Many people who develop an itching or burning sensation in their anal region are too embarrassed to tell their family doctor about it.

The cause is often harmless, namely, enlarged haemorrhoids.

Ignoring it though, can lead to very unpleasant consequences.

Haemorrhoids are cushions of tissue filled with blood vessels, found at the end of the rectum just inside the anus, that help control bowel movements and let us discriminate between liquid and solid stool, and gas.

“Everyone has them – they’re perfectly normal,” says proctologist Bernhard Strittmatter.

Without these anal cushions, a person would be incontinent – unable to hold stool before reaching the toilet.

If the blood vessels in them become swollen and inflamed, the tissue stretches and can weaken the seal of the anal canal.

This allows mucus, and sometimes, faeces, to leak onto the sensitive skin of the anal region.

Doctors call this condition haemorrhoidal disease. It’s also known as piles, but most people simply say they “have haemorrhoids”.

Besides itching, burning and mucus discharge, there may also be bleeding.

“If the blood is bright red, it’s a strong indication of enlarged haemorrhoids,” said Dr Andreas Ommer, a specialist at the Rectum and Colon Centre in Essen, Germany.

Dark red blood, on the other hand, can be a sign of an intestinal disorder.

An examination by a doctor is needed to identify the cause and properly treat it.

A common cause of enlarged haemorrhoids is genetic predisposition.

“It can be an inherited connective tissue weakness,” Strittmatter said. Haemorrhoids are made up of elastic connective tissue.

Risk factors for enlarged haemorrhoids include constipation and insufficient exercise.

If the body isn’t active, bowel function becomes sluggish.

Sitting for long periods of time on the toilet and straining during bowel movements puts greater pressure on the blood vessels in haemorrhoids, causing them to stretch and swell.

To help prevent this, it’s a good idea not to have reading material with you on the toilet, advises pharmacist Ursula Sellerberg.

Enlarged haemorrhoids are graded according to severity.

Grade 1 haemorrhoids don’t protrude out of the anal canal.

In grade 2, they protrude during bowel movements, but retract afterwards.

“In grade 3, the haemorrhoids can protrude spontaneously” – for instance, during hard physical labour, Strittmatter notes. They don’t retract by themselves, but have to be pushed back in manually.

Grade 4 haemorrhoids are constantly protruded and can’t be pushed back in.

To make sure things don’t go this far, people with symptoms of enlarged haemorrhoids should see a doctor as soon as possible.

“In grade 1 cases, a medication is injected into the enlarged haemorrhoids to shrink them,” Dr Ommer points out.

For grade 2 patients, a rubber band is placed around the neck of the enlarged haemorrhoids to cut off circulation.

After about two weeks, they fall off during a bowel movement.

Grades 3 and 4 require surgery to remove the excess tissue.

Keeping stools soft so that they pass easily helps to prevent enlarged haemorrhoids.

So, doctors recommend a diet with a lot of fruits, vegetables and whole grain products, along with plenty of fluids. Exercise is important as well.

Dr Ommer recommends psyllium – and plenty of fluids – for people who tend to get constipated. High in dietary fibre, it absorbs water and gently stimulates normal bowel elimination. – dpa