Piles (haemorrhoids) Q&As
Published by Bupa's health information team, July 2009.
Answers to questions about piles
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- Why does the skin around my anus get itchy when I have piles?
- Are there any natural or herbal remedies that can help piles?
- What treatments for piles can I get from the pharmacy?
- What is haemorrhoidal artery ligation?
Why does the skin around my anus get itchy when I have piles?
Itching is a common symptom of piles. It can happen if your piles are internal or external - each has a different underlying cause.
Explanation
The itching you get when you have internal piles is caused by mucus passing from the lining of your rectum onto the skin around your anus. Your rectum is lined with a thin film called the rectal mucosa. It produces mucus to help keep the area lubricated and stop infections from entering your body through your anus. Piles can cause the rectal mucosa to slip down out of place. The mucus then passes onto the skin around your anus causing it to become irritated and itchy. This can also soil your underwear.
If you have external piles, the itching is usually caused by skin tags. These can trap moisture around the skin of your anus, which irritates the area. Skin tags can also make it difficult to clean yourself properly after you have had a bowel movement, which can lead to itching and discomfort.
You may find creams, ointments and suppositories ease any pain and itchiness. There are many different products available. Some contain a local anaesthetic such as lidocaine. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.
It's important to remember that none of these treatments will cure your piles, they will only give short-term relief.
Further information
- CORE (The Digestive Disorders Foundation)
www.corecharity.org.uk
Sources
- Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336:380-83. www.bmj.com
- Haemorrhoids. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 7 February 2009
- Soothing haemorrhoidal preparations. Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
Are there any natural or herbal remedies that can help piles?
A number of herbal and natural remedies have been suggested as treatments for piles. In general, however, there isn't enough evidence to show that they work. The best way to reduce symptoms without taking conventional medicines is to eat a healthy diet with enough fibre and drink plenty of water, as well as taking care to clean yourself after each bowel movement.
Explanation
Sitz baths have long been considered a natural remedy for piles. A sitz bath is when you sit in a bath or basin filled with warm or cold water so that only your hips and buttocks are immersed. It's thought that the warm water draws blood flow to the area and relaxes the sphincter muscle (which controls the opening and closing of the anus), relieving pain. Cold water is thought to draw heat out of the piles and reduce the blood flow into them, so there is less pressure inside to make them feel inflamed.
Sitz baths are also considered helpful in keeping your anal area clean.
However, there is little evidence to show that sitz baths are effective, and there is uncertainty over the use of hot or cold water and how long you should immerse yourself for. As such, doctors don't recommend them as a treatment for piles.
Other remedies that have been suggested include flavonoid supplements. Flavonoids are water-soluble plant pigments found in some foods, for example soya and onions. It's not exactly clear how they work, but it's thought that taking flavonoid supplements has an anti-inflammatory effect and can strengthen blood vessels. However, flavonoids aren't licensed in the UK for treating piles and there is little evidence to show that they do actually work.
The best way to treat your piles naturally is to make changes in your diet so that you have softer, bulkier, more regular bowel movements. This will help to relieve constipation and reduce your need for straining on the toilet. Try to:
- eat plenty of fibre-rich foods such as fruit, vegetables and wholegrain cereals (for example, brown rice, wholemeal bread and wholemeal pasta)
- drink plenty of fluids - aim to drink six to eight glasses of fluids a day, and don't have caffeinated drinks
Good hygiene is also key in preventing symptoms. Cleaning yourself after a bowel movement can be uncomfortable when you have piles, but poor hygiene around your anus can make your symptoms worse and cause skin conditions such as dermatitis. Try using moistened towels or baby wipes rather than toilet paper and pat the area dry instead of rubbing it.
Speak to your GP if you have any questions or concerns about piles or treatments for them.
Further information
- CORE (The Digestive Disorders Foundation)
www.corecharity.org.uk
Sources
- Haemorrhoids. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 7 February 2009
- Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336:380-83.www.bmj.com
- Tejirian T, Abbas MA. Sitz bath: where is the evidence? Scientific basis of a common practice. Dis Colon Rectum 2005; 48(12):2336-40
What treatments for piles can I get from the pharmacy?
