What are Haemorrhoids (Piles) ?
We all have haemorrhoidal tissue inside the anal canal. It consists of blood vessels and connective tissue and it plays an important role in maintaining continence. When this tissue enlarges and cause symptoms we call it haemorrhoids.
Types of Haemorrhoids?
Internal (inside )Haemorrhoids: These develop inside the anal canal and are covered by the lining of the bowel which is not sensitive to touch. It tends to cause painless rectal bleeding. Occasionally they prolapse and get clotted causing severe pain.
External (outside) Haemorrhoids: These develop near the margin of the anus and are covered by sensitive skin. They tend to cause painless lumps at the margin of the anus. If they get clotted they can cause severe pain.
What Causes Haemorrhoids?
There are many factors that cause haemorrhoids:
- Increasing age
- Chronic constipation or diarrhoea
- Straining during bowel movements
- Spending long time on the toilet (e.g. reading)
- Heavy weight lifting
These factors cause the veins to swell and the tissue supporting them to stretch. This makes the haemorrhoids to protrude and the vein walls to burst causing bleeding.
What are the Symptoms of Haemorrhoids?
- Bleeding during bowel movements. Typically this happens at the end of bowel movement and may spray the walls of the toilet bowl.
- Anal itching
- Prolapse of tissue during the bowel movements
- Painful anal lumps
Do Haemorrhoids Lead to Cancer?
No. There is absolutely no relationship between haemorrhoids and cancer. However, rectal bleeding occurs in haemorrhoids as well many other diseases of the digestive tract. Therefore, do not assume that your symptoms are from haemorrhoids. You need to see a specialist to assess your condition and make the correct diagnosis.
How are Haemorrhoids Treated?
Mild symptoms can settle with conservative management as follows:
- Increase the fibre in the diet (e.g. fruits and vegetables)
- Fibre supplements (e.g. Metamucil or Benefiber)
- Drinking more fluids
- Regular Exercise
- Adopting healthy bowel habits:
- Not straining during bowel movement
- Going to toilet when feel ready
- Not sitting long time on the toilet (i.e. no reading while on the toilet)
- Sitting in plain warm water bath for ten minutes can relief pain from thrombosed (clotted) haemorrhoids
More troublesome haemorrhoids require more treatment often as outpatient procedure:
Rubber Band Ligation: Small tight rubber bands are placed around the roots of internal haemorrhoids. These bands cut the blood supply and cause the haemorrhoids to die and fall off within a week or so. The procedure cause mild discomfort and bleeding. Rarely major bleeding can occur and if this happens you need to go to hospital. I often perform the rubber band ligation at same time as the end of a colonoscopy to ensure that the haemorrhoids are the cause of the rectal bleeding and symptoms and no other condition is missed.
Injection: Haemorrhoids are injected with a substance that causes the haemorrhoids to shrivel up. It is a mostly painless procedure but can rarely can cause serious infections. I don't prefer this method.
Surgery for Haemorrhoids ( Haemorrhoidectomy)
Only 10% of patients with haemorrhoids will require surgery. The operation is reserved mostly for patients with large prolapsing haemorrhoids, symptomatic large external haemorrhoids, or haemorrhoids that do not settle with repeated rubber band ligation. Haemorrhoidectomy is highly effective and haemorrhoids rarely return afterward. However, the operation causes more pain and more complications. The operation is most often done under general anaesthesia and require hospital stay, however, sometimes it can be done under sedation and local anaesthesia as a day procedure.
What is Stapled Haemorrhoidectomy?
This is a new technique to remove the haemorrhoids that was developed in an effort to reduce postoperative pain. It involves a circular stapler device inserted via the anus under anaesthesia. The device divide and staples the haemorrhoids to fix them higher up. It is effective and less painful but has a higher rate of recurrence and does not work for large external haemorrhoids.