Painful and embarrassing to talk about, hemorrhoids also known as piles, are enlarged and swollen blood vessels in or around the lower rectum and anus. Increased pressure in these blood vessels results in swelling and lumps. Let’s distinguishes the different types and possible treatments.

HEMORRHOIDS VARY IN SIZE and can occur inside or outside the anus. Internal hemorrhoids develop in the back passage, 2-4cm above the opening of the anus. They normally are not painful and may remain undetected due to the lack of pain-sensitive nerve fibers in the internal anal membrane. However if they protruded or hang out from the anus, there may be pain and irritation External hemorrhoids develop on the outside edge of the anus and tend to hurt.

Internal hemorrhoids are classified using a grading system from one to four.

• Grade one hemorrhoids are small swellings often inside the lining of your anus. They cannot be seen and are very common. In some cases they will enlarge to grade two.

• Grade two hemorrhoids are larger in size but are still within your anus. Sometimes they become pushed out when you pass a stool, but will return immediately after.

• Grade three hemorrhoids appear outside your anus; you may be able to feel one or more small lumps hanging out. They are also referred to as prolapsed haemorrhoids. You'll usually be able to push them back inside using your finger.

• Grade four hemorrhoids can become quite large and remain outside your anus permanently. They cannot be pushed back and will need to be treated by your doctor.

External hemorrhoids, also known as perianal haematoma, are small lumps that develop on the outside edge of the anus. They can become increasingly itchy. If a blood clot forms inside them, it can cause a lot of pain, requiring immediate treatment. This type of hemorrhoid is less common.

Strain encounters

Straining when trying to pass a stool often leads to increased pressure in the blood vessels in the anus and rectum (end of the large bowel). The blood vessels in and around the anus become swollen and inflamed.

Don't hold back

There's no guaranteed way of preventing hemorrhoids, but a high-fiber diet rich in fruit, vegetables, and whole grain cereals can help ease your symptoms. This will help keep your feces soft, reducing your risk of becoming constipated - the primary cause of hemorrhoids is straining to pass a stool. Dietary fiber acts like a sponge absorbing water to increase the bulk and softness of stools. This ensures that they are eliminated easily from the body. But do remember to increase your fluid intake when increasing your intake of fiber.

It's also recommended that you empty your bowels as and when you need to. By delaying when you pass your stool, this could mean the stool becomes harder and drier. As a result, this increases the likelihood of pressure building up in your anus and rectum blood vessels.

General recommendations include:

• Eating plenty of fresh fruit and vegetables (at least five portions a day).

• Cutting down on fat (particularly animal fat), sugary food, and refined and processed food.

• Eating plenty of pulses such as peas, beans and lentils,

• Eating plenty of wholegrain foods such as whole meal bread, pasta and breakfast cereals.

Taking fiber supplements that are available over the counter such as Fybogel and C-Lium

• Drinking plenty of fluid. You should drink six to eight glasses of water every day in order to keep your faeces soft.

• Drinking alcohol (if your do) only in moderation.

• Losing weight - being overweight can be a contributing factor to having hemorrhoids.

• Exercising regularly - this can prevent constipation and reduce the pressure in your blood vessels.

Other factors that can increase the chances of having hemorrhoids:

• Being overweight

• Prolonged constipation

• Prolonged diarrhea

• Prolonged sitting or standing

• Regularly lifting heavy objects

• Pregnancy and child birth - where there is increased abdominal pressure on the pelvic blood vessels

• Aging

Symptoms include

• Itchy around the anus

• Discomfort around the anus, such as feeling sore or it being visibly red

• Excessive straining when passing a stool

• Bleeding after passing a stool

• Mucus discharge after passing a stool

• Pain while passing a stool

• Feeling like the bowels are still full and need emptying even after passing motion.

Treatments range from sitz-baths to surgery

DIY for mild hemorrhoids:

• Pain from hemorrhoids can be eased by sitting in a bath of warm water. This should reduce the itching. Adding Epsom salts to the water also helps to relieve inflammation.

• If hemorrhoids extend outside the anal canal, using cold compresses or ice packs can help to ease pain and reduce swelling.

• If a hemorrhoid has prolapsed, try pushing it back gently into the anal canal.

• Clean your anus after each bowel movement by patting gently with moist toilet paper or moistened pads such as baby wipes. Avoid using dry toilet paper.

• Use hemorrhoidal preparations that are available over the counter eg:

>> Ointments/suppositories containing protectants and vasoconstrictors such as

Preparation-H. Protectants help to protect the skin membrane whereas the

vasoconstrictors help to constrict the blood vessels.

>> Ointments containing local anasthetics such as Xylocaine to help to numb the area. Oral tablets such as Daflon that strengthen veins.

Please note the following when using OTC products:

>> If your condition does not improve after seven days of self treatment, see your doctor. Also seek your doctor immediately should you experience severe bleeding, seepage or pain.

>> If you have any medical conditions such as high blood pressure, heart disease, diabetes, thyroid disease or if you are on any antidepressant medications, pls seek advice from your doctor/pharmacist before using OTC preparations containing vasoconstrictors.

Sometimes surgical intervention may be necessary to treat hemorrhoids. Such procedures include:

• Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.

• Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.

• Infrared coagulation. A special device is used to burn hemorrhoidal tissue.

• Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery.