There are certain conversations that happen every day in a pharmacy where you can almost see the hesitation before the words come out.
A person walks up to the counter, looks around to see who is listening, lowers their voice and says: “I need something… for piles.”
It is one of those conditions where embarrassment often delays people from asking for help. Many suffer in silence, hoping it will disappear on its own. The reality is that haemorrhoids (the medical term for piles) are extremely common, and pharmacists see them regularly.
In simple terms, haemorrhoids are swollen blood vessels around the anus and lower rectum. We all actually have these blood vessels naturally, but problems occur when they become enlarged, inflamed or irritated.
There are two main types:
Internal haemorrhoids occur inside the rectum. People may notice bright red blood after passing stools, usually on the toilet paper or dripping into the toilet bowl. They are often painless because the inside of the rectum has fewer pain-sensitive nerves.
External haemorrhoids develop under the skin around the anus. These can be much more uncomfortable and may cause itching, swelling, soreness and sometimes a painful lump, especially if a blood clot forms inside.
One of the most common things I hear from patients is: “I don’t understand why this has happened. I haven’t changed anything.”
But piles are usually caused by pressure building up in the veins around that area. The most common trigger is constipation. Hard stools and straining increase pressure, almost like repeatedly forcing blood into already delicate veins.
Other factors can include pregnancy, being overweight, prolonged sitting, heavy lifting and spending too long sitting on the toilet scrolling through a phone. Yes, that last one comes up more often than people realise!
The toilet is not an office, a reading room or a place to catch up on social media. Sitting for long periods increases pressure around the rectal veins and can contribute to the problem.
A question many people ask is: “If I have bleeding, is it definitely piles?”
The answer is no.
Although piles are a very common cause of bright red rectal bleeding, bleeding should not automatically be dismissed as haemorrhoids. Particularly in older adults, persistent bleeding, a change in bowel habits, unexplained weight loss, abdominal pain or changes in stool appearance need proper medical assessment.
This is where pharmacists play an important role. We can help identify when self-care is appropriate and when someone needs to see their GP.
For mild piles, treatment usually focuses on reducing irritation and making bowel movements easier.
The first step is often surprisingly simple: improve the stool consistency.
Increasing fibre intake through fruit, vegetables, wholegrains and pulses can help. Drinking enough fluid is also important. Some people need a short course of a stool-softening laxative if constipation is contributing.
Many people rush straight to creams and suppositories, but these only treat the symptoms. They can reduce itching, soreness and inflammation, but they do not remove the underlying cause.
Products containing local anaesthetics can help with discomfort for short-term use. Mild steroid preparations may reduce inflammation and itching but should not be used continuously without advice, as prolonged use can thin the skin and cause irritation.
Warm baths or gently cleaning the area with water rather than harsh soaps can also help. The skin around the anus is sensitive, and excessive wiping or fragranced products can make symptoms worse.
One thing I often remind patients is: do not ignore constipation.
A person may spend money repeatedly buying piles treatments, but if they continue straining every time they go to the toilet, the problem is likely to keep returning.
Lifestyle changes often make the biggest difference:
- Don’t delay going when you feel the urge.
- Avoid prolonged sitting on the toilet.
- Increase fibre gradually to avoid bloating.
- Stay physically active.
- Maintain a healthy weight.
Another common misconception is that piles only happen to older people. They can affect anyone. I have seen young adults, pregnant women and even very fit individuals seeking advice.
The condition does not discriminate.
The important message is that there is no need to feel embarrassed. Pharmacists have these conversations every day. We are not shocked, we are not judging, and we are certainly not keeping a mental record of who came in asking for piles cream!
However, we do want people to ask early. A quick conversation can often prevent weeks of discomfort and help identify when something needs further investigation.
Your body has many ways of telling you something needs attention. Sometimes the message is subtle. Sometimes it is literally a pain in the backside.
Until next time, look after your health — even the parts you would rather not talk about.
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