Haemorrhoids, also known as piles, are a common problem. It is estimated that eight million people in the United Kingdom are affected by haemorrhoids.¹

Haemorrhoids can cause many symptoms, including itching. This article will explain what haemorrhoids are, what causes them, the symptoms (including itching), and treatments for haemorrhoids.

Introduction

Haemorrhoids are caused when the blood vessels inside the bottom (anus) grow bigger than normal and become irritated.² These can cause small lumps of tissue either inside the bum or sometimes they can come out of the anus and cause lumps around your bottom which are usually pea-sized.³

Sometimes haemorrhoids don’t cause any problems at all, and someone with haemorrhoids may not even know that they have them.³ However, sometimes they can cause symptoms which bother people in their everyday life. This article will explain these symptoms with an emphasis on itching and how to treat them.

Types of haemorrhoids

Haemorrhoids are graded from First Degree to Fourth Degree.² This grading scale helps your doctor decide what treatment to use.

First degree

First Degree haemorrhoids are not visible from the outside of the anus as they are small swellings on the lining of the large intestines.²

Second degree

Second Degree haemorrhoids are larger than First Degree ones. 2 They may also come out of your anus while you go to the toilet, but will go back inside again afterwards.²

Third degree

Haemorrhoids are considered Third Degree when at least one hangs down from the anus but can still be pushed inside.²

Fourth degree

These haemorrhoids are larger and cannot be pushed back inside the anus.²

Causes of haemorrhoids

We do not know exactly what causes haemorrhoids. It’s thought that if the pressure in the blood vessels in your anus is higher than normal, this can lead to haemorrhoids.² This high pressure can be caused by many things, including:²

• Constipation, which can mean people spend a long time straining on the toilet leads to high pressure in the blood vessels.
• Regularly sitting down for a long time
• Being over the recommended weight range
• Having a cough for a long time
• Getting older
• Vomiting again and again
• Pregnancy
• If there is a history of haemorrhoids in your family.

Symptoms of haemorrhoids

Haemorrhoids can cause many symptoms that you may notice. These include:^{3, 2} 

• Pain around your bum
• Seeing bright red blood after you have defecated (pooed)
• Lumps around your bum
• You may still feel like you need to poop after you have just gone
• Mucous visible either on toilet paper or your underwear after wiping your bum
• Redness around your anus
• Swelling around your bottom
• Itching at the bum (your doctor may call this pruritus ani)⁴ 

What makes haemorrhoids itchy?

There are several reasons why haemorrhoids may itch, though itching is not always a symptom.⁴ These reasons are listed below.

Mucous

Haemorrhoids make mucous, which is a sticky substance that helps to protect your body from damage.⁵ However, haemorrhoids mean that you make more mucus than normal and this can stick to the skin around your bum. Over time, this mucus will dry and that can cause itchiness in that area.⁴ This can happen whether the haemorrhoids have moved outside your body, or if they are still inside.⁴

Inflammation

Haemorrhoids are inflamed areas of tissue inside your bum.³ When part of your body is inflamed, this causes itchiness.^{4, 6} 

When part of a person is damaged, the body creates something called “inflammatory mediators.”⁷ These are chemicals that signal to your body what to do so that it can protect against whatever has caused the problem.⁷ These chemicals affect the nerves in your skin which is what causes itching.⁶

Bacteria

Haemorrhoids exist in and around the anus, which naturally means that they are exposed to poo.

Because of this, the haemorrhoids will come into contact with bacteria from your stool. This can make the haemorrhoids more irritated and therefore cause them to itch.⁴

Straining

If you are straining on the toilet, for example, due to constipation and/or diarrhoea, your haemorrhoids may become more inflamed.⁴ This can lead to more itching in the area.

Chafing

Rubbing on the haemorrhoids, for example with toilet paper or with tight clothing, can make them more irritated and therefore cause them to itch.⁴

Harsh soaps

If you clean your skin with soaps that are too strong for your skin, this can cause a problem called contact dermatitis.⁸ This can mean that your skin becomes itchy, dry and cracked.⁸

Healing

When your body is healing itself, the area which was damaged often begins to itch.⁹ This is a normal part of getting better.⁹

Allergy to haemorrhoid treatment

Your doctor or pharmacist may give you creams to use on your haemorrhoids to treat the symptoms (These will be discussed later).³ If you are allergic to these medications, this may cause itching.¹⁴

If you come into contact with something you are allergic to, your body makes chemicals called histamines.¹⁰ These cause your skin to show redness, swelling and itchiness.¹⁰

Haemorrhoid treatment

Often, no treatment at all is needed for haemorrhoids as they usually get better by themselves within a week.³ There are lots of things that you can do to help with haemorrhoids.

