Bright-red bleeding: If you have piles, you might see bright-red bleeding on the toilet paper, in the toilet bowl or on the surface of the faeces.

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1 What are haemorrhoids/piles? In the inner lining of the anus there are three haemorrhoidal cushions of tissue, which help to seal the anus and contribute to the control of the bowels (continence). Often, as a result of straining and constipation, these cushions can swell and become displaced, so that they can slide out of the anus (called prolapse) during a bowel movement. Haemorrhoidal tissue has a rich blood supply, which explains why bleeding is common. What are the symptoms of piles? Bright-red bleeding: If you have piles, you might see bright-red bleeding on the toilet paper, in the toilet bowl or on the surface of the faeces. Prolapse: You might also feel a prolapse, which is when the haemorrhoid comes down when passing faeces. Piles often go back inside naturally or they can be pushed back, but occasionally they stay down. A mucus discharge: Sometimes a bulging haemorrhoid can allow the seepage of mucus from the anus. Pain: You can get pain with piles, but this is uncommon. Acute pain and the appearance of a lump protruding from the anus can be the result of thrombosis of the haemorrhoid. This can often be treated by urgent surgery to relieve the discomfort. What are the treatments for piles? Piles are harmless; therefore, once a diagnosis of piles is made, treatment is directed at minimising the symptoms. What can I do to prevent or treat piles? High-fibre diet: If you aim to eat a high-fibre diet and drink plenty of water (between six and ten glasses a day), you should be able to keep your faeces soft, which will help you pass them without straining. Sometimes your doctor or dietician will recommend a fibre supplement to help you. Avoid straining on the toilet: Try not to strain (push too hard) when you go to the toilet; it is Page 1

2 better to try to pass faeces only when your body is ready to do so. What treatments are available from the doctor? Injection therapy: Piles can be injected internally, which does not hurt. This causes them to shrivel up and helps to stop bleeding. The injection can cause a dull ache for several hours, and there may be some bleeding or mucous discharge for a few days. If you experience pain, you can take a simple painkiller (such as paracetamol). There is no reason why you need to stop your normal activity after this small operation. This treatment can be repeated if necessary, usually at intervals of approximately six weeks. Banding: Banding is a treatment that can be very effective for controlling both bleeding and prolapse (protrusion). A small rubber band is placed around the haemorrhoid, which then scars and falls off. This usually causes some discomfort, which can be controlled with simple painkillers. You may also find a sitz bath (a 15-minute bath in water as warm as you can tolerate) very soothing. There can be some bleeding or mucous discharge for a few days, but this shouldn't prevent you from normal activities. This treatment can be repeated if necessary, usually at intervals of approximately six weeks. Haemorrhoidectomy: For some types of haemorrhoids, or if other treatments have failed, an operation called a haemorrhoidectomy might be recommended. In this operation, the haemorrhoids are surgically removed (see below for further information). Are there any complications of outpatient treatment? The outpatient treatment of haemorrhoids (injection and banding) is extremely safe and carries few risks. As with any procedure, complications do occur occasionally. Therefore, in the few days following your injection or banding, you should contact your general practitioner, or our Colorectal Specialist Nurse, if you notice any of the following problems: increasing pain, redness, swelling or discharge severe bleeding constipation for more than three days, despite using a laxative difficulty in passing urine high temperature (over 38ºC), or chills nausea or vomiting What should I do if I notice bleeding from my rectum after being treated for piles? Because piles are not always cured after just one treatment, the symptoms might be caused by the piles recurring. You might have been given a follow-up appointment at the Colorectal Page 2

