What are piles (haemorrhoids)?
Haemorrhoids, also known as piles, are swollen veins inside or under the skin surrounding your anus and lower rectum. The walls of these blood vessels can sometimes stretch so thin that the veins bulge and get easily irritated, especially when using the bathroom. Haemorrhoids usually rectify themselves, however in some cases, treatment is needed.
There are four different types of haemorrhoids. These include:
- First-degree haemorrhoids – These are small swellings that develop on the inside of the anus and aren’t visible from the outside.
- Second-degree haemorrhoids – These are larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again.
- Third-degree haemorrhoids – These are one or more small soft lumps that hang down from the anus and can be pushed back inside.
- Fourth-degree haemorrhoids - These are larger lumps that hang down from the anus and can’t be pushed back inside.
What causes haemorrhoids?
The veins around your anus tend to stretch under pressure which can cause them to swell. Haemorrhoids are usually formed because of increased pressure in the lower rectum from straining during bowel movements, chronic diarrhoea, or constipation. Regular heavy lifting, eating a low-fibre diet, being overweight, or sitting for long periods on the toilet can also contribute to haemorrhoids forming.
As you age, your likelihood of developing haemorrhoids increases. This is because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen during pregnancy when the baby’s weight puts pressure on the anus.
Haemorrhoids are quite common during pregnancy and postpartum recovery. This is because the growing uterus puts pressure on the pelvic floor and inferior vena cava – a large vein on the right side of the body which receives blood from the lower limbs. This in turn increases the pressure on the veins below your uterus, causing them to swell. The increase in the hormone, progesterone, can also relax the walls of your veins, meaning that they swell more easily.
In most cases, postpartum haemorrhoids will go away on their own not long after birth, as the pressure on the lower rectum is eased. However, in some cases, they can persist for up to six months after birth.
Does exercising and running cause piles or make them worse?
Running and other activities such as cycling can irritate the perianal skin and hemorrhoidal tissue due to the repetitive nature of the movements required. If you are just going on a short run around the local park, this is unlikely to cause any problem, but for endurance runners, the irritation can cause the area to flare-up which results in external haemorrhoids. Long-distance running combined with dehydration can also make symptoms worse.
While haemorrhoids are quite common and tend to affect men and women similarly, female athletes will have a slightly increased risk of developing haemorrhoids if they begin to exercise not long after giving birth. This is because the increase in the hormone progesterone will make it easier for their veins to swell around the anal area. This, combined with the friction of a repetitive sport such as running, can cause haemorrhoid flare ups and irritation.
Other intense forms of exercise, such as lifting heavy weights can also increase your risk of developing haemorrhoids. This is also true for strenuous activities such as cross-fit. Exercise bikes and rowing machines could also cause irritation and make symptoms worse.
If you are suffering from haemorrhoids, it is always best to allow them to heal before resuming your normal exercise routine.
Activities such as swimming, hiking and yoga are ideal if you are suffering from a haemorrhoid flare up, as they don’t cause as much friction in the anal area (provided your clothing doesn't rub).
It is still important to exercise, as a sedentary lifestyle can cause many health problems. When you sit still for a long period of time, blood begins to pool, which leads to swollen veins. Moreover, a lack of physical exercise can also heighten your risk of constipation which can make your current symptoms worse or trigger further problems.
What are the symptoms of haemorrhoids?
While some internal haemorrhoids show no symptoms at all, external haemorrhoids may cause irritation, pain and itching around the anus as well as a painful lump or swelling around the anal area.
People may also suffer from painful bowel movements and blood in their stools. If you do have blood in your bowel movements, it is always best to go and see your doctor, as bleeding could be caused by other conditions and will need to be evaluated.
What are the treatment options for haemorrhoids, and how do you get rid of them?
Although haemorrhoids can sometimes disappear on their own, in some cases, further treatment may be required.
If your haemorrhoids only produce mild discomfort, your doctor may suggest over-the-counter creams or ointments to help relieve symptoms.
If surgery is required, one of the most common treatment options is called a haemorrhoidectomy. This is carried out under general anaesthetic and involves a surgeon cutting out the haemorrhoid and removing any excess tissue. This treatment can cause quite a bit of discomfort for the patient after the procedure, and they will usually take around a week or so to recover.
At The Whiteley Clinic, we offer a revolutionary treatment for haemorrhoids called the Rafaelo Procedure. The Rafaelo Procedure is a safe and effective treatment for internal haemorrhoids, using the established technology of radiofrequency ablation which helps to treat the root cause of the condition. The Rafaelo Procedure usually only takes one 15-minute treatment session and requires minimal post-operative after-care. It is a walk-in walk-out procedure meaning there is no need for long hospital stays and patients can get back to their normal daily activities very soon after treatment. Symptoms should also improve almost immediately.
How can you prevent haemorrhoids?
There are many things you can do to help reduce your risk of developing haemorrhoids. Firstly, a high fibre diet has been known to help to prevent haemorrhoids. By adding a variety of fruit, nuts, whole grains, pulses and vegetables into your shopping trolley, you will keep your digestive system functioning well which, in turn, will help to keep your stools healthy and well-formed. This will reduce the risk of haemorrhoids developing, as you are less likely to strain whilst on the toilet.
Drinking between six to eight glasses of water a day will also help to keep your stools soft, which should help to reduce your risk.
I would also recommend that people go to the toilet as soon as it is needed, as waiting to pass a bowel movement could cause the stool to dry out and make it harder to pass. In a similar vein, people should try to prevent straining and holding their breath while on the toilet when trying to pass a bowel movement. This can create greater pressure in the veins in the lower rectum, causing them to swell.
Staying active can help to reduce your chances of developing constipation – which will reduce the pressure on your veins from prolonged periods of sitting. Exercise could also help people to lose weight, which could be contributing to their haemorrhoids.
Mr Amyn Haji is the Laparoscopic Colorectal and General Surgeon at The Whiteley Clinic
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