Family doctor

What are haemorrhoids?

The anus is lined by spongy tissue which acts as a cushion to help seal the anus, and to ease the passage of a bowel motion. When this tissue becomes stretched or swollen, it is called a haemorrhoid or a pile. Haemorrhoids can develop whenever there is increased pressure in the veins of the anus. This can occur with straining from constipation or heavy lifting, during bad diarrhoea, or during pregnancy and childbirth.

There are two types of haemorrhoids:

1. Internal - arising from the lining of the lower rectum and anus.

2. External - arising in the skin at the opening of the anus.

It is not uncommon to have both internal and external haemorrhoids at the same time.

What are the symptoms?

The most common symptoms are itching, discomfort and bleeding. Haemorrhoids may prevent the anus from shutting properly, resulting in mucus discharge, itching, and sometimes faecal soiling of your underwear.

When large, they may prolapse through the anus and need to be pushed back inside. A prolapsed haemorrhoid may become engorged with blood, in which case a very painful thrombosis or strangulation can occur.

It is most important that any bleeding from the rectum is reported to your doctor, even if you know you have haemorrhoids because it is possible the bleeding may be due to other more serious causes.

How are haemorrhoids treated?

Small haemorrhoids will often go away with simple conservative treatment. This involves increasing dietary fibre and fluid intake to keep bowel motions soft and reduce the need for straining. Anal itching can be reduced by careful anal hygiene, and by avoiding rubbing the area with dry toilet paper or using soap, which removes the natural protective grease from the anal skin. Instead, clean with a soft tissue moistened with warm water, then dry the area well by dabbing with a dry tissue or towel.

Sometimes you may be given an ointment or suppository to help reduce troublesome irritation. It is not advisable to use steroid containing ointments for more than a month or two at a time. If symptoms persist, other treatment may be recommended, such as rubber band ligation and haemorrhoidectomy. Most painful haemorrhoids are best treated by haemorrhoidectomy within a few days of onset.

Rubber Band Ligation

This is an effective and simple method of treating the less severe type of haemorrhoids and is usually done as office procedure, allowing the patient to return to work the same day.

A small rubber band is stretched over the haemorrhoid. The rubber band will tighten and strangle the haemorrhoid causing it to drop off in 2 - 5 days. Rubber band ligation often causes some discomfort or dull ache for about 48 hours, so don't plan on any major activity for 2 days. Usually 2 or 3 visits are required to treat all internal haemorrhoids by rubber band ligation. A small amount of bleeding can be expected when the haemorrhoid drops off. If the bleeding becomes more severe you should contact your specialist immediately.

Paracetamol, or relaxing in a warm bath should relieve any pain or discomfort. No special diet is necessary but it is important to keep your bowel motions soft and regular. Rarely (1 person in 100,000) severe infection can occur. In this case, you will suddenly feel very unwell, with fever and shivering, and may have severe anal pain. If you suspect this, seek medical help IMMEDIATELY. This is most important, regardless or the time of day or night, because treatment with antibiotics is of the utmost urgency.

Sclerotherapy

Another method of treating small internal haemorrhoids is by sclerotherapy (injections), which is done as an office procedure, allowing the patient to return to work the same day. A small amount of irritant fluid is injected into the haemorrhoid which results in shrinkage and reduction of the haemorrhoid. Usually 2 visits are required to treat the haemorrhoids by this method. Sclerotherapy can cause minor self-limiting rectal bleeding and a dull ache for up to 48 hours so don't plan any major activity for 2 days.

Paracetamol, or relaxing in a warm bath, should relieve any pain or discomfort. No special diet is necessary but it is important to keep your bowel motions soft and regular.

Haemorrhoidectomy

Haemorrhoidectomy is a surgical procedure to remove the swollen haemorrhoidal tissue. It is done in hospital under local or general anaesthesia. The resulting wounds are sutured closed with a dissolving suture, and typically take 10 -14 days to heal. Hospital stay is usually 1 - 3 days.

After haemorrhoidectomy

Do not attempt any heavy lifting or strenuous exercise for at least one week. Lesser activities such as climbing stairs, walking and driving may be carried out in moderation. Constipation can be particularly unpleasant, so it important to keep the bowel movements soft and regular.

A high-fibre diet is recommended - including plenty of fruit and vegetables. Drink at least 6 - 8 glasses of water daily. In addition, it is sometimes necessary to take a stimulant laxative such as dulcolax for the first week or two. Some discomfort and a little bloody discharge can be expected, especially after bowel movements, but this will diminish as healing progresses. It is important to keep the area clean and dry. Avoid using dry toilet paper - instead use a warm flannel or moist soft tissue to keep the anal area clean and dry. Saline baths (1/2 cup of salt per bath) several times daily, especially after bowel movements, are good for hygiene, and are very soothing. If is not possible to bath, have a suitable basin available to sit in (use 1tbspn. Salt per basin of warm water).

Getting help

Seek medical help if you feel that you are becoming constipated or if there is excessive or prolonged bleeding.