3 Clinic, or you can make an appointment at the Clinic to discuss a further course of treatment. If, however, you develop bleeding many weeks after your haemorrhoids have successfully been treated, you should not automatically assume that your piles have recurred. Bleeding from or around the rectum can also be caused by a variety of other conditions, and you should consult your general practitioner if you are in doubt. Symptoms that suggest bleeding from causes other than piles include: dark-red blood (which is usually from higher up the bowel) blood mixed into the faeces bleeding at the same time as a persistent change in bowel habit; for example, the development of loose faeces or an increased frequency of bowel action bleeding and abdominal pain bleeding and anal pain at the same time as passing faeces. What does a haemorrhoidectomy operation entail? Haemorroidectomy is an operation to remove haemorrhoids (piles). This surgery is required for some types of haemorrhoids, or if other forms of treatment have not been able to control the symptoms Admission: You might be admitted to hospital on the day of your surgery or the day before Laxative and enema: You will have been advised to start to take a mild laxative such as lactulose (20mls, twice a day) two days before the operation. Immediately before your surgery, your nurse will give you an enema to empty the bowel. Anaesthetic choice: Several different kinds of anaesthesia can be used, and the method will be tailored to your particular needs and wishes. The anaesthetist will discuss the options with you. If you have a general anaesthetic, you will be asleep for the entire operation. Some patients are better suited to a spinal or caudal anaesthetic. This is a small injection in the lower back to numb the area so that you will not feel the surgery. If you have a spinal or caudal anaesthetic, you will be be conscious and able to talk to the anaesthetist during the procedure. Many patients who undergo day-case surgery or 23-hour-stay surgery will not require a general anaesthetic. Instead, controlled sedation and the injection of a local anaesthetic can allow the operation to be performed painlessly and a rapid recovery. Most patients who have had sedation do not remember the surgery taking place. Surgery: Haemorrhoids usually have an external component outside the anus as well as the main component inside the anal canal. Depending on the number of piles, these are removed in two to four separate areas. The tissues are then closed with stitches (sutures) or Page 3

4 the wounds can be left open to heal. Most of the stitches lie inside the anal canal, but some will be on the outside. The stitches dissolves over a period of two to four weeks. You don't need to have them removed and no special dressings are required. Pain relief: In order to minimise the pain associated with your operation, a number of measures will be taken: At the time of surgery, local anaesthetic will be injected. This will provide pain relief for much of the day. After surgery, you will be given painkillers to take by mouth You will take a laxative for two weeks after the operation to prevent constipation. You will be encouraged to have sitz baths (a 15-minute bath in water as warm as you can tolerate) several times daily, or as often as you require them. These are very soothing and can provide several hours of pain relief. Recovery after your operation: Within a few hours of your operation, you will be encouraged to get up and walk around, with assistance if required. You may eat and drink normally, and we recommend a high-fibre diet, and lots of fluids (at least six to ten glasses of water daily). You can leave the hospital on the same day (for planned day-case surgery) or on the following day. You should expect to pass faeces within two to three days, and this might be uncomfortable at first. A small amount of bleeding is expected. Over the first few weeks, you might notice some change in your ability to control wind, which will resolve. Provided you feel comfortable, there are no restrictions on your normal activity and you may lift things, drive and go back to work. What can go wrong with the haemorroidectomy operation? Haemorrhoidectomy is generally a very safe operation and is associated with few risks. However, as with any surgical procedure, complications do occur occasionally, and about 2% of patients need to have a second anaesthetic to attend to a complication. Immediately after the operation, 10-20% of patients find it difficult to pass urine and a catheter might be required to empty the bladder. Approximately 5% of patients experience more bleeding than expected, and might need to be readmitted to hospital either for simple observation or, rarely, for another operation. Infection is very rare, which is surprising considering the site of the operation. The stitches (sutures) that are used to close the tissues sometimes separate, leaving an open wound; if this happens, you should not be worried because healing will still take place rapidly. In the long term, the recurrence of symptoms is rare, although a few patients might develop skin tags, which do not usually require any special treatment. If you are a clinic patient and have further questions, contact our Colorectal Specialist Nurse, Page 4

5 Tel: , or speak to the doctor or ward staff when you come to the hospital. Page 5