Bowel > Bowel Problems > Haemorrhoids, Anal Tears & Fissures

Haemorrhoids, Anal Tears & Fissures

Haemorrhoids (piles), anal tears & anal fissures can all result in bleeding from the anus, which can be quite alarming. All these conditions are relatively common and in most cases any bleeding is not a cause for alarm. However, any bleeding from the anus should always be investigated immediately as it may be a symptom of a more serious condition.

What are haemorrhoids?

Haemorrhoids or piles are enlarged and swollen blood vessels which are in or around the lower rectum and the anus. Most of the time you are not aware of having haemorrhoids but in most cases you will feel a small lump which is just inside or outside the anus. Bleeding from a pile can be quite scary when first discovered but it is not serious.

What causes haemorrhoids (piles)?

Piles are usually caused when you strain to pass a stool. So people who are frequently constipated and who regularly strain, often suffer from piles. They are also common during or after pregnancy due to the pressure from the developing baby, hormonal changes and the delivery of the baby. Smaller piles will disappear naturally when constipation is alleviated.

If there is an irritation or an itch associated with piles, ask your pharmacist for advice. There are a number of preparations that can help ease the discomfort. Larger piles that do not resolve may need treatment from a surgeon.

Injecting Haemorrhoids

This treatment is particularly effective for haemorrhoids that bleed. It is sometimes called sclerotherapy. Injecting a small amount of a chemical called phenol into the base of the haemorrhoids causes them to shrink in size. This can take a number of weeks to be effective, so you should not expect immediate results.

What should I do when I get home?

You may experience some discomfort or a feeling of fullness in the anus for a day or so after the injection. This is quite normal. You should take regular painkillers if needed. You can bathe or shower as you wish and you can return to normal activities as soon as you feel comfortable.

You may see some minor spots of blood on the stools or on the paper when you wipe yourself after opening your bowels. This will settle with time.

Complications following injection of haemorrhoids are very rare. Very occasionally it can cause problems with the urinary system in men. If you have more severe pain, or a high temperature following the injection you should go to your nearest hospital.

Can I prevent the haemorrhoids from coming back?

Unfortunately, having your haemorrhoids injected does not guarantee that they will never come back. Injection usually improves symptoms for a few months, but in many cases the injections need to be repeated.

Increasing the fibre in your diet and your fluid intake can help prevent further problems with haemorrhoids. A high fibre diet is known to be as effective as injections for preventing further problems. Avoiding straining and constipation is the most useful thing patients can do to prevent the problem coming back. If the fibre content of your diet is not sufficient to keep your stools soft, then a fibre supplement such as Fybogel can help.

Tear in the anus / Anal fissures

Bleeding from the anus can occur if you have passed a rather big and / or hard stool and experienced some pain during and after the passing. This is usually caused by a small tear in the lining of the anal canal.

Anal fissures are splits around the anus. They can open when you have a bowel movement and may continue to hurt afterwards. They may also bleed.

You can prevent the fissures from reopening by trying to avoid constipation. This will therefore make your faeces easy to pass.

Is bleeding from the back passage serious?

Most of the time, bleeding from the anus is not serious, however it is important to seek professional medical advice.

Bleeding from the anus can be serious if the bleeding is connected to a bowel disease or condition rather than the anus itself. These diseases / conditions include:

Cancer of the rectum / lower colon
Innocent or benign tumours (polyps)
Inflammation of the rectum (proctitis)
Inflammation of the colon (colitis)

These conditions can be managed and looked after.

Your GP will help to evaluate your problem and may use the following procedures when examining you:

Examine your abdomen, searching for lumps or tender areas
Examine your back passage to check the anal canal

Following these investigations, your GP may decide to send you to a specialist who may investigate further and you may need to undergo some of the common tests and procedures listed below.

Common Tests and Procedures

Proctoscopy - this is a visual inspection of the anal canal using a proctoscope. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end. It is approximately 5 inches or 15 cm long. During proctoscopy, the proctoscope is lubricated and inserted into the rectum. When the plug at the end of the tube is removed, an unobstructed view of the interior of the rectal cavity can be seen allowing the doctor to check if there are any problems causing the bleeding.

Sigmoidoscopy - this procedure will probably be carried out by a specialist that your GP has sent you to see. This procedure uses the same principle as the Proctoscopy but the tube that is used is longer and more flexible. This helps the doctor to see the whole of the rectum and round the bends in the colon. The doctor will pump air into the bowel and may also take a small sample of tissue from the bowel for examination (biopsy). This is done with forceps and is not painful. You will be prepared by your doctor before this procedure takes place and will likely be asked to take a laxative or an enema before the procedure to clean out the colon.

Barium enema x ray - this procedure is used to look for problems in the colon, such as polyps, inflammation (colitis), narrowing of the colon, tumours, diverticula, etc. It will be carried out by a specialist. Before your x ray is taken you will have to lie on your side and a lubricated tube will be inserted into your back passage. Barium sulphate will be poured down the tube which will allow the outline of the intestine to show up on the actual x ray. Air will also be pumped into the rectum as well and you will have to move about so that the barium reaches all around your colon.

Further Help

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

You can also call our specialist helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or visit our Continence Clinic Database facility in the Specialist Services section to find out where your nearest clinic is or call our general enquiries line on 01536 533255 for details.