Avoiding constipation and subsequent straining at stool is an important part of reducing the frequency and severity of symptoms. Having a diet high in fibre is a good way of ensuring normal bowel function.

Sometimes, it may be necessary to use laxatives to ensure that the bowel works without undue strain. Bulk-forming or softening agents are better than harsh purgatives, as these latter may become habit-forming and the bowel gets lazy and requires larger doses.

Proper examination of the bowel is always necessary to exclude a primary cause for the bleeding, such as a cancer. It may be that some other condition such as a cancer of the rectum may be present as well.

Injection of haemorrhoids is a satisfactory method of dealing with first and early second degree piles. A solution, usually of phenol in almond oil, is injected into the mucosa around the dilated veins and causes clotting in the veins and eventual fibrosis, which occludes the dilated veins.

Another technique for second degree piles is to insert a proctostope to see the projecting pile and slip a small rubber band over it. This cuts off the blood supply at the base and, after a week or so, the obstructed pile sloughs off. This procedure is sometimes associated with secondary bleeding.

*391/71/1*

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