Haemorrhoids

What are haemorrhoids?

Haemorrhoids, or ‘piles’, are swollen blood vessels that can develop inside the rectum or under the skin around the anus.Haemorrhoids occur when vessels in the anal canal dilate as a result of constant straining and loosened anal cushions.

According to their position, haemorrhoids are typically classified into the below sub-types:

  • Internal – develop inside the anal canal
  • External – develop under the skin around the anus and are often painful1
  • Mixed – presence of both internal and external haemorrhoids inside and around the lower edge of the anal canal (anal verge)

Signs and symptoms of haemorrhoids

Signs and symptoms of haemorrhoids may include:

  • Itchiness around anus
  • Skin tag or lumps around anus
  • Pain or discomfort around anus before or after bowel motions
  • Bleeding from the rectum after bowel motion
  • Prolapsing mass from rectum after straining on the toilet
  • Thrombosis (a blood clot in vessels, causing excruciating pain)
  • Unexplained anaemia, causing tiredness and breathlessness

Treatment

Treatment for haemorrhoids will depend on the position (internal, external or mixed) and severity of symptoms.

There are several treatment options for haemorrhoids, which include:

Conventional haemorrhoidectomy surgery

Conventional haemorrhoidectomy is a short procedure performed under general anaesthetic to remove external haemorrhoids or prominent skin tags. The wound is located close to the anus, with a hospital stay of two to three days and postoperative pain lasting one to two weeks.

Stapled haemorrhoidopexy

Stapled haemorrhoidopexy is a short procedure performed under general anaesthetic to remove haemorrhoids using a specialised circular stapler and repair the mucosa, while pulling the haemorrhoidal tissue back into the anal canal. There is no external wound, and postoperative pain is reduced considerably compared to conventional haemorrhoidectomy.

Medications

Haemorrhoids can be treated topically using specialised ointments and suppositories to reduce bleeding and swelling. Oral medications can be prescribed, generally fiber supplements, to relive symptoms and constrict haemorrhoid vessels.

Rubber band ligation (RBL)

Haemorrhoids can be removed through a rubber band ligation process by your colorectal surgeon. This involves ligating the haemorrhoid with a rubber band to cut off the blood supply, which leads to the haemorrhoid sloughing off spontaneously due to a lack of blood supply. After the procedure, patients may experience a slight sense of urgency regarding bowel movements.

Injection sclerotherapy

Internal haemorrhoids can be treated by your colorectal surgeon by injecting a sclerosant into the haemorrhoid vessels which will be obliterated due to the chemical reaction.

Frequently asked questions

What causes haemorrhoids?

Certain risk factors can play a role in the development of haemorrhoids. These include:

  • Family history of haemorrhoids
  • Constipation and straining
  • Low fibre diet
  • Lack of water intake
  • Ageing
  • Pregnancy
How do I prevent haemorrhoids?

To prevent haemorrhoids, it is important to avoid foods that upset your bowel (including spicy and fried food), keep up your intake of water and consume foods high in fibre to prevent constipation. It is important to avoid straining during bowel movements and having severe diarrhoea, as these can cause acute attacks of haemorrhoids.

References

For a full list of references, click here.
  1. Mayo Clinic (2019). Hemorrhoids. Accessed 18 November 2019 at  https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268

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