(May 2012) by Dr Clinton Anderson

While it may not be the most delightful topic, haemorrhoids, or piles as they are commonly known, is a part of everyday medical practice. Piles could be defined as a distended portion of the vein/s in the anal canal. This ballooning of the vein can occur inside the canal (internal piles) or outside of it (external piles). Think of it as a varicose vein in the anus.

The cause of piles may be related to genetics – just as some families tend to have a predisposition to varicose veins, piles seem to be more common in some families. The bottom line is a failure of the vein wall to withstand the pressures generated in the anal canal. This may be during the passage of faeces (typically with constipation), and/or with the passage of a foetal head during a vaginal delivery. Hence, it is very common for women to get piles after a vaginal delivery.

So what’s the problem? Firstly, some patients don’t like the way they look or feel. One might consider them an "obnoxious protuberance from a fundamental orifice". Secondly, pain. The severity can range from being mildly irritating to being an almighty pain in the rear, to the extent of preventing sitting and interfering with sleep. Thirdly, size. They can be as tiny as a pea or as large as a golf ball. Generally, pain increases with size. Fourthly, bleeding. Piles may rupture and bleed. If the bleeding becomes a long term or intermittent problem, one might develop iron deficiency which, if unchecked, may lead to anaemia. A dictum worth mentioning here is that in the presence of piles, do not presume that bleeding is from the piles – especially if one is 40 years or older. Sometimes the bleeding can be from higher up in the bowel. It is best to check it out.

Remedies range from keeping a regular bowel habit/avoiding constipation and straining at stool/defaecation. The use of topically applied remedies such as ointments and suppositories may help. The larger piles may be reduced in size with the use of ice packs. (Speak to your healthcare provider about how to do this safely). Lastly, there is a range of more aggressive strategies – from banding to injecting and, ultimately, surgery under anaesthesia.