Don’t dwell on the dunny. Forget about reading on the dunny. It may be relaxing and it may be a refuge from domesticity or your desk, but it may also be bad for your rectum. The latest medical advice is to be efficient at stool. Don’t loll about. If you cannot achieve complete satisfaction just clean up and return later.

The habit of reading, smoking or taking phone calls while on the toilet encourages prolonged straining. The longer you sit, the longer you strain. Straining builds up the pressure in the lower abdomen, blood collects in the rectum and the tissue becomes engorged. This often leads to haemorrhoids.

Over years, straining also stretches the nerves supplying your pelvic-floor muscles. In turn, this causes the muscles to lose tone and strength and the pelvic floor sags. The result is that you become less effective at evacuation. Because this often happens to women after childbirth, this problem is sometimes overlooked in men.

Laxatives can be used, from time to time, to help things along, but it is far better to rely on a high-fibre diet. Overuse of laxatives can be harmful, too. People who are laxative dependent may have continuously runny motions so their anus is never challenged to open. They end up with anal inelasticity and also get haemorrhoids.

While women frequently trace their haemorrhoids to pregnancy and to bearing down during childbirth, many men are chronic strainers. They delay going to the toilet, perhaps because of work commitments or perhaps as a result of bad instruction when they were boys. The longer they delay, the harder it may be to pass a stool.

During a delay, the water content of the stool is slowly reabsorbed back into the bowel wall and the stool hardens. When these men finally get to the toilet, the motion is more difficult to pass and so they strain.

Everyone has three anal cushions just inside their anal ring. These cushions are analogous to the lips at the other end of the alimentary canal. They are highly sensitive and are important in retaining continence as they have receptors which receive signals about initiating the bowel action. When the anal cushions become stretched, engorged or prolapsed, they are commonly called piles, or haemorrhoids. These cushions may fall out and be trapped on the outside where they may become strangulated because their blood supply is cut off by a tight anal sphincter. Or, if the muscles around the anus are stretched through chronic overstraining, they may be weakened and unable to contract efficiently enough to retract the piles.

Piles are common and most men have a problem with them at some time in their lives. Maintaining a good diet with lots of fibre can reduce your chances of getting them. But it is important to remember that fibre alone is insufficient. You have to drink a lot of water (not beer) to make the fibre effective and bulky.

You may first suspect you have haemorrhoids because you notice blood in the toilet or on your underwear. Many men never look in the bowl, but if they did happen to notice some blood, a large number of them wouldn’t act on it, anyway. They would delay in the hope of it resolving spontaneously.

It is essential to know where the blood is coming from. You cannot tell the source just on a description, no matter what people say. You should be investigated quickly to eliminate the possibility of anything sinister, such as bowel cancer. If you’re over forty and have a family history of bowel cancer or polyps, you should go straight to your doctor.

Once you’re certain the bleeding is because of haemorrhoids, you can decide whether they are troublesome enough to be treated. If they are not severe you may decide to leave them.

There are many myths about piles. In Britain in winter people say you’ll get haemorrhoids from sitting on a radiator. In the Australian summer they say you’ll get them from sitting on a cold concrete floor. This is nonsense.

Lifestyle factors are regarded as very significant in the development of piles and this is reflected in the shift in the method of treating them. Thirty years ago there were far more operations. Now patients are instructed to modify their diet first: to eat regularly, to increase fibre and water, to exercise and to go to the toilet at first urge. If diet fails, there are other treatments. Bleeding prolapsed piles can be injected with a chemical which shrinks them or they can be tied off with elastic bands, or both. Surgery is usually only performed now on severe, complicated piles.

If you don’t feel confident enough to rely on St Fiacre (the patron saint of haemorrhoids) to protect you, then follow the four golden rules for good rectum maintenance:

• Respond promptly to a call to stool.

• Don’t dwell on the dunny.

• Eat lots of fibre (remember the water).

• Watch out for blood (especially if you are forty or over).

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