There are several different kinds of creams, ointments and suppositories for piles that can be bought over-the-counter from your pharmacy. However, it's important to remember that these treatments will only relieve symptoms, they won't cure piles.
Explanation
The aim of creams, ointments and suppositories is to soothe and relieve symptoms. There are several types of medicine available. They all contain different ingredients, which will have different effects on your symptoms.
- Local anaesthetics, such as lidocaine reduce pain by numbing the area.
- Local anaesthetics and astringents, such as Germoloids cream, ointment and suppositories and Hemocaine cream, reduce swelling and numb the area relieving pain.
- Corticosteroid and astringents, such as Anusol HC Plus and Anusol HC ointment and suppositories, help to reduce inflammation and swelling in the area.
- Corticosteroid and local anaesthetics numb the area giving pain relief, and reduce inflammation. Most of these are prescription-only. However, there are some over-the-counter brands available, such as Germoloids HC spray.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice. Don't use medicines containing anaesthetic for longer than a few days as your skin can become sensitive to them. Also, medicines containing corticosteroids should only be used for a maximum of seven days. If they are used for longer than this, your skin may become sensitive to them, begin to thin or develop ulcers. They can also cause dermatitis.
If you visit your GP, make sure you tell him or her if you're taking any over-the-counter medicines.
If you're pregnant, only use mild medicines that contain astringents and lubricants. Don't take medicines containing local anaesthetic or corticosteroid as it's possible that they may be harmful for you or your baby during pregnancy.
You can also take painkillers such as paracetamol to help relieve any pain you get from your piles. Don't take painkillers containing opioid analgesics, such as codeine, as they can cause constipation. Also, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aren't suitable if you have bleeding from your rectum.
It's important to remember that all these medicines are for the short-term relief of symptoms only and won't cure your piles. It's important to also change your diet to make your bowel movements softer, bulkier and more regular. This will help to relieve constipation and reduce your need for straining on the toilet.
If your symptoms continue to get worse despite using medicines, or if you have any questions or concerns, visit your GP.
Further information
- CORE (The Digestive Disorders Foundation)
www.corecharity.org.uk
Sources
- Haemorrhoids. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 7 February 2009
- Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336:380-83. www.bmj.com
- Soothing haemorrhoidal preparations. Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
What is haemorrhoidal artery ligation?
Haemorrhoidal artery ligation is a relatively new surgical procedure used to treat piles. It's also sometimes referred to as HALO (haemorrhoidal artery ligation operation).
Explanation
Haemorrhoidal artery ligation is an operation that ties off certain arteries that supply blood to your piles. Surgery for piles is only considered if out-patient treatments haven't helped with your symptoms - only a small number of people with piles will need surgery.
The procedure is usually carried out as a day case under local anaesthetic. This completely blocks feeling from your bottom and you will stay awake during the operation.
In a haemorrhoidal artery ligation, a narrow, tube-like telescopic camera, called a proctoscope, is used to look inside your rectum. Air can be blown through the tube to open up your bowel so your doctor can see it more clearly. Your doctor uses this and an instrument called a miniature Doppler ultrasound probe to find the arteries that are supplying blood to your piles. These arteries are then tied off using dissolvable stitches. Once the blood supply has been cut off, the piles shrink in size.
The long-term effectiveness of this procedure isn't yet clear, especially when compared to other treatments for piles. However, research has shown that people who have this operation spend less time in hospital and have fewer complications and less pain afterwards than those who have a haemorrhoidectomy (the surgical removal of piles).
If you have any questions or concerns about piles or surgical treatments for them, talk to your GP or doctor.
Further information
- CORE (The Digestive Disorders Foundation)
www.corecharity.org.uk
Sources
- Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336:380-83. www.bmj.com
- Haemorrhoids. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 7 February 2009
- Scheyer M, Antonietti E, Rollinger G, et al. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006; 191:89-93
Related topics
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2009
Piles (haemorrhoids) factsheet
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