Is treatment for haemorrhoids always necessary?

Written by: Professor Richard Cohen
Edited by: Sarah Sherlock

Many people will experience of haemorrhoids (piles) at some stage during their lifetime. There are different degrees of haemorrhoids, and each individual may or may not want them treated. To tell us more, leading expert colorectal and general surgeon, Professor Richard Cohen, has explained what options patients have when presenting with haemorrhoids.

What do haemorrhoids (piles) look like? What symptoms do patients have?

Haemorrhoids can present in many different ways. The most common presentation is a patient who experiences bleeding from their back passage when they open their bowels. This is usually painless in the case of haemorrhoids, and if pain is an aspect of the symptom, it's usually due to something else, such as an anal fissure.


Patients with haemorrhoids also sometimes present with prolapse, where the haemorrhoids either permanently sit outside the back passage or come out when the patient opens their bowels, and, occasionally, have to be pushed back inside manually by the patient. It's a condition that people live with for quite some time, but it's also a very treatable one if the patient wishes to have their symptoms alleviated.


What are the most common causes of haemorrhoids?

The most typical causes of piles or haemorrhoids are actually unknown. I have spent a substantial part of my career with colleagues doing investigations into exactly why haemorrhoids arise and why patients get haemorrhoids.


I think it is just a very common condition, and it is represented by cushions of tissue inside the back passage that contain both arteries and veins. They get stretched, and the cushions get pushed outwards, giving rise to different degrees of haemorrhoids.


So, some patients have purely internal haemorrhoids which might just bleed, and other patients have a mixture of internal and external haemorrhoids that are covered with skin that they can feel which they find unsightly or uncomfortable. A handful of patients just have external haemorrhoids, skin tags or skin-covered haemorrhoids.


What should patients with haemorrhoids do or avoid doing?

I think if you have haemorrhoids, the first thing you can do is try lifestyle measures such as increasing the amount of liquid that you drink and increasing the amount of fiber in your diet. There is no question that softer stools are easier to pass than hard stools, and softer stools will help alleviate the symptoms of haemorrhoids.


Is there any way to prevent haemorrhoids?

The honest answer is no, I do not believe that there is. I think if you are susceptible to developing haemorrhoids, it is likely that you will. Indeed, I have patients who tell me that their piles or haemorrhoids run in the family.


Professor Richard Cohen can guide you when it comes to treatment for haemorrhoids. If you are experiencing piles, or would like more information, you can schedule a consultation via his Top Doctors profile today. 

By Professor Richard Cohen
Colorectal surgery

Professor Richard Cohen is a leading colorectal and general surgeon based at the Cleveland Clinic in London. He is an expert on open and minimally-invasive laparoscopic colorectal surgery, colorectal cancer, and irritable bowel disease (IBD). Currently, Professor Cohen serves as a clinical professor of surgery, consultant surgeon, and honorary senior lecturer at University College London (UCL). He is renowned as a pioneer of introducing new techniques in the United Kingdom. 

After receiving his medical qualification from Combridge with distinction in 1987, Professor Cohen continued his training as a surgery registrar in Northwest England, and later as a senior registrar at Guy's and St Thomas' Hospital surgical training programme. Whilst undergoing his training, Professor Cohen also accomplished to carry out research at Yale University, USA, for his Master's thesis.

Professor Cohen joined UCL in 2005, where he has since helped to develop the colorectal service. Here and within his private practices, Professor Cohen maintains his expertise in open and minimally invasive colorectal surgery. Beyond his advanced surgery techniques, he focuses on colorectal cancer, benign colorectal disease, and management of ulcerative colitis, Crohn's disease, and IBD. He is a leading example for his practice fellows and other surgeons in his field.

Following his expertise in such subject, Professor Cohen continues to do research on topics of interest. These include pelvic floor disorders (incontinence and constipation), Crohn's disease, and colorectal cancer in Ashkenasi Jews. Research has persisted to be a passion of his, and subsequently he has had many papers published in peer-reviewed journals. Professor Cohen extends his involvement in colorectal surgery by also training young surgeons and lecturing nationally and internationally.

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