Piles Treatment

Piles are cushions of blood vessels that sit inside the anal canal in everyone. They help seal the canal and keep it continent. They become a problem when the vessels swell and the tissue holding them in place stretches, so the cushion bleeds, drops down, or both.

Straining is what stretches it. Constipation and long periods on the toilet are the usual causes; pregnancy, heavy lifting and a chronic cough do the same thing. Once the supporting tissue has stretched it does not tighten again on its own. Piles come back if the straining does.

Surgeons grade them by how far they come down. First-degree piles stay inside and only bleed. Second-degree come down when you strain and go back by themselves. Third-degree have to be pushed back. Fourth-degree stay outside. The grade is what decides how they are treated, so it is the thing your surgeon will be establishing when they examine you.

A doctor makes the diagnosis by looking and by feeling. They examine the outside of the anus, then pass a gloved finger to check the tone of the muscle and feel for anything the eye cannot see, then use a short lighted tube called a proctoscope to see the cushions themselves and grade them.

The examination takes a couple of minutes and should not be painful. Tell them if it is, because a fissure can sit alongside piles and changes what happens next.

Bleeding is the reason to be examined and not to self-treat. Piles are the commonest cause of fresh blood when passing stool and they are not the only one, so a doctor's job at this visit is as much to rule other things out as to confirm what you already suspect. If you are over forty-five, if the bleeding is dark, or if your bowel habit has changed, expect them to suggest looking further up.

It depends entirely on which treatment you have, and the range is wide. An ointment or an injection asks nothing of your day. Banding leaves a dull ache and a feeling of fullness for a day or two, and you can work through it.

Laser and stapled surgery are Day Care procedures under a spinal anaesthetic. Expect two to three days before you are comfortable sitting for long, and about a week before you stop thinking about it. Open surgery is the outlier: a night in hospital, and two to three weeks in which passing stool is genuinely sore.

Whatever you have, the thing that decides whether the result lasts is what happens afterwards. Fibre, water and not sitting on the toilet with a phone are what keep the straining down, and straining is what caused it. Your surgeon will see you at about six weeks to check it has healed.