Piles are a misery! Officially they are called hemorrhoids and are round swellings on the inside of the anal canal.

Many people with piles don't consult a GP so it's difficult to know exactly how many people in the UK get them. There are a lot of treatments you can buy from the chemist and a lot of people just self medicate. However, estimates range from between four and 25 in 100 people.

Although piles can develop from inside your anal canal, they can also hang down out of your rectum. They are graded by degree:

First degree piles are swellings on the inside lining of your anal canal. They may bleed but can't be seen from outside the anus.

Second degree piles are larger and stick out (prolapse) from the anus when you have a bowel movement, but return on their own afterwards.

Third degree piles are similar, but hang out from your anus and only return inside when pushed back in.

Fourth degree piles permanently hang down from your anus and you can't push them back inside. They may become extremely swollen and painful if the blood in them clots.

External piles are swellings that develop from below the anal cushions and they can be more painful than the other types of piles. There can be another cause of lumps around the anus and that might be a sentinel pile, which is the painless skin tag that develops when a crack in the anus (an anal fissure) heals up.

Yes this is the most common complaint that people put up with so that they do not have to see their Doctor about it. Symptoms of piles Some of the common symptoms of piles include:
·painless bleeding from the anus, which may be seen in the toilet bowl or or on toilet paper, or from soiled underwear
·a lump on the anus
·a slimy discharge of mucus
·a feeling that the bowels haven't emptied completely
·itchy skin around the anus
·swelling around the anus
·pain and discomfort after a bowel movement with external piles
These symptoms may be caused by problems other than piles so it is always essential that you should see a doctor for advice.

The exact cause of piles isn't known although one theory is that piles are a result of a weakness of the tissue that connects the anal cushions to the muscle layers underneath. In combination with frequently straining while passing hard bowel movements, this can cause the anal cushions to slide out of their usual place and down the rectum.
·eating a low-fibre diet
·straining to empty the bowels (for example, with constipation)
·in ageing because the support structures in the rectum weaken
·in pregnancy
·being born with a weakness in your rectum or a family history of piles

It is essential to visit your doctor if you notice any signs of bleeding from your rectum.

GP will ask about symptoms and examine you. This may involve a rectal examination, where he or she will gently insert a gloved finger into your rectum. (This is what probably puts most people off the idea of seeing a doctor and it shouldn't, doctors have seen it all before.) The Doctor may also ask about your medical history.

Yes I know what you mean, it is not a nice thought that your doctor may use a proctoscope to look inside your rectum. A proctoscope is a narrow, tube-like telescopic camera. Air can be blown through the tube to open up the bowel so it can be seen more clearly. This test can help to rule out problems in your rectum. But I do agree with Saffy that it is silly to be embarrassed or reluctant, doctors are used to examining every part of the body.

You doctor may refer you for a flexible sigmoidoscopy or colonoscopy test that will need to be done in hospital. This allows your doctor to look inside your large bowel. These tests are sometimes done to check that your condition isn't caused by something more serious.

There are a number of treatments that can help relieve the symptoms of piles, but there isn't a cure as such. Self-help with regular warm baths may relieve irritation and help to keep the anal area clean. It's important not to strain your bowels during a bowel movement. If you have daily bowel movements that are solid but soft, you won't need to strain as faeces will pass easily and won't put pressure on the blood vessels in your anal area.

As I understand it there are several medicines and self help techniques that can be tried for the condition.

If you're passing hard or infrequent faeces, you could try a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxatives such as lactulose, which will soften your faeces. Don't use laxatives that stimulate the bowel, such as senna, unless your doctor advises you to.

Soothing creams, ointments and suppositories may ease any pain and itchiness. There are many different products available. Some contain a local anaesthetic such as lidocaine.

Products containing corticosteroids, such as Anugesic-HC and Proctosedyl, may reduce inflammation and pain.

Whatever you decide to do on a sel help basis always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice before you go ahead with the treatment. If it does not help, then you will need to go back to your doctor.

Yes I am also aware of the self help techniques but the step up from that if these self-help measures and medicines don't work, or you have a higher grade of piles, is a visit to hospital for one of the following procedures that you can have in hospital, but you won't need to stay overnight.

Banding is used mostly to treat second degree piles, but you can also have it with first degree piles if other medicines haven't worked for you. With banding, the doctor will place a small elastic band just above the pile. This will cut off the blood supply to the pile, causing it to die and fall off after a few days. The area left behind will heal up naturally.

Sclerotherapy is another option and your piles will be injected with an oily solution, that will them shrivel up. It's used for first or second degree piles.
Then there is infrared coagulation or laser, where infrared light is used to seal the veins above the pile causing it to shrink or cryosurgery, which destroys the pile by freezing it - the pile will later shrink and fall off and there is also bipolar diathermy and direct current electrotherapy, where an electrical current is used to burn the pile off