Piles, also known as hemorrhoids, are swollen veins located around the anus. They are very common, with estimates suggesting up to 75% of people will be affected by piles at some point in their lifetime. Piles can cause symptoms like itching, pain, and bleeding, especially when passing stools. As we get older, our risk of developing piles tends to increase. But do piles always get worse with age? Let’s take a closer look at the evidence.
What causes piles?
Before looking at whether piles get worse with age, it helps to understand what causes them in the first place. Piles can occur due to:
- Chronic constipation and straining when passing stools
- Chronic diarrhea
- Sitting on the toilet for long periods
- Being overweight and obese
- Pregnancy – pressure from the baby and hormonal changes
- Heavy lifting
- Coughing and sneezing repeatedly
- Ageing and connective tissue weakness
As you can see, there are many contributing factors. But two key ones linked to ageing are chronic constipation and connective tissue weakness.
Constipation worsens with age
Let’s start with constipation. This refers to infrequent, difficult, and painful bowel movements. Studies show constipation becomes more common as we get older:
- Up to 30% of adults over 60 suffer from chronic constipation, compared to just 2-7% of younger adults.
- Older adults pass stools less frequently, often only 2-3 times per week rather than daily.
- This is likely due to changes in diet, poorer fluid intake, reduced physical activity, side effects of medications, and disorders affecting the colon.
We know straining to pass hard stools increases pressure in the anal veins and commonly leads to piles. So by worsening constipation, ageing indirectly makes piles more likely.
Connective tissues weaken with age
Connective tissues provide structural support throughout the body. This includes the anal cushions – pads of tissue containing blood vessels that line the anal canal. With age, connective tissues gradually lose strength and elasticity. This can cause:
- Stretching and downward sagging of the anal cushions
- Bulging of veins from the weak spots
- Impaired venous blood flow, leading to swelling
These changes enlarge and weaken the veins, making them more vulnerable to irritation and inflammation. Just like varicose veins in the legs, piles in the anus are more likely as connective tissues deteriorate.
Do piles always progress with age?
Given piles are more common in older adults, it’s clear the ageing process itself increases susceptibility. However, it’s important to note that deterioration varies between individuals. Piles certainly don’t inevitably worsen in all older people. Progression depends on:
- Genetics – Inherited weaknesses affect how well connective tissues withstand age-related changes.
- Diet – Eating plenty of fiber prevents constipation and straining.
- Fluid intake – Staying hydrated keeps stools soft.
- Physical activity – Exercise stimulates bowel movements.
- Body weight – Added weight strains anal cushions.
- General health – Chronic coughing, weakened pelvic floor, and other disorders can contribute.
- Ongoing care – Seeing a doctor for early treatment helps.
With attention to these lifestyle factors, it’s quite possible to reach old age without piles getting significantly worse. However, neglecting health often allows gradual progression over the years.
What are the stages of piles?
To better understand changes with age, it helps to look at the 4 graded stages of piles:
| Stage | Characteristics | Symptoms |
|---|---|---|
| 1 | Veins swollen but remain inside anal canal; minor prolapse during bowel movements | None or mild discomfort |
| 2 | Veins protrude from anus during bowel movements but spontaneously return inside | Pain and itching after passing stools |
| 3 | Veins protrude from anus during bowel movements and must be pushed back inside manually | Pain, swelling, bleeding |
| 4 | Veins permanently prolapsed and cannot be pushed back inside | Severe pain, bleeding, mucus discharge |
Although possible at any age, the more advanced stages are most likely to develop with prolonged neglect and ageing. Without care, minor piles can slowly progress to prolapse, bleeding, obstruction, and extreme discomfort.
Do piles increase cancer risk?
An important question is whether piles lead to cancer as they advance. The evidence is reassuring:
- Piles are not cancerous growths – merely swollen blood vessels.
- There is no direct link between piles and cancers of the colon or anus.
- However, both conditions share common risk factors like age, weight, and diet.
- Larger piles that fully prolapse can sometimes conceal anal cancers though.
- Bleeding from piles does not indicate cancer, but rectal bleeding always needs medical investigation.
Provided other symptoms are absent, people with piles are unlikely to have higher cancer risks solely due to their hemorrhoids. Nonetheless, it’s advisable for older adults to keep up to date with cancer screening.
When should you seek help for piles?
Most people can manage early piles with home treatments and lifestyle changes. But see your doctor if you notice:
- Bleeding – while common this always needs checking
- Severe pain
- Lumps lasting more than a week
- Itching not relieved by over-the-counter creams
- Prolapse unable to be pushed back inside
Don’t assume symptoms are just harmless piles. It’s important older adults have abnormalities examined to exclude other conditions.
Medical treatments
If piles are impacting quality of life, a doctor can provide treatments such as:
- Medications – Oral and topical drugs to relieve swelling, pain, and itching
- Banding – Rubber bands applied to shrink internal piles
- Sclerotherapy – Injections to reduce blood supply
- Cauterization – Burning tissue to prevent further bleeding
- Surgery – Removing large, painful, or prolapsed piles
Don’t simply put up with worsening symptoms. Seeking medical advice provides options to get piles under control.
Home remedies and prevention
Alongside treatment, simple self-care steps can help piles:
- Use moist toilet paper and wet wipes to prevent irritation
- Take warm baths to relieve pain and swelling
- Try over-the-counter anesthetic gels and ointments
- Wear comfortable, loose underwear and clothing
- Sit on a doughnut-shaped cushion to ease pressure
- Drink 6-8 glasses of fluid daily
- Eat more fiber such as fruit, vegetables, and whole grains
- Exercise regularly to avoid constipation
Making these positive lifestyle changes can reduce the risk of piles flaring up or getting more severe.
Conclusion
In conclusion, advancing age itself makes piles more likely due to increasing constipation and tissue weakness. However, progression is not inevitable. By maintaining a healthy diet, activity levels, and bowel habits – and getting medical care when necessary – many older adults can limit deterioration or even improve their piles.