A. They are. They are really dilated blood vessels, like varicose veins in the back passage. They swell up, largely if the person is constipated and must strain. They mainly remain inside the anal valve, although larger ones sometimes prolapse to the exterior. Others develop at the anal margin and often become painful as a clot forms and fills the vessel.

Q. Are there any symptoms?

A. Often there is bright red bleeding with a bowel action.

External ones may be painful, especially if they suddenly enlarge. There may be some irritation and itch.

Q. What about diagnosis and treatment?

A. Any bleeding from the bowel demands a proper examination by the doctor, especially in older persons aged 45 or more. Many cases of so-called piles have turned out to be a cancer of the rectum or colon. He will do a manual examination and look by direct vision with an instrument called a proctoscope, sigmoidoscope or maybe the colonoscope. Checking for cancer is essential every time.

Provided piles are the diagnosis, relieving constipation is essential. Daily use of unprocessed bran is good therapy. Add two tablespoonsful to your breakfast cereal or stewed fruit each morning. Most cases readily respond to this. Hot and cold sitz baths often give relief. The insertion of suppositories is also beneficial. Clotted external piles are treated surgically, with incision and clot removal. Persisting large bleeding piles are also removed surgically, either by surgical dissection or rubber band ligation and cryotherapy. Results are invariably satisfactory. Prevention of recurrences is best carried out with a high fibre diet.

Q. So we come to the end of our little volume.

A. I hope our readers have found it interesting and informative. Our last piece of advice is to take notice of symptoms. They are often the signals of internal disease. Ignoring them may be dangerous.

If there is any query, visit your doctor. He is there ready and willing to offer assistance. A proper medical history, plus examination with appropriate investigations is the best way to have internal disorders diagnosed. Treatment will follow. Today medical therapy has reached a high level of success. Treatment, whether it be via drugs, dietary advice, surgery or alternative methods, can bring relief to most conditions. Early diagnosis, even in serious diseases such as cancer, will lead to prompt treatment and in many cases a satisfactory outcome is possible. To delay is unwise.

Use this book as it is intended. To supplement what your doctor tells you, to help you seek early medical attention from the experts. We leave it up to you and wish you good health for many years ahead.

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