Also known as haemorrhoids, piles are swellings around the anus or within the anal canal that have enlarged blood vessels inside them.

Tissue inside the anal canal may become swollen as a result of straining to defecate, for example. If piles are damaged, this can cause pain and bleeding.

Piles often exist without causing any problems and people may not realise they have them.

If symptoms do occur, they may include the following:

• Bleeding when a stool is passed
• Pain and discomfort after passing a stool
• A lump inside the anal canal or around the anus
• Itchy and/or sore bottom
• A slimy mucus discharge from the anus
• Sense that a bowl movement has not fully emptied the bowel

The symptoms of hemorroids often clear up spontaneously or with the use of simple ,treatments such as dietary changes and/or the use of creams and suppositories that relieve discomfort and swelling. However, severe piles may require more intensive treatment.

The treatment approach primarily depends on the location of the pile in the anal canal. Treating piles in the lowest third of the anal canal with non-surgical treatments is likely to cause significant pain due to the amount of pain-sensing nerves in the area.

For piles located in the upper two thirds of the canal, however, non-surgical procedures can be used, such as banding, sclerotherapy and electrotherapy. These techniques are described in more detail below.

Banding

Banding refers to the placement of a tight elastic band around the base of the pile to cut off its blood supply. Starved of blood, the pile usually dies and falls off within a week of the procedure.

The pile then passes out of the body when the patient goes to toilet, although they may not be aware when this occurs.

Banding does not generally require an overnight hospital stay or anesthetic and patients can usually resume everyday activities the following day.

Immediately after the treatment, a person may notice a small amount of bleeding after using the loo.

There may also be mild pain or discomfort, which can usually be relieved with the use of simple analgesic medications.

A doctor can prescribe a stronger medication for pain relief, if necessary. If a blood clot is passed or if there is a lot of bright red blood, pain or a fever, then patients should visit their local A and E department.

In some cases, ulcers develop at the banding site, but these usually heal independently and do not require treatment.

Sclerotherapy

This procedure involves injecting a hardening chemical solution into the pile, which scars the tissue and reduces its blood supply.

The scarring causes the blood vessel to collapse and the pile to shrink and harden so that it eventually shrivels up about 4 to 6 weeks after treatment. This technique can be used to treat many piles simultaneously.

The procedure is very safe and few side effects are usually experienced. In some cases, patients may experience mild pain during the couple of days following treatment. Light rectal bleeding may also occur for a short period.

Sclerotherapy is commonly prescribed when people fail to respond to hemorrhoid treatments or when hemorrhoids cannot be treated with banding.

For banding, piles need to be large enough to be tied with the elastic band and when piles are too small for this, sclerotherapy is typically used.

Patients may experience slight pain or discomfort, which can be treated with simple analgesic medications.

Electrotherapy

Also called electrocoagulation, this procedure uses an electric current to destroy the pile. This is another option for people with small piles that cannot be treated with banding.

An instrument called a proctoscope is placed in the anus and used to locate the pile. A probe is then placed at the base of the pile and an electric current delivered to the pile using a hand piece that is connected to the probe.

The aim is to use the electric current to thicken the blood in vessels supplying the pile and cauterize it at the base.

The pile then starts to shrink. Multiple hemorrhoids can be treated simultaneously, depending on the patient’s tolerance levels.

Mild, short-term pain may be felt during or after the procedure and rectal bleeding may occur for a short period.