Hemorrhoids (often known as piles) are enlarged and engorged blood vessels in or around the back passage (anus). These may be associated with pain, bleeding, itching and feeling as if a lump or bump is hanging down.

• You may notice a pain or ache around the anus and lower bowel (rectum), which can be really quite severe.
• There may be itching of the area.
• There may be bleeding from the back passage. This will be bright red blood, not usually mixed in with the motion but often seen on the toilet paper.
• There is often a feeling of something coming down, or a bulge or lump at the anus.
• If a hemorrhoid at the outside of the anus gets a blood clot in it (thrombosed external pile) it leads to a particularly tender, hardish lump.

Hemorrhoids are very common. They are said to be more common in countries where the diet has traditionally been more processed and low in fiber. The main contributory causes are those things that cause us to raise the pressure in the abdomen. This causes the blood vessels to swell and become engorged.

It seems that the people most at risk of developing hemorrhoids are those who have more causes for raised abdominal pressure, such as:

• Those chronically straining with constipation.
• After or during pregnancy. Here, the baby may actually press on the main blood vessel that returns blood to the heart (the vena cava).
• Overweight people.
• People with heavy lifting jobs.

Most episodes of trouble from hemorrhoids come and go quite quickly. If simple measures do not help or the problem is lasting, keeps returning or worsening, then you should see your doctor, especially if you have any other associated symptoms such as weight loss; change of bowel habit; slime (mucus) in the motions; or darker, changed blood mixed in with the stools.

Your doctor will ask a few questions and is likely to examine you and may want to feel inside the anus with a gloved finger. Sometimes he will look inside with an instrument (proctoscope). This enables him or her to confirm the diagnosis, and to rule out other, more serious problems such as cancer.

It is usually best, with hemorrhoids, to get by with the least treatment possible, as even after the most extensive treatments they may still return.

• Many times they will settle down over a matter of days without any treatment.
• Cream or suppositories (bullet-shaped tablets to be inserted into the anus) may be bought over the counter, or your doctor may prescribe one. These soothe itching and pain, and cause swelling and bleeding to diminish.
• Cold compresses, even ice, can be helpful.

If you do not get better with these approaches, your doctor may ask a specialist to see you who may:

• Put little rubber bands round the hemorrhoids, which will cause them to shrivel and wither away
• Inject a substance into the hemorrhoids which causes them to wither away (sclerotherapy)
• Cut away the problem, usually under a general anesthetic

Hemorrhoids are very common, and will occur anyway, but, as implied above, useful aspects of prevention are:

• Avoid becoming overweight, and lose weight if you are
• Eat a high fiber diet
• Exercise regularly