Haemorrhoids and Anal Fissures
Rectal problems are very common, with almost everyone experiencing at least some discomfort, itching or pain during their lifetime. Despite their commonality, rectal problems can be quite uncomfortable, embarrassing and painful to live with.
Some of the most common rectal issues include haemorrhoids and anal fissures, otherwise known as anal tears. Although the symptoms of each can be quite similar and hard to differentiate between unless examined, the injuries are both very different and will therefore require different treatments.
Haemorrhoids, also commonly known as piles, are swellings that develop in and around the back passage and the anal canal. Depending on where the swelling is located, some people may not even notice that they have one. Haemorrhoids that form internally, for instance, will cause little to no pain due to the absence of pain nerve fibres. External piles, which can be located in the lower part of the anal canal as well as outside of the anal canal (on the anus external surface) can cause pain and discomfort, as there are so many pain nerve endings in this area.
Some people can live with haemorrhoids for some time without noticing any symptoms. However, when symptoms do occur they can be uncomfortable. These symptoms include:
- Bleeding while passing a stool (a bowel movement/waste).
- Itching in and around the anus.
- Soreness and swelling around the anus.
- A lump hanging outside the anus, which may need to be pushed back in after passing a stool.
The cause of haemorrhoids is usually associated with an increase in pressure in the blood vessels within and around the anus. Haemorrhoids can be a consequence of constipation, many cases being caused by straining to have a bowel movement. Those who experience chronic diarrhoea could also find themselves at risk of developing haemorrhoids. Some of the factors that could put you at risk of developing haemorrhoids are:
- Being pregnant.
- Being overweight or obese.
- Age - with close to 50% of those who are over the age of 50 having haemorrhoids.
- Regularly lifting heavy objects.
- Sitting down for long periods of time.
Diagnosis can make many people feel embarrassed, however haemorrhoids are very common and GPs will have seen numerous patients with similar symptoms to you. If you are experiencing painful symptoms or discomfort in any way, book an appointment to visit your GP for a check-up. Very often the diagnosis can be achieved through discussing your symptoms and a short rectal examination. Only when piles aren’t that visible will you be required to undergo further examination using a Proctoscope (a tube with a light on the end which allows the doctor to see the lining of your anal passage).
At home treatment and prevention
Most haemorrhoid symptoms will subside after a couple of days, with many people finding that a change in their situation can also relieve their symptoms (e.g. haemorrhoids caused by pregnancy usually reduce after birth). Cases that do not go away on their own, however, can be treated with a number of simple lifestyle changes:
- Increasing the fibre in your diet to make passing stools easier.
- Going to the toilet as soon as you feel the urge to go - don’t wait. The longer you wait the harder stools can become.
- Drinking plenty of water and avoiding caffeine - being dehydrated can cause stools to harden, therefore making them more difficult to pass and in turn leading to straining.
- Exercising regularly - exercise can prevent constipation, lessening the need to strain.
Topical treatments or tablets can also help with the treatment of haemorrhoids, and can be obtained either over-the-counter at a pharmacist’s or via prescription. For more severe cases of haemorrhoids there are other non-surgical options, such as banding, where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should then fall off after about a week.
Anal fissures are again a very common rectal issue, affecting an estimated 1 in every 10 people at some point in their life. Anal fissures appear as tears or sores (ulcers) that form in the lining of the anal canal. People living with anal fissures will experience symptoms such as bleeding, a sharp pain, and sometimes a deep burning sensation, when trying to pass stools. Although many cases of anal fissures will go away on their own, you should still visit your doctor if you suspect you may have developed one. Your GP can then carry out a rectal examination to rule out any other issues (e.g. haemorrhoids).
An anal fissure is caused by damage to the lining of the anus and the anal canal, with constipation, persistent diarrhoea and pregnancy being key contributing factors to the development of anal fissures. Those living with Crohn’s or Ulcerative Colitis may also find they are more at risk of developing anal fissures.
Most anal fissures will heal on their own after a few weeks. However, if the cause of the constipation or damage to the anal lining is not remedied then you could be more susceptible to anal fissures in future. There are many treatments you can consider to help with anal fissures. Lifestyle changes can be adopted quickly and easily to help prevent and treat the issue, such as eating more fibre, drinking lots of water, exercising regularly and going to the toilet when the urge first presents itself.
If you do experience pain you can take simple medication such as ibuprofen and paracetamol to help manage the pain, while avoiding codeine which can worsen constipation. In extreme cases where standard pain medication is not sufficient, your GP can prescribe laxatives to allow softer stools to pass through.
Sources used in writing this article are available on request
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Last revised: 10 February 2017
Next review: 10 February 2020