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See Dr Morton’s page soothe piles
Ooh my piles!
Whilst clearing out a garage and attic full of boxes that had remained unopened since our move to Surrey eight years ago, I came across a copy of Viz magazine from my student days. Growing-up in Newcastle, where the magazine originated, I felt compelled to look inside…
The comic strips of ‘Nobby’s Piles’ and ‘Buster Gonad’ (I am sure suitable ‘ammo’ for another article) appealed to my surgical incline. ‘Nobby’, a man clearly troubled by his enormous haemorrhoids utilised innumerable different terms for them: piles, grapes, Chalfonts (St Giles), farmers (Giles), Emmas, Sigmunds and Clements (Freud) and several others, not suitable for such a forum, were laid out in black and white. Whilst this whimsical, school-boy humour made me giggle it also brought home an insight into the reluctance of ‘the British’ to talk of such things.
Apologising is a very British thing to do. We do it when we don’t even know what we are apologising for! The frequency with which people apologise when referred to me with either a bowel problem or when I ask them about their bowel habit as part of an assessment of the ‘general health’ is incredible. The lack of a willingness of the population to talk about their bowels is one of concern.
Rectal bleeding or pain is a common problem. Frequently it is caused by haemorrhoids, but equally there are other more serious conditions that may cause either a change in bowel habit or bleeding per rectum. It is therefore important that anyone bleeding from their bottom take medical advice.
The term ‘piles’ is frequently applied to describe two main conditions.
“True haemorrhoids” typically present with an awareness of painless bright red rectal bleeding after or along with the passage of a stool. The blood may cover the stool, drip into the pan or merely be evident upon the toilet tissue. Haemorrhoids are classically graded into four groups:
Grade I: no prolapse
Grade II: prolapse upon ‘bearing down’ but reduce spontaneously
Grade III: prolapse upon ‘bearing down’, but requiring manual reduction
Grade IV: prolapse with inability to be manually reduced
Once the piles prolapse through the anal verge they may also cause a mucous discharge, a perianal mass, itchiness, and rarely incontinence. Pain is rarely a feature unless they become thrombosed (clotted) or necrotic.
This is a very painful condition where the blood clots in the prolapsed haemorrhoids. Alternatively it may occur de novo without any clear evidence of internal piles where it is more of a burst blood vessel in the skin just beyond the anal verge. Whist intense this pain typically resolves in 2–3 days. The swelling may take a few weeks to resolve, however some people are left with small perianal skin tag(s) after healing.
Internal and external haemorrhoids may present differently; however, many people may have a combination of the two. The presence of a pile in the anal canal or at the verge may cause irritation of the surrounding skin, and thus itchiness around the anus.
A “>topical anaesthetic such as Scheriproct helps ease any pain or itching and also helps reduce swelling and irritation. This must also be supplemented with good perianal hygiene and constipation should be avoided.
Prolonged use of topical treatments may in themselves cause perianal irritation and should symptoms not settle quickly then a prompt medical opinion should be sought.
Thanks. I never quite understood this before. Now I know what help to get