Treating haemorrhoids (piles)

Haemorrhoids (piles) often clear up by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.

Making simple dietary changes and not straining on the toilet are often recommended first.

Creams, ointments and suppositories,which youinsert into your bottom, are available from pharmacies without a prescription. They can be used to relieve any swelling anddiscomfort.

If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canalthe lower third closest to your anus,or the upper two-thirds. The lower third contains nervesthat can transmit pain, while the upper two-thirds do not.

Non-surgical treatments for haemorrhoidsin the lower part of the canalare likely to be very painful, as the nerves in this area can detect pain. In these cases, haemorrhoid surgery will usually be recommended.

The various treatments forhaemorrhoids are outlined below. You can also read a summary of the pros and cons of haemorrhoid treatments , allowing you to compare your treatment options.

Dietary changes and self care

If Constipation is thought to be the cause ofyour haemorrhoids, you need tokeep your stools soft and regular so you don't strain when going to the toilet.

You can do this by increasing the amount of fibre in your diet . Good sources of fibre include wholegrain bread, cereal, fruit and vegetables.

You should also drink plenty of water and avoid caffeine.

When going to the toilet, you should:

  • avoid straining to pass stools, as it may make your haemorrhoids worse
  • usebaby wipes or moist toilet paper,rather than dry toilet paper,to clean your bottomafter passing a stool
  • pat the areaaround your bottom rather than rubbing it

They can be used to relieve any swelling anddiscomfort.

These medicinesshould only be used for five to seven days at a time.They may irritate the sensitive skin around your anus if you use themlonger than this.

Any medication should be combined with the diet and self care advice discussed above.

There's no evidence to suggest that one method is more effective than another.

Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it.

Don't use more than one product at once.

Corticosteroid cream

If you have severe inflammation in and around your back passage, your GPmay prescribe corticosteroid cream , whichcontains steroids.

You shouldn't use corticosteroid cream for more than a week at a time as it can make the skin around your anus thinner and the irritation worse.

Painkillers

Common painkilling medication, such as paracetamol , can help relieve the pain of haemorrhoids.

However, if you have excessive bleeding, avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen ,as they can make rectal bleeding worse.

You should also avoid using codeine painkillers as they can cause constipation.

Your GP may prescribe products that contain local anaesthetic to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days because they can make the skin aroundyour back passage more sensitive.

Laxatives

If you're constipated, your GP may prescribe a laxative . Laxatives are a type of medicine that can help you empty your bowels.

Non-surgical treatments

If dietary changes and medication don't improve your symptoms,your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.

If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended.

Banding

Bandinginvolves placinga very tight elastic band around the base of your haemorrhoids to cut off theirblood supply. The haemorrhoids should then fall offwithin about a week of having the treatment.

Banding is usually a day procedure that doesn't need an anaesthetic , and most people can get back to their normal activities the next day.

You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger if needed.

You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet.

Ifyou notice some mucus discharge within a week of the procedure, itusually means that the haemorrhoids have fallen off.

Directly after the procedure, you may notice blood on the toilet paper after going to the toilet.This is normal, but there shouldn't be a lot of bleeding.

If you pass a lot of bright red blood or blood clots , go to your nearest accident and emergency (A&E) department immediately.

Ulcerscan occur at the site of the banding, although these usually heal without needing further treatment.

Injections (sclerotherapy)

A treatment called sclerotherapy may be used as an alternative to banding.

During sclerotherapy,achemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection.

It also hardens the tissue of the haemorrhoid so a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.

You should avoid strenuous exercise for the rest of the day after having the injection.

You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.

Electrotherapy

Electrotherapy, also known as electrocoagulation, is anotheralternative to bandingfor people withsmallerhaemorrhoids.

During the procedure, adevice called a proctoscope is inserted into the anus to locatethe haemorrhoid.

An electric current is then passed through a small metal probe placed at the base of the haemorrhoid, above the dentate line. The specialist can control the electric current using controls attached to the probe.

The aim of electrotherapyis to cause the blood supplying the haemorrhoid to thicken, which shrinks it. If necessary, more than one haemorrhoid can be treated during each session.

Electrotherapycan either be carried out on anoutpatient basis using a low electric current, or a higher dose can be given while the person is under a general anaesthetic or spinal anaesthetic.

You may experience some mild pain during or after electrotherapy, but in most cases this doesn't last long.Rectal bleeding is another possibleside effect of the procedure, but this is usuallyshort-lived.

Electrotherapyis recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids.

It can also be usedas an alternative to surgery fortreating larger haemorrhoids, but there's less evidencefor its effectiveness.

Surgery

Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery.

Surgery is particularly useful for haemorrhoids that have developed below the dentate line unlike non-surgical treatments, anaesthetic is used to ensure you don't feel any pain.

There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.

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Content supplied by the NHS Website

Medically Reviewed by a doctor on 18 Jan 2017