Haemorrhoids (also called piles) are small lumps that form inside and around the anus (back passage or rectum). They are very common and are sometimes described as varicose veins of the anus. Depending on where the haemorrhoid is located and how big it is, it can be painless or quite uncomfortable. You can have one or multiple haemorrhoids.

Types of haemorrhoids

There are three types of haemorrhoids.1

• Internal — Found inside the rectum, these can bleed but be painless.
• Prolapsed — This is when the veins push through the anus and appear outside of thebody, especially after going to the toilet. These can be painful.
• External — These haemorrhoids feel like hard lumps, but they are actually small bleeds (haemorrhages) under the skin of the anus.

Signs and symptoms of haemorrhoids

If you have haemorrhoids you may notice several symptoms. These include:2

• itchy or irritated anus
• pain and discomfort
• swelling around your anus
• bleeding after having a bowel movement (poo) — either bright red blood on the toilet paper or streaks of blood on your poo
• a hard lump in your anus.

What causes haemorrhoids?

Haemorrhoids are caused by increased pressure in the blood vessels around your anus which can cause swelling and inflammation. The most common cause of haemorrhoids is constipation (difficulty having a bowel motion due to hard poo).3 Constipation can cause you to strain when doing a poo, which puts pressure on these blood vessels.

Haemorrhoids are also very common in pregnancy. This is because:4

• constipation is common during pregnancy
• the baby can put pressure on the abdomen
• more blood flows around the body during pregnancy
• pregnancy hormones can cause the blood vessels to soften.Things that can increase your risk of developing haemorrhoids include:5
• having a low-fibre diet, which contributes to constipation
• straining during bowel movements
• prolonged sitting on the toilet
• getting older
• being overweight
• regularly lifting heavy objects
• having anal sex.

How are haemorrhoids diagnosed?

Diagnosing haemorrhoids usually involves an examination of your back passage. This can be done in two ways:6

• digital examination, where your doctor uses a gloved, lubricated finger to feel the inside of your rectum for any abnormalities.
• visual inspection (proctoscopy) where the doctor inserts a device called a proctoscope (hollow tube with a light at the end) into your rectum to check for haemorrhoids.

How to treat haemorrhoids

Haemorrhoids often heal by themselves without any treatment.7 Usually, you can relieve mild pain and swelling by:8

• eating more fruits, vegetables and wholegrains, as the increased fibre will make your poo softer and easier to pass
• drinking more water to help digest the increased fibre and to help with constipation
• taking stool softeners to relieve constipation
• soaking your anal area in a warm bath for 10-15 minutes a day, two to three times a day
• taking paracetamol or ibuprofen to relieve pain
• using topical over-the-counter (OTC) haemorrhoid cream available at your pharmacy. These contain a local anaesthetic for pain relief and a corticosteroid to help reduce swelling and inflammation. If these measures don’t improve your symptoms, other treatment options include:9
• corticosteroid cream prescribed by your doctor for severe inflammation
• injection of chemicals into the haemorrhoid (sclerotherapy) which numbs the pain, prevents bleeding and helps to reduce the size of the haemorrhoid over the next four to six weeks
• placement of a tight rubber band around the haemorrhoid (rubber band ligation) which cuts off the blood supply to the haemorrhoid, causing it to fall off within the next 7-10 days.

For severe haemorrhoids, a surgical procedure called a haemorrhoidectomy may be needed. This is when the haemorrhoid is surgically removed under general anaesthetic.

When should you see a doctor

If you notice any blood when you have a bowel movement, it’s important to visit your doctor. This is because blood may be a sign of other serious conditions, including bowel cancer. If haemorrhoids aren’t to blame, your doctor may recommend a colonoscopy (a surgical procedure to look inside your bowel and check for signs of cancer).

You should also see your doctor if you have:

• been treating haemorrhoids and they are not improving
• noticed changes in your bowel habits
• noticed changes in the colour of your pooexperienced recent, unintentional weight loss.

How to prevent haemorrhoids

The best way to prevent haemorrhoids is to prevent constipation. This involves:10

• including good sources of fibre in your diet such as fruits, vegetables, wholegrains, pulses and beans, and nuts and seeds
• taking a fibre supplement if you think you’re not getting enough fibre — check with your Pharmacist first
• drinking plenty of water
• limiting alcohol and caffeine
• exercising regularly.

You should also:11

• empty your bowel when you have the urge as holding on can make your poo harder
• avoid straining when you go to the toilet
• avoid sitting on the toilet for long periods
• avoid medications that can cause constipation such as codeine, where possibleachieve and maintain a healthy weight.

1 Better Health Channel, Haemorrhoids, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/haemorrhoids

2 Mayo Clinic, Hemorrhoids, https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268

3 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles

4 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles

5 Mayo Clinic, Hemorrhoids, https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268

6 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles

7 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles

8 Mayo Clinic, Hemorrhoids, https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280

9 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles

10 Better Health Channel, Constipation, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation

11 Healthdirect, Haemorrhoids, https://www.healthdirect.gov.au/haemorrhoids-piles