How to get rid of piles

Piles, also known as haemorrhoids, are swellings that develop inside your back passage (rectum) or around your bottom (anus). They occur when veins become enlarged and stretched, and can cause bleeding and pain. 

Depending on the severity of your piles and how many you have, symptoms may vary from mild to severe. Given the location of piles, they can cause discomfort and pain, especially when passing stools.  

Piles can be internal when they occur in your rectum, or external when they occur just in or around your anus. 

Anyone can get piles and around half of the UK population will experience piles at some point in their life. You may not always need medical treatment for piles; simple lifestyle changes can be enough to resolve mild cases of piles. 

Causes

Piles are most often caused by straining too much when passing stools, usually as a result of eating a diet low in fibre, which causes hard stools.

There are, however, several other risk factors for developing piles, including: 

• Coughing, sneezing and vomiting
• Excessively tight anal sphincter muscles — this can be caused by: 
• Abnormal activity of the nerves supplying the sphincter muscles
• Irritable bowel syndrome
• Spasms triggered by an anal fissure
• Your natural anatomy
• Holding your breath when straining to perform physical tasks
• Impaired blood flow through your veins eg during pregnancy or if you have the condition portal hypertension
• Persistent constipation or diarrhoea
• Sitting or standing for long periods of time

Symptoms

The most common symptom of piles occurs immediately after opening your bowels and is bright red blood in the toilet or on the toilet paper after you’ve wiped your bottom. This is more common than blood mixed in with your stools. 

Other piles symptoms include: 

• A burning sensation around your anus
• An itchy anus
• Anal pain — pain may be severe if the blood supply to your piles has been cut off
• Feeling that your bowels are never empty
• Mucus leaking from your anus

These symptoms are not limited to piles; they can occur with other conditions affecting your bowel or anus, such as: 

• Bowel cancer
• Inflammatory bowel disease ie Crohn's disease or ulcerative colitis
• Peri-anal haematoma — blood collected in a small area underneath your skin, usually caused by a burst blood vessel 
• Rectal prolapse — where part of your rectum slips down through your anus

If you have any of the symptoms described, you should see your GP. You may have piles or you may have another condition that needs treatment.

How to treat piles

The type of piles treatment you receive will depend on the severity, location and number of piles you have. Treatment will focus on addressing the cause of your piles as well as the symptoms so that you can find relief from your symptoms but can also reduce your risk of developing piles in the future.

Home remedies for piles

Try not to strain too much when passing a stool. Afterwards, to reduce any irritation and soreness around your anus, wash and pat dry your bottom using a wet wipe or moistened pad, or using a hairdryer on a low setting. Make sure you do not rub the area dry as this can further irritate your piles.

A daily warm bath or shower can also ease your discomfort. You can additionally try using a sitz bath two to three times a day. This is a small, shallow tub that fits on top of a toilet seat. When seated on a sitz bath filled with warm water your buttocks should be covered with water. Using a sitz bath for 15–20 minutes can reduce irritation, soreness and itching. Afterwards, pat dry your bottom; do not rub.

Other ways to reduce your discomfort include: 

• Applying an ice pack to your bottom for up to 10 minutes, three times a day
• Gently pushing your piles back in if they’ve slipped out eg after passing a stool
• Sitting on soft cushions, instead of hard surfaces

Dietary changes

To avoid straining when passing stools, which can worsen and irritate your piles, follow a diet that will reduce your chances of becoming constipated. This means increasing the amount of fibre in your diet by eating high-fibre foods, such as beans, broccoli, fresh fruit and whole grains.

It is also important to stay hydrated to ensure your stools stay soft. Make sure you drink 1.5–2 litres of fluids every day (equivalent to about six to eight cups).

Exercise

Certain types of regular exercise, such as brisk walking, stretching and yoga, can help keep your bowel movements regular and relieve pressure on your piles.

However, other exercises, such as lunges, squats and weightlifting can strain your lower body and consequently worsen your piles symptoms.

Medicines for piles

Certain over-the-counter haemorrhoid creams contain numbing agents alongside a low dose of the corticosteroid, hydrocortisone. When applied, these creams can reduce inflammation, swelling and itchiness. However, hydrocortisone creams can also weaken and thin your skin, so you should not use them for more than one week. If you develop a rash or dry skin, stop using the cream and speak to your doctor. 

For haemorrhoid pain relief, you can also take over-the-counter painkillers, such as paracetamol, ibuprofen or aspirin. Avoid taking painkillers containing codeine as they can cause constipation, which will worsen your symptoms. 

In the short term, you can try taking an over-the-counter laxative, such as methylcellulose or psyllium, to help you avoid straining when passing a stool. However, laxatives should not be used frequently or in the long term due to side effects, which include diarrhoea that can worsen your piles. Instead, focus on changing your diet to improve the consistency of your stools. 

Medical procedures for piles

When other treatments, such as dietary changes and over-the-counter medications, do not improve your piles, more invasive treatments may be needed, including surgery. Treatments include: 

Cryotherapy

Liquid nitrogen is carefully applied onto your piles, which causes them to freeze and fall off.

Rubber band ligation

A small rubber band will be placed around the base of your pile to cut off its blood supply. Your pile will then shrink over time and fall off after about a week. No anaesthesia is needed but the area treated will be numbed, so you won’t feel any pain but may feel some pressure. Afterwards, you may experience a small amount of bleeding.

If you have multiple piles, you may need to come back several times for each of them to be treated one at a time.

Sclerotherapy

A special fluid called phenol is injected into the blood vessels in your piles, which causes scar tissue to form. This cuts off the blood supply to your piles, which will eventually shrink and fall off. No anaesthesia is needed but the area treated will be numbed first.

Sclerotherapy may be recommended if rubber band ligation is not appropriate or if you’re taking medication that thins your blood.

Infrared coagulation

If you have small or medium-sized piles, infrared coagulation can be used to shrink your piles using a strong beam of infrared light. The infrared energy is directed at the base of your piles and causes scar tissue to form, which cuts off the blood supply to your piles. This causes them to shrink and eventually fall off. No anaesthesia is needed but the area treated will be numbed first.

You may need more than one round of treatment with infrared coagulation for it to work.

Haemorrhoidectomy

This is a type of piles removal surgery that can be performed under general anaesthetic, where you are asleep, or under spinal anaesthetic, where you are awake but can’t feel anything from the waist down. Your surgeon will cut out your piles and stitch the wound back together. Recovery from a haemorrhoidectomy is painful but the procedure is very effective for treating piles.

Stapled haemorrhoidopexy

This procedure is performed under a general anaesthetic and involves stapling your piles so that the tissue is no longer hanging down. Stapling the piles cuts off their blood supply, which causes them to shrink over time and eventually fall off.

New treatments for piles

The UK National Institute for Health and Care Excellence (NICE) is currently assessing a new treatment for approval that uses radiofrequency energy to destroy the piles blood vessels and surrounding piles tissue. While this treatment and current piles treatments focus on the rectal and anal areas, new research is also investigating treatments that address the whole vein system.

Outlook

Piles can come and go for many years, becoming more frequent with age. Pain caused by piles is also particularly common over the age of 50.

As piles often recur after treatment, it is important that you continue to eat a high-fibre diet to avoid constipation and consequently straining when passing stools. Leading an active lifestyle and maintaining a healthy weight will also reduce your risk of developing piles in the future.

Small piles may go away on their own after a few days but larger piles often need treatment. So if you have piles that are not going away using home remedies or over-the-counter medication, see your doctor.