Haemorrhoids and Anal Conditions

There are many diseases that effect the anus but the more common disorders include haemorrhoids, anal tears (fissures) and abnormal connections and tracts in the anus (fistulae). Often the first sign of these conditions is bleeding or discharge from the anus with or without pain and you should always get this investigated to rule out something more serious. More information about all anorectal treatments can be found in the treatments section.

Anal skin tags

These are very common and sometimes associated with piles. People can get quite upset with these but they are harmless. It is an easy operation to remove them but it is better to live with them if possible.

Anal fissure

Anal fissures are splits within the very delicate skin of the anus internally which may open every time you have a bowel movement, resulting in bleeding and sharp, severe knife-like pain on defecation. These small tears can occur when you pass a big or hard stool.

Other possible causes include persistent diarrhoea, inflammatory bowel disease (IBD) such as Crohn’s disease and pregnancy and childbirth. Once the fissure is there it causes spasm in the anal sphincter muscles that in itself is painful but also prevents the fissure from healing.

Most anal tears and fissures resolve themselves but there are number of treatments available including creams and even BOTOX. These treatments especially the latter are usually very effective and are based on trying to relax the sphincter muscle to allow healing of the fissure. If a painful fissure persists then there are some simple surgical procedures to help the healing. Softening the stools with gentle laxatives is also beneficial.

Anal fistulae

These are abnormal tracts or connections between the inside of the anus and the outside. They often start off with an anal abscess which is a painful infected lump at the side of the anus. Often the patient experiences bouts of anal pain that are not associated with opening the bowels. There may be a pus or mucous discharge and sometimes bleeding occurs. Sometimes you will notice a small opening or hole by the side of the anus. Whilst these are not dangerous it is important to get them treated as they can lead to more severe anal infections and abscesses and the longer they are left sometimes the more difficult they are to treat.

Perianal haematoma

These are sudden painful small lumps that appear at the edge of the anus caused bleeding. They look like a cherry sized lump at the anal margin and are often mistaken for a thrombosed pile. If caught within 24 hours a small cut under local anaesthetic can be made to extrude the clot and instance relief is gained. If left they will completely resolve over a week or two.


Haemorrhoids contrary to popular belief are not enlarged varicose veins of the anus. Just inside the anal anal canal there are spongy cushions made up of a meshwork of tiny blood vessels. It is when these cushions become swollen or enlarged that we call them haemorrhoids or piles. Many people will suffer from piles at some point in their life. If you strain at stool or are prone to constipation you are more likely to get piles.

They are also common during or after pregnancy due to the pressure of the baby on the rectum, hormonal changes and the strain placed on the body when the baby is delivered. The most common symptom is fresh rectal bleeding when one wipes after a bowel action. Sometimes the bleeding can be more profuse and drip into the pan.

Other symptoms include itching, aching and mucous discharge. Piles can be internal but they can also prolapse out of the anus intermittently or indeed permanently. Painful haemorrhoids are rare and is usually an indiction of the pile thrombosing.

Often haemorrhoids are associated with external skin tags that are permanent. Most symptoms will improve by adopting certain lifestyle and dietary changes. Propriety and prescribed creams are available and can help although long term use is not advised.

If there is no improvement in your piles or they are very symptomatic there are a number of non-surgical and surgical treatments that can help.