First-degree piles are swollen cushions that always remain within in the anal canal; these are painless.
Second-degree piles are pushed down (prolapsed) when faeces are passed, but return to their starting position afterwards.
Third-degree piles are pushed down (prolapsed) when faeces are passed, or come down at other times. They do not go back by themselves after faeces have been passed.
Who gets piles?
Piles can occur at any age, but are more common in older people. They affect both men and women. In fact, most people suffer from piles at some time, but usually they are nothing more than a temporary problem. Many experts believe that they are caused by continuous high pressure in the veins of the body, which occurs because humans stand upright. They are particularly common in pregnancy because of the additional pressure from the baby, and because of hormonal changes. Sometimes they result from straining hard to pass faeces, which is more likely if you do not eat enough fibre, or lifting heavy weights. They are not caused by sitting on hot radiators or cold, hard surfaces, or by sedentary jobs.
What are the symptoms of piles?
The symptoms of piles can come and go. There are five main symptoms:
* bleeding, with bright red blood
* itching and irritation
* aching pain and discomfort
* a lump, which may be tender
* soiling of underwear with slime or faeces (‘skid marks’).
Itching and irritation probably occur because the lumpy piles stop acting as soft pads to keep the mucus in; instead, a little mucus leaks out and irritates the area around the anus. Pain and discomfort comes from swelling around the pile, and from scratching of the lining of the anal canal by faeces as they pass over the lumpy area. The scratching also causes bleeding, which is a fresh bright red colour and may be seen on faeces or toilet paper or dripping in the pan. A pile that has been pushed down (a second- or third-degree pile) may be felt as a lump at the anus.
How you can help yourself
Most piles get better in a few days without any treatment, but there are several ways of relieving the discomfort.
* Wash the area gently with warm, salty water, to get rid of irritant mucus that has leaked out. Dry carefully with cotton wool and apply petroleum jelly (available from pharmacies) or nappy rash cream to protect your skin if more mucus or moisture leaks out.
* Use soft toilet paper, and dab rather than wipe.
* Wear loose underwear and clothing (i.e. not tight trousers), so that nothing will rub the pile.
* Do not scratch. For more information on dealing with itch, look at the section on anal itching.
* Avoid constipation by eating lots of fresh fruit and vegetables and bran cereal. Aim for faeces that are soft enough to change their shape as you push them out.
* Drink plenty of fluids.
* After you have passed the faeces, do not strain to finish. People with piles often think there is more to come, but this is a false sensation caused by the swollen spongy pads in the piles themselves. Do not read on the toilet and aim to be out of the toilet within a minute.
* If you can feel a lump, try pushing it gently upwards; try to relax your anus as you do so.
* If you have a lot of discomfort, buy a haemorrhoid cream or gel. A pharmacist will be able to help you choose one that is suitable for you. A haemorrhoid cream or gel does not cure the pile, but will usually relieve the discomfort effectively until the pile goes away of its own accord. Do not use it for longer than a week or two.
To stop piles returning, continue the high-fibre diet to keep your stools soft and do not put off opening your bowels, and avoid straining.
When to see your doctor
See your doctor if the symptoms last longer than a week. You should also see your doctor if you have bleeding, to ensure that there is not some other cause. Your doctor will examine your anus, feel inside the anal canal and may also insert a small metal tube, called a proctoscope, an inch or two into the anal canal to give a better view. For more information, look at the section on seeing your doctor about an anal problem.
