist. Again, a number of potential treatments are available depending on the symptoms and findings on examination.

Internal piles can be frozen, burned, chemically destroyed or tied off. Of these, I favour suction banding which causes the piles to shrivel up and drop off after a few days. It is a quick and simple out-patient procedure and can be easily repeated after several weeks if necessary. For a minority, however, it is painful. Simple pain relief treats this and it is gone in 24 hours. For this reason, if you've not had this treatment before, I recommend attending with somebody who can accompany you home. I would also take the next day off work!

If banding fails to control symptoms, 2 other procedures are available:

Haemorrhoidal arterial ligation (HAL) or transanal haemorrhoidal devascularisation (THD) involves placing stitches in the bowel lining above the piles to cut off their blood supply. This is a day case procedure requiring a light anaesthetic. Continuing the suture along any larger piles can also lift and prevent future prolapse.

Stapled haemorrhoidopexy (Circular stapled haemorrhoidectomy/PPH procedure) uses a specially designed device to remove prolapsing piles by cutting them away and sealing the area. Again, a general or spinal anaesthetic is required and most patients are discharged the same day.

It is rare these days to have to resort to the traditional operation of cutting haemorrhoids away. The prolonged recovery and pain associated with this procedure often puts people off consulting in the first place as they are unaware that they may have other options for treatment.