HealthInfo West Coast-Te Tai Poutini
Haemorrhoids (piles)
Important
It's important to tell your GP about any bleeding from your bottom to have it assessed, and to rule out more serious causes.
Haemorrhoids (piles) are cushion-like structures in your anal canal (back passage) where poo (faeces) is passed. We all have them to help control of the passage of poo. Sometimes the blood vessels in them fill with too much blood and become swollen lumps causing symptoms. This is very common, occurring in up to 50% of the adult population at some time.
If they swell in the upper part of your anal passage they're called internal haemorrhoids. These are often painless. Sometimes they can extend out past your anus, but they're still internal haemorrhoids. This can be painful if they won't go back in.
When the blood vessels in the lower part of your anal canal near the opening swell up they're called external haemorrhoids. These often project out of the anus but not always. These can be painful because there are nerve fibres in this area.
What causes haemorrhoids?
Swollen haemorrhoids usually develop due to pressure in the anal region, but sometimes they happen for no apparent reason.
They can be caused by:
- constipation and straining on the toilet
- passing frequent or hard stools (poos)
- pregnancy – due to pressure from the baby and also from the effect of hormones on the veins
- ageing
- hereditary factors that can run in families due to an inherited weakness in the tissues in the anal canal
- other causes, including heavy lifting and persistent cough.
What are the symptoms?
There are several possible symptoms.
Bleeding from your bottom
It's usually bright red blood. You may notice it when you wipe or it may be in the toilet.
Itching or irritation of your anal area
Especially if there's a mucus discharge from the haemorrhoids. Internal haemorrhoids can make you feel as if you have not completely emptied your bowels when you go to the toilet.
A lump in your anal area
This may come down after you pass a bowel motion then go back up. If an internal haemorrhoid comes down and gets caught in your anus it may become strangulated. This can be very painful as the blood supply to the haemorrhoid gets cut off. Sometimes they go back up by themselves or you may need to push it back up yourself. An external haemorrhoid can form a clot of blood in it and this can also be very painful. This is called a thrombosed external haemorrhoid.
If you have any of these symptoms you need to see your GP to be examined.
It's particularly important to report any bleeding from your bottom to have it assessed and rule out more serious causes.
How are haemorrhoids diagnosed?
Your GP will take a history of your symptoms then examine you. This involves a visual inspection of the anal area and a digital rectal exam. Your GP will insert a lubricated gloved finger into your anal canal to feel for lumps and look for bleeding.
Sometimes your doctor may need to look inside your anal canal if they can't see anything externally. Your GP will use a small hollow plastic tube (proctoscope) which is inserted into your anus to view the anal passage.
If your GP doesn't find any haemorrhoids, they may refer you to a specialist for further investigation.
HealthInfo recommends the following pages
- Patient.info – Piles
Factsheet about piles, including information about symptoms and treatment.
On the next page: Treating haemorrhoids (piles)
Written by HealthInfo clinical advisers. Endorsed by General Surgeons Canterbury DHB. Page created January 2019.
SourcesReview key: HIHAE-13803
