Haemorrhoids
Haemorrhoids, commonly known as piles refer to a condition in which the veins around the anus or inside the rectum become swollen and inflamed. Many people may suffer from haemorrhoids at some point in their lifetime. It is more common in individuals aged between 45 and 65 years and in pregnant women. External haemorrhoids occur on the skin around the anus whereas internal haemorrhoids develop in the rectum. Internal haemorrhoids may protrude through the anus.
Predisposing factors: Chronic constipation leading to excessive straining during bowel movement
- Low fibre diets
- Pregnancy (increased pressure in the abdomen)
- Aging (weak connective tissue in the rectum and anus)
Symptoms
Internal haemorrhoids: The most common symptom is passage of bright red blood with the stools. If the haemorrhoids have prolapsed, they cause pain, discomfort and itching around the anus.
External haemorrhoids: Blood clots may form in the swollen veins causing bleeding, painful swelling or a hard lump.
Diagnosis
Your doctor will perform full physical examination, which involves digital rectal exam with a gloved, lubricated finger and a proctoscope. Additional diagnostic tests may be ordered to rule out other causes of bleeding.
- Colonoscopy: Colonoscopy is a procedure in which a flexible lighted tube is passed through the anus into the rectum and the colon. The colonoscope helps to view the pictures of inside of the rectum and colon.
- Sigmoidoscopy: This procedure uses a shorter tube called a sigmoidoscope to transmit images of the rectum and the sigmoid colon (the lower portion of the colon).
- Barium enema X-ray: This procedure involves taking an X-ray after injecting a contrast material called barium into the colon.
Treatment
Conservative management
Lifestyle modifications and dietary changes are often helpful in reducing the symptoms of haemorrhoids. To avoid straining associated with constipation, a diet high in fibre will add bulk and soften the stools helping them pass more easily. Fruits, fresh vegetables and cereals provide a good source of fibre, while supplements such as methylcellulose or psyllium husks may be of benefit. Drinking plenty of water and regular exercise helps prevent constipation.
Over-the-counter creams and suppositories help relieve the pain and itching. However, these are short time remedies as long-term use can cause damage to the skin.
Surgery
Surgical removal called Haemorrhoidectomy, becomes necessary when the haemorrhoids are large enough and do not respond to conservative management. The surgery is performed under general, regional or local anaesthetic depending on the procedure.
The different types are:
Rubber Band Ligation – A rubber band is placed around the base of the haemorrhoids to cut off the blood supply so they shrink and disappear in a few days. This may be advised to treat smaller haemorrhoids that are less symptomatic. This will usually be performed as a hospital day case.
Haemorrhoidectomy – This surgical procedure is used for the removal of internal and external haemorrhoids. Your doctor will use electrocautery to excise the haemorrhoids. You will have a period of hospital admission. The procedure may be associated with complication such as wound infection, early post-operative pain, bleeding, faecal incontinence (bowel leakage) and anal strictures (narrowing of the anal passage).
