Piles, or haemorrhoids, are swollen, enlarged veins that form in or around the anus and rectum (lower part of the large intestine). They can cause discomfort, pain and bleeding.^1a,2a   Types of haemorrhoids: Haemorrhoids can be internal or external, depending on where they form.^1b   Internal haemorrhoids develop inside the rectum. You usually can’t see or feel them, and they rarely cause discomfort, although they may bleed.^2b,3a   Prolapsed haemorrhoids are internal haemorrhoids that prolapse (protrude) through the anus. An internal haemorrhoid can cause severe pain if it is completely prolapsed, meaning it has slid out of the anus and cannot be pushed back inside.^{2c, 1c} External haemorrhoids develop under the skin around the anus, and you can usually see or feel them. They can be itchy and painful and occasionally bleed.^2d     Thrombosed haemorrhoids are when blood pools in an external haemorrhoid and forms a clot, or thrombus. (This clot only affects the anal area and doesn’t move to other parts of the body.) These haemorrhoids are usually painful and cause a purple or blue lump to form outside your anus. This anal mass may appear suddenly and get worse during the first 48 hours. The pain generally lessens after a few days.^2e,1d,3b   Haemorrhoid Grades/Degrees Haemorrhoids can also be classified according to their size and severity

• Grade 1 – small swellings on the inside lining of the anus that can’t be seen from the outside.
• Grade 2 – larger swellings that may emerge from your anus when you have a bowel movement, before disappearing inside again.
• Grade 3 – one or more small, soft lumps hang down from the anus that can be pushed back inside (“prolapsing and reducible”).
• Grade 4 – larger lumps hang down from the anus that can’t be pushed back inside (“irreducible”).

One reason haemorrhoids are so common in humans is our upright posture, which puts pressure on veins in the anus and rectum, making swelling more likely.^1e   Other factors that may increase pressure on these veins and consequently raise risk for developing piles include: ^1e  

• Age. Haemorrhoids become more common as we get older because the tissues supporting veins in the rectum and anus can weaken and stretch.^3c Piles affect more than half of people over age 50.^2g
• Straining and holding your breath when trying to pass stool creates greater pressure on the veins in the lower rectum.^3d
• Sitting for long periods, especially on the toilet, as this increases pressure on veins in the anus.^3d
• Chronic constipation, which leads to more straining. Chronic diarrhoea can also be problematic as it may also cause increased time spent on the toilet.⁵
• The baby’s weight puts pressure on the anal area.^3c
• Being overweight^2h
• A low-fibre diet, which can lead to constipation.^2h
• Straining to lift heavy objects. ^2h

Symptoms of haemorrhoids may include:^1f,3a  

• Bleeding during bowel movements. You may notice small amounts of bright red blood on toilet paper or in the toilet.
• Protrusion of skin during bowel movements
• Itching, irritation, pain or discomfort in the anal area
• Sensitive lump(s) near the anus.

Many people get relief from smaller piles (Grades 1 and 2) with simple home treatment and lifestyle changes. Haemorrhoid pain and bleeding may last around a week. In the meantime, you can take these steps to help ease symptoms:^2i,6,1g,7   Apply over-the-counter medications to the affected area. Use a clinically proven product suitable for treating Grade 1 or 2 haemorrhoids such as ActiProct® Gel. It contains natural ingredients, such as 2QR-Complex, extracted from Aloe Vera, which provide rapid relief. This gel is easy to apply, and within 60 seconds has a cooling effect that soothes haemorrhoids and anal discomfort by reducing inflammation, pain and itching. It also protects the skin from irritation and friction during toilet visits.⁶   Soak in a warm sitz bath for 10-20 minutes a few times a day to help the healing process.^1g A sitz bath is a shallow bath you sit in to relieve discomfort in the anal area. It relaxes your anal sphincter, which helps increase blood flow through your anal tissues. This promotes healing and helps reduce discomfort and swelling caused by haemorrhoids.⁷ Gently clean yourself after a bowel movement. Try toilet paper with lotion, wet wipes or a moistened tissue or washcloth.²ⁱ Take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.²ⁱ

Most haemorrhoid symptoms, while uncomfortable, generally improve within a week of home treatment and don’t cause serious problems.^2j However, while rare, complications can occur, so it’s important to see your doctor if you have haemorrhoids and:^2k,2l

• Abdominal pain
• Nausea and vomiting
• Fever and chills
• Severe rectal bleeding and pain
• Chronic constipation or diarrhoea
• Haemorrhoids don’t improve after a week of home treatment.
• Symptoms worsen or interfere with your daily life or sleep.

Don’t assume rectal bleeding is due to haemorrhoids, especially if you’ve also noticed changes in your bowel habits. Rectal bleeding can also be a symptom of other more serious diseases, such as colorectal cancer.^3e   Many people put off seeking treatment and continue to experience discomfort from haemorrhoids unnecessarily. Don’t let embarrassment stop you from seeking medical help as there are several treatments available, including effective surgeries, for when piles become more serious and no longer respond to home care.^2m

The following measures help reduce the symptoms of haemorrhoids and prevent them from worsening, as well as lowering the risk of their forming in the first place:  

• Include more high-fibre foods in your diet. fruit, vegetables and whole grains. Among several health benefits, fibre makes stools soft and less dense, so they pass easily ^3d To get enough dietary fibre, adults should aim for at least five portions of fruit and vegetables (with skins if possible) and at least two portions of high-fibre cereal and grain products daily.⁸
• Consider over-the-counter fibre supplements if you are struggling to eat enough high-fibre foods.^3d
• Avoid excessive straining to reduce pressure on haemorrhoids and help prevent protrusion.^3d
• Avoid sitting on the toilet for long periods – aim for no more than 1-2 minutes at a time.^1g
• Drink plenty of fluid: six to eight glasses of water and other liquids each day helps to keep stools soft.^3d
• Exercise regularly to help prevent constipation. Staying active also helps you lose excess weight that can contribute to haemorrhoids developing.
• Go to the toilet when you get the urge — don’t delay or try to hold it in.²ⁿ
• Only use laxatives or enemas as recommended by your doctor. Overuse can disrupt your body’s ability to regulate bowel movements.²ⁿ