1. Piles (haemorrhoids) Ask your local community pharmacist for advice on treatments for piles

2. About piles Piles are also known as haemorrhoids. They are very common, half the population will suffer with piles at some point. They are swollen blood vessels inside the rectum or outside the anus. They are usually not serious, generally not painful, but they can be very uncomfortable.

3. The costs Annually the NHS in England spends approximately £1.7 million on prescriptions for the treatment of piles. Most of these prescriptions can be purchased over-the- counter from community pharmacy. If 80% of this prescribing was reduced we could save over £1.3 million. The NHS can then invest the £1.3 million in improving local healthcare services.

4. Symptoms: Bright red blood after passing a stool. Lump(s) hanging down outside the anus which may need to be pushed back in after passing a stool. A mucus discharge after passing a stool. Itching, soreness, redness and swelling. Most piles are mild and symptoms often disappear after a few days. Sometimes there are no symptoms. If symptoms are present they are: Piles are not usually painful, unless their blood supply is interrupted.

5. Causes The exact cause of piles is unclear. It is thought to be due to increased pressure on the blood vessels. This causes them to become enlarged and inflamed. Most likely due to straining caused by constipation. The following increase the likelihood of developing piles  Ageing (if you are over the age of 45).  Family history.  Being overweight or obese.  Persistent cough.  Pregnant.  Repeated vomiting.  Constipation.  Lifting heavy objects.  Prolonged diarrhoea.  Sitting down or standing for long periods of time.

6. What can I do to help? Often symptoms will improve after a few days by themselves. Piles during pregnancy will often get better after the baby is born. There are over-the-counter treatments available and lifestyle changes that can help. Increase the fibre in your diet. Drink lots of fluids (particularly water), decrease caffeine and alcohol intake.

7. What can I do to help? Go to the toilet when you feel the urge. Avoid medications that cause constipation e.g. codeine. Lose weight. Increase the amount of exercise you do. Warm baths will help soothe piles. A cold compress can help to shrink the piles. Try to avoid standing or sitting for long periods of time.

8. How to treat piles SPEAK TO A LOCAL PHARMACIST TO GET ADVICE ON THE BEST TREATMENT FOR YOUR SYMPTOMS Soothing agents. Astringents to relieve irritation and inflammation. Local anaesthetics to alleviate pain, burning and itching. Corticosteroids to reduce the swelling, inflammation and ease discomfort. Laxatives can make it easier to go to the toilet and reduce straining. Creams, ointments or suppositories can help. They contain different ingredients to relieve your symptoms:

9. When should I see a GP? If you have persistent piles. If you have severe symptoms. If you experience pain. If your stools appear black and tarry. Any rectal bleeding should be checked out by a GP to rule out more serious causes.