Dear Dr Nina: I have what, I suspect, are bleeding piles. Do I need to go to the doctor?
Q I have what, I suspect, are bleeding piles. Do I need to go to the doctor?
Dr Nina replies: It is never normal to pass blood from the back passage so this should always be checked out. If you are passing bright red blood, most notable on wiping yourself, then haemorrhoids are a likely cause. Haemorrhoids are thought to affect more than 50pc of adults at some time in their lives. They mainly occur in those over 30.
Haemorrhoids can be internal or external. External ones are more painful. They become inflamed and protrude out as lumps of skin from the back passage. If a clot forms in one of these we refer to it as a thrombosed haemorrhoid, which can cause severe pain. Internal haemorrhoids are less likely to be painful but they can bleed causing bright red blood to be passed from the back passage. Haemorrhoids can also cause itching, burning or discomfort.
Anything that causes increased pressure into the back passage can cause haemorrhoids. Pregnancy and childbirth are a very common cause because, as the baby grows, the pressure increases and forceful pushing during labour further exacerbates this issue. Other common causes are constipation, straining during bowel motions, and obesity.
Haemorrhoids can be diagnosed easily by examining the anal area or during a rectal exam where the doctor examines just inside the back passage with a finger. They may also be noticed during a routine bowel exam or colonoscopy. If you have noticed swelling in the anal area or are having pain or passing blood, especially if you are over 50, it is important to see a doctor. Although haemorrhoids are the most common cause of these symptoms other conditions including bowel cancer can also cause swelling pain and blood from the back passage.
Thankfully, in most cases, haemorrhoids settle without the need for too much medical intervention. If you suffer with a flare up using over the counter haemorrhoid treatment may provide relief. Other simple remedies include warm baths several times daily, gently cleansing with witch hazel solution, taking over the counter painkillers such as paracetamol or ibuprofen and applying ice to the anal area.
If the haemorrhoid is particularly painful there are some prescription remedies available as suppository and cream or ointment that can add to the relief. If a clot has formed in an external pile and the pain is severe, a doctor may recommend attending to have the clot released. This is usually only done within the first two days of the pile flaring. Otherwise inflammation or clots will resolve themselves over seven to 10 days. Once the inflammation has settled a small skin tag may remain outside the anal area. If haemorrhoids are becoming a chronic problem or are reoccurring there are a number of surgical procedures that can be tried.
Start treatment early and if things don’t settle within a week, see your doctor.
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