Piles (haemorrhoids) often go away by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.
Making simple dietary changes and not straining on the toilet are often recommended first.
If more invasive treatment is needed, the type of treatment used will depend on where your haemorrhoids are, particularly if they have developed above, on or below the dentate line. This is a line in the anal canal that separates the areas where the nerves can and can't transmit pain messages.
Non-surgical treatments are likely to be very painful for haemorrhoids that have developed on or below the dentate line, as the nerves in this area can detect pain. In these cases, haemorrhoid surgery will normally be recommended.
Dietary changes and self-care
If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular, so that you don't strain when passing stools.
You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables. Read more about preventing constipation.
You should also drink plenty of water and avoid caffeine (found in tea, coffee and cola).
Follow the below advice when going to the toilet:
- avoid straining to pass stools, as this may make your haemorrhoids worse
- after passing a stool, use moist toilet paper or baby wipes to clean your bottom, rather than dry toilet paper
- pat the area around your bottom, rather than rubbing it
Over-the-counter topical treatments
Various creams, ointments and suppositories (which are inserted into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.
These medicines should only be used for five to seven days at a time. If you use them for longer, they may irritate the sensitive skin around your anus. Any medication should be combined with the diet and self-care advice detailed above.
There is no evidence that one method is more effective than another. Ask your pharmacist for advice about which product is most suitable for you. Always read the patient information leaflet that comes with your medicine before using it.
Do not use more than one product at the same time.
If you have severe inflammation in and around your back passage, your GP may prescribe corticosteroid cream, which contains steroids.
You should not use corticosteroid cream for more than a week at a time, as it can make the skin around your anus thinner and the irritation worse.
Common painkilling medication, such as paracetamol, can relieve the pain of haemorrhoids. However, you should avoid codeine painkillers, as they can cause constipation.
Products that contain local anaesthetic (painkilling medication) may also be prescribed by your GP to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days, as they can make the skin around your back passage more sensitive.
If you are constipated, your GP may prescribe a laxative. This is a type of medication that can help you empty your bowels.
If dietary changes and medication don't help, your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.
If your haemorrhoids are found to have developed above the dentate line, non-surgical procedures such as banding and sclerotherapy may be recommended.
Banding is a procedure that involves placing a very tight elastic band around the base of your haemorrhoids, to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.
Banding is usually a day procedure, without the need for an anaesthetic, and most people can return to their normal activities the next day. You may feel some pain or discomfort for a day or so. Normal painkillers are usually effective, but your GP can prescribe something stronger, if needed.
You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet. If you notice some mucus discharge within a week of the procedure, it usually means the haemorrhoid has fallen off.
Directly after the procedure, you may notice blood on the toilet paper after going to the toilet. This is normal, but there should not be a lot of bleeding. If you pass a lot of bright red blood or blood clots (solid lumps of blood), go to your nearest accident and emergency (A&E) department immediately.
Ulcers (open sores) can occur at the site of the banding, although these usually heal without needing treatment.
A treatment called sclerotherapy may be used as an alternative to banding.
During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.
After the injection, avoid strenuous exercise for the rest of the day. You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.
Infrared coagulation is also sometimes used to treat haemorrhoids.
During the procedure, a special device that emits infrared light is used to burn the haemorrhoid tissue and cut off their blood supply.
A similar procedure can also be carried out using an electric current instead of infrared light. This is known as diathermy or electrotherapy.
Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people with the condition will eventually need surgery.
Surgery is particularly useful for haemorrhoids that have developed below the dentate line because, unlike non-surgical treatments, anaesthetic is used to ensure you don’t feel any pain as they are carried out.
There are many different types of surgery that can be used for haemorrhoids, but they usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.
Read more about surgery for haemorrhoids.