Things you can do at home

There are several easy things you can do to help haemorrhoids without seeing your doctor, including:³

• Drinking lots of water
• Stop drinking caffeine
• Cut out alcohol
• Eat food with lots of fibre
• Exercise a few times per week
• After using the toilet, wipe yourself clean with damp loo roll
• Keep your bottom dry and clean
• Take paracetamol if you are in pain
• Wrap an ice pack in a towel and use it to soothe the area
• Take a lukewarm bath

Help from your healthcare team

If you do the above treatments for a week and the symptoms have stayed the same or got worse, you should make an appointment with your doctor.³

Non-surgical treatments

There are some treatments that your healthcare team may recommend that do not need surgery. These can normally be done while you are awake, with numbing to the affected area, and you can usually go home on the same day.³

Medication from your pharmacist

If you believe you have haemorrhoids, you can visit your pharmacist who will be able to provide you with medications which ease your symptoms.³ These can include:³

• Cool compresses to make the area more comfortable
• Creams to help with the itching, swelling and pain
• Constipation relief so that you don’t have to strain when pooping

Infrared coagulation

During this process, the blood supply to the haemorrhoids is cut off using infrared light which causes them to shrink.³

Rubber band ligation

If you have rubber band ligation, your healthcare worker will place a band around the haemorrhoids to prevent blood from getting to them.³ This causes them to shrink and eventually drop off.³

Electrotherapy

Electrotherapy involves an electric current being used on your haemorrhoids, which leads to them shrinking.³

Sclerotherapy

If you have sclerotherapy, your doctor will inject a liquid into the haemorrhoids to make them get smaller.³

Surgery for haemorrhoids

Sometimes, the above treatments are not suitable. If this is the case, surgery may be required. These usually involve anaesthetics that will put you to sleep and you will normally have to stay in hospital for the night.³

Haemorrhoidal artery ligation

During this procedure, the surgeon will use stitches to stop blood from reaching your haemorrhoids which makes them shrink.³

Haemorrhoidectomy

If you have a haemorrhoidectomy, this means that the surgeon will cut out the haemorrhoids to get rid of them.³

Stapled hemorrhoidectomy

This procedure involves the surgeon moving the haemorrhoids back into your body and using surgical staples to hold them in place.³

Diagnosis of haemorrhoids

If your haemorrhoids do not improve by themselves, you will need to see your General Practitioner. At first, they will ask you questions about your health, bowel movements, and whether you have had any blood or pain while going to the toilet.² 

Rectal examination

They will first ask you some questions, and then they will ask you to examine the area.² This involves looking at the outside of your anus to see if there are visible haemorrhoids. They may also use gloves and a lubricant to gently examine the inside of your anus to check for any changes.² The examination is not painful, but you may feel mild discomfort.²

If your doctor thinks it is suitable, they may refer you for a proctoscopy.

Proctoscopy

During a proctoscopy, a small flexible camera with a light is gently put inside your anus to let your doctor look at the inside of your large intestine to give them a better view of your health.² 

Differential diagnosis

Some conditions that are not haemorrhoids can cause similar symptoms. Your doctor will want to rule these out before diagnosing haemorrhoids. Some of these conditions include:⁴

• Yeast infection can cause a red, itchy or painful rash with yellow discharge and scaly skin over the top¹¹
• Psoriasis is a skin condition that causes scales to form on the skin which can become itchy and sore¹²   
• Anal fissures are ulcers which appear in the skin of the intestine near the opening of the anus which can cause blood and pain while pooping¹³ 
• If you have sensitivity to some things in your diet, for example, spicy food, dairy or carbonated drinks, this can mean that you experience problems similar to those of people with haemorrhoids.⁴ 

Conclusion

Haemorrhoids can cause many symptoms, including itching. However, they will often improve by themselves and there are many treatments which can help you control the symptoms.