Haemorrhoids

Also called Piles

Swollen blood vessels in the back passage. Extremely common, and assuming rectal bleeding is piles is how bowel cancer gets missed.

What it is

Haemorrhoids are swollen vascular cushions in the anal canal. They are extremely common, particularly in pregnancy and with chronic constipation.

They are also the reason a great many people ignore rectal bleeding for months.

That is the point of this entry. Bleeding from the bottom is common and usually benign, and it is also the commonest presenting symptom of bowel cancer. Assuming it is piles, without anybody having looked, is a decision that costs lives.

Anybody with rectal bleeding should be examined. Anybody over 50, or with a change in bowel habit, weight loss or anaemia, should be investigated.

Signs you might notice

Bright red blood on the paper, on the surface of the stool, or in the pan after passing a motion.

Itching, soreness, or a feeling of something coming down.

A lump around the anus, which may reduce or may need pushing back.

Sudden severe pain with a hard lump suggests a thrombosed haemorrhoid, which is very painful and settles over one to two weeks.

Warning signs meaning it is not just piles: darker blood or blood mixed through the stool, a change in bowel habit, weight loss, tiredness from anaemia, or a family history of bowel cancer.

How it can affect day-to-day life

Embarrassment causes the delay, and it is worth naming directly, because the alternative is a late cancer diagnosis.

Constipation is both cause and consequence, and treating it properly resolves a large proportion of piles without anything else.

Straining and prolonged sitting on the toilet, particularly with a phone, is a genuine contributor and worth mentioning.

Supporting someone well

Treat the constipation. Fibre, fluid, and a stool softener if needed. This does more than any cream.

Do not strain, and do not sit on the toilet for long periods. Use a footstool so the knees are above the hips.

Use topical treatments for symptom relief, for short periods only.

Get bleeding checked, every time, whatever you assume it is.

Do the bowel screening kit when it arrives.

Ask about banding or surgery for persistent or prolapsing haemorrhoids.

Sudden severe pain with a lump: cold packs, pain relief, and it usually settles, but get it looked at.

Where to get help

A pharmacist can advise on treatment; a GP should examine anybody with bleeding.

Urgent assessment for a change in bowel habit, weight loss, anaemia, or darker blood.

Guts UK and Bowel Cancer UK both publish clear guidance on when bleeding needs investigating.