Piles (Bawaseer) and Anal Fissure: Symptoms, Treatment and When to Worry

It is one of those problems people suffer through for months because they are too embarrassed to talk about it. Pain on the toilet, a streak of blood on the tissue, an itch or a lump that will not go away. Piles (bawaseer) and anal fissures are among the commonest causes, and both are very treatable. Many people lose time and money on quacks, pastes and injections when simple steps at home, and a proper check, would solve it.

What are piles?

Piles, or haemorrhoids, are swollen blood vessels in and around the anus, a bit like varicose veins. They can be inside the anal canal (internal) or under the skin around the opening (external).

• Internal piles usually cause painless, bright red bleeding after a stool, and sometimes slip out (prolapse) and go back in on their own or need to be pushed back.
• External piles cause an itchy or painful lump around the anus. A clot inside can make it suddenly very painful and hard.

What is an anal fissure?

An anal fissure is a small tear in the lining of the anus, usually caused by passing a hard stool. It causes sharp, burning or cutting pain during and after a bowel movement that can last for hours, and a little bright red blood on the tissue. The pain makes you hold back, which makes the stool harder, and the cycle continues.

Symptoms

• Bright red blood on toilet paper, on the stool or in the bowl
• Itching, irritation or mucus around the anus
• A lump or swelling near the anus
• Pain or discomfort when sitting or passing stool
• A feeling that the bowel has not emptied

What causes them?

• Constipation and straining, see our guide to constipation
• Long periods on the toilet, particularly sitting with a mobile phone
• Chronic diarrhoea
• A low-fibre diet, and not drinking enough water
• Pregnancy and childbirth
• Being overweight, and heavy lifting
• Sitting for long hours, and ageing

Spicy food does not cause piles, but it can irritate them and make symptoms worse in some people.

Home treatment that works

• Fibre and fluids: aim for 25 to 30 grams of fibre a day from daal, vegetables, fruit, whole-wheat roti, daliya and oats, and drink 2 to 2.5 litres of water. Isabgol (psyllium) taken with a full glass of water is helpful.
• Soften the stool: a gentle laxative such as lactulose can help while the area heals.
• Sitz bath: sit in a basin of warm water for 10 to 15 minutes, two to three times a day, particularly after a bowel movement. It soothes pain and relaxes the muscle.
• Do not strain or sit for more than a few minutes on the toilet, and leave the phone outside.
• Go when you feel the urge instead of holding it.
• Clean gently with water and pat dry, and avoid rough wipes, perfumed soaps and hard rubbing.
• A cold pack can reduce swelling in external piles.
• Take a short walk daily, and avoid long periods of sitting.

Creams and medicines

• Local anaesthetic creams such as lignocaine give short-term relief from pain and itching.
• Steroid creams such as hydrocortisone can reduce swelling and itch, but should be used for no more than about a week, since longer use thins the skin.
• Flavonoid medicines such as calcium dobesilate are commonly used to ease bleeding and swelling in piles.
• For fissures, doctors may prescribe an ointment that relaxes the anal muscle, such as glyceryl trinitrate (GTN) or diltiazem, applied as directed. GTN can cause headaches. Most fissures that are acute heal within weeks with these steps.
• Stronger painkillers are not recommended, since they cause constipation.

When procedures are needed

If symptoms continue despite treatment, a surgeon may suggest a procedure: rubber band ligation, injection (sclerotherapy) or infrared therapy for internal piles, and surgery (haemorrhoidectomy) for large or severe ones. A chronic fissure may need a small operation to relax the muscle (lateral sphincterotomy) or a botulinum injection. Please see a qualified surgeon, and avoid roadside quacks, pastes and unsterile injections, which can cause infection and permanent damage.

Do not assume it is piles

Bleeding from the bottom can also be a sign of more serious conditions, including bowel cancer. See a doctor, and do not treat on your own with creams for months, if:

• Bleeding is repeated, heavy or dark, or mixed with the stool
• You are over 40, or have a family history of bowel cancer
• There is a change in your bowel habit, weight loss, tiredness or anaemia
• Pain is severe, or there is a hard painful lump with fever
• A fissure does not heal in 6 to 8 weeks

Prevention

• Eat a high-fibre diet and drink plenty of water
• Do not strain, and avoid long toilet time
• Stay active and keep a healthy weight
• Treat constipation or diarrhoea early

Key takeaways

• Piles and fissures are common, and mostly caused by constipation and straining.
• Fibre, water, sitz baths and softening the stool treat most cases.
• Bleeding is not always piles, so see a doctor if it persists, especially after 40.
• Avoid quacks and unsterile injections.

Related medicines on Medimart

These are commonly used for piles, fissures and constipation:

• Lactulose: a gentle laxative to soften stool
• Calcium dobesilate: used to ease bleeding and swelling in piles
• Lignocaine (lidocaine): a local anaesthetic for pain and itching
• Hydrocortisone: a mild steroid for short-term use on swelling and itch
• Glyceryl trinitrate: an ointment prescribed for anal fissures
• Diltiazem: another prescribed option for fissures

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse constipation and bowel care products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. Bleeding from the bottom should be checked by a doctor.