Haemorrhoids

Introduction

Haemorrhoids, which are also known as piles, are a result of enlarged blood vessels in the area of the rectum and anus. These swollen vessels cause a large lump that may hang outside of the anus. Sometimes, it is necessary to push the lump back inside the body, usually after you have been to the toilet. Most incidents of haemorrhoids are mild and do not cause pain. They will heal themselves. Moderate cases that cause itching or soreness can be treated with non-prescription medication. More serious cases, such as those that cause significant pain or that result in bleeding after expelling a stool, could require a consultation with your doctor.

The precise cause of haemorrhoids is unknown. Research has shown that they may be linked to heightened pressure within the blood vessels situated in the anus and surrounding area. For many people, haemorrhoids occur when a low fibre diet leads to constipation, which in turn causes increased straining when attempting to go to the toilet. Additional factors that influence the risk of developing haemorrhoids include:

. Family history

. Being older than 45

. Being overweight

. Being pregnant

. Lifting weights

. Prolonged sitting

. Persistent cough

. Repeated vomiting

. Enduring diarrhoea

Piles are generally categorised as either internal or external depending on whether they occur above or below what is known as the dentate line. This is a visible marker inside the anus. Above this line, the nerves are no longer able to sense pain. Below this line, pain signals can still be sent and received.

Other classifications of haemorrhoids depend upon both their size and their severity.

First degree haemorrhoids are the smallest type. They develop exclusively inside the anus and are not visible externally.

Second degree haemorrhoids are slightly larger. They may emerge from the anus when using the toilet but will easily return again afterwards of their own accord.

Third degree haemorrhoids are what is known as reducible. They generally hang down outside of the anus but are relatively soft and can manually be pushed inside again. More than one haemorrhoid may be visible at once.

Fourth degree haemorrhoids are the biggest type and they are irreducible. This means it is impossible to manually push them back inside the anus.

What are the available treatments for haemorrhoids?

Lifestyle changes

For the majority of cases of piles, which will be one of the milder forms, very little treatment is needed. Sometimes, all you need to do is make a few modifications to your lifestyle. This can help mitigate contributing factors such as constipation and overstraining.

. Dehydration can contribute to constipation and the development of haemorrhoids. Ensure you drink enough water.

. A high fibre diet improves digestion, including by softening stools. This makes going to the toilet easier, with less need for straining.

. When you need the toilet, go promptly. Waiting can lead to increased strain, which in turn leads to haemorrhoids developing.

. Another way to reduce haemorrhoids by alleviating constipation is by exercising more frequently. This loosens your bowel movements.

Treatment

One of the main treatments for haemorrhoids is Proctosedyl ointment, the brand name of a medication that contains cinchocaine hydrochloride and hydrocortisone. In the UK, it is available exclusively as a prescription-only-medicine (POM). The manufacturer is Sanofi-Aventis.

The first active ingredient, cinchocaine hydrochloride, is classified as a local anaesthetic. This means it is a medicine that prevents pain signals from being transmitted to the brain via the nerves, and it works on a specific area rather than the entire body. The place where the ointment is applied will become numb. In the case of cinchocaine, its use as a treatment for piles should stop any associated itching and pain around the anus.

Proctosedyl ointment also contains hydrocortisone as an active ingredient. Hydrocortisone is what is known as a corticosteroid, which means it has pain-relieving and anti-inflammatory properties. Inflammation is a natural part of the body’s immune response when dealing with illness or injury, and it is what causes redness, swelling and itchiness as well as pain. It does this through widening the blood vessels. Hydrocortisone can be applied topically to the inflamed area, operating from inside the cells to lower the levels of substances that cause inflammation. This includes any pain, swelling and inflammation resulting from haemorrhoids.

Combining cinchocaine hydrochloride and hydrocortisone into one effective treatment allows these two ingredients to relieve the pain and itching associated with piles in the short-term. Proctosedyl ointment lets you manage your condition by applying the medicine directly to the anus. This allows you to treat external haemorrhoids, but every tube of ointment is accompanied by a plastic applicator so you can apply it to internal haemorrhoids as well. Just attach the applicator to the top of the tube, then gently insert into the rectum. In some cases, the most effective way to treat piles that are solely internal may be with a Proctosedyl suppository or similar medication.

Always follow the prescribed instructions when using Proctosedyl. Further guidance is available through the patient information leaflet, or you can speak directly to a health professional, including one of our pharmacists, for expert advice and support.

The patient information leaflet for Proctosedyl ointment is available at:

https://www.medicines.org.uk/emc/medicine/8301

The patient information leaflet for Proctosedyl suppositories is available at:

https://www.medicines.org.uk/emc/medicine/8302

Availability

View your preferred pharmacy’s page or visit in person at your convenience to discuss this service in further detail.