I’ve suffered for 20 years with piles. Nothing treats them and they’re ruining my life: DR SCURR reveals the little-know way you CAN beat them for good

I’ve suffered for about 20 years with internal haemorrhoids. I’ve had surgery, but the bleeding has become more frequent and can start even after too much standing or bending over while gardening. I’ve been prescribed ointment and suppositories on and off for eight years. Needless to say I’m suffering – and spend a lot of time horizontal in bed.

Jill Jefferson, Lancashire.

Dr Martin Scurr replies: Haemorrhoids are essentially varicose veins of the lining of the rectum. The membrane covering these veins is fragile and so they are easily damaged, causing bleeding.

Much later, as the swelling worsens, the veins can prolapse out through the anal canal – in less severe cases they can pop out as you strain for a bowel movement or passage of wind, for instance, but return to their original internal position.

But they can also protrude past the anal opening without any straining – fortunately, you have never reached this stage.

Haemorrhoids occur when the blood vessels in the ‘cushions’ of tissue that help seal the anal canal (so you don’t leak gas or stools) become enlarged, as a result of pressure. This can be triggered by a range of factors, primarily constipation (causing straining), pregnancy, chronic cough and heavy lifting.

Surgery such as banding – essentially, where a surgical elastic band is placed around the haemorrhoid, cutting off the blood supply so it falls off – can help in milder cases. As can haemorrhoidectomy, where the veins are surgically removed.

While these procedures work for most people, sadly they have not worked long-term for you.

And the treatments you’ve been prescribed only address the symptoms, calming the swelling and inflammation, and easing the discomfort and itch.

There is another option – ligation of the inferior haemorrhoidal arteries. This, like the other procedures, is aimed at cutting the blood flow to the haemorrhoidal cushions, reducing the swelling. This is done by placing a tiny stitch around each blood vessel – and is a less painful option than attempting to completely remove them.

My advice is to speak to your GP about being referred to a specialist to discuss this operation, which offers the best hope of a long-term solution for you.

I suffer with pain from arthritis in my hip, pain in my lower back and night-time cramps. I also have no feeling in one thigh. Would a full-body MRI scan get to the root of my problems?

Kristina White, Dorset.

Dr Martin Scurr replies: Making an accurate diagnosis usually starts with listening to a full description of the symptoms, forming a hypothesis on what might be the problem and then seeking to prove this by relevant tests.

Scans such as MRIs are, to some extent, putting the cart before the horse – and I would strongly advise against a full-body scan without first investigating your symptoms in detail.

Lower back pain, the cramps in one or both legs at night – and the lack of feeling in one thigh – suggest you might have a problem in the lower spine. (I wonder if the arthritis in your hip was confirmed in an X-ray – if not, it may be that pain in the region of the hip is actually referred pain from the spine, rather than from the joint itself.)

The symptoms you describe can be triggered by a number of conditions, such as disc degeneration (where discs between the bones in the spine become worn); osteoporosis (a bone-thinning disease that’s common in women your age, you’re 77) – leading to bones in the spine crumbling; and spinal stenosis, where there is narrowing of the spinal canal, which may put pressure on nerves that control sensation in the legs.

My suggestion is that the symptoms need full evaluation by physical examination from your GP – to include checking the tendon reflexes (such as tapping the knee and ankle with a tendon hammer) to check if there is a problem with the nerve function which might be due to pressure in the spine.

Any abnormalities would suggest the need for an MRI but just of your lower spine.

In my view… Statin side-effect risks should be toned down 

There aren’t many good news stories at the moment, but the recent report that statins have fewer side-effects than some patients fear is one of them.

New research has shown most of the side-effects listed on the leaflets in packs are not backed by evidence, and there’s a call for warnings to be toned down.

While it’s good that patients read them, the problem is knowing what’s a genuine risk for you – and what’s been included because this is a legal requirement. For instance, muscle pain is a known side-effect, but it’s easy to interpret aching limbs after a game of tennis as due to your statin when it’s just a sign of being older.

As I so often warn my patients, if there was a leaflet when you bought a car stating these steel boxes on wheels kill people, you’d never get in – every time we do so, we’re balancing the benefits against the risks. It’s much the same with statins – and these drugs are life savers.