Haemorrhoids, also called “piles”, are swollen (but normally present) veins found on the inside (internal haemorrhoids) or outside (external haemorrhoids) of the anus. They often feel like soft ‘lumps’ of tissue and are the most common cause of bright rectal bleeding.
Haemorrhoids are most commonly caused by constipation and straining while passing a bowel motion. This results in increased pressure on the delicate tissues of the lower rectum and anal canal causing in swelling, irritation and bleeding. Haemorrhoids are also very common after childbirth.
The most common symptoms associated with haemorrhoids include:
(i) bright red bleeding. This can result in blood on the toilet paper, blood dripping into toilet bowel, or blood coating the sides of the bowel motion.
(ii) a feeling of fullness, or a lump, in the anal area.
(iii) Itchiness around the anal area making it difficult to clean.
Haemorrhoids are usually diagnosed during a physical examination of the anal area. They may also be identified during a colonoscopy or sigmoidoscopy. Haemorrhoids are typically categorized as internal, external or both, and can also be graded according to size.
Most haemorrhoids cause occasional symptoms but are self-resolving and do not require any treatment. However, in some patients, haemorrhoids do not settle in a timely fashion and cause chronic rectal bleeding and/or irritation of the anal area.
There are several topical medications available that can be used to reduce discomfort and inflammation of the haemorrhoids and surrounding tissue. These are available in creams and suppositories and include a combination of a local anaesthetics, muscle relaxant and steroid anti-inflammatory. Soothing wipes (witch hazel wipes), zinc-based creams and sitz-baths with Epsom can all be effective. An ice pack can also help reduce swelling of external haemorrhoids.
For recurrent or persistent internal haemorrhoids, ‘haemorrhoidal banding’ is one of the most effective treatments. This involves placing an elastic band around the swollen veins which cuts of circulation and the haemorrhoid withers away. Most of the time this is done in an endoscopy centre during a colonoscopy. Sclerotherapy, injection of a chemical solution into the blood vessel, can also shrink the haemorrhoid. At GastroX, we have ultrathin fibre optic scopes that allow for assessment of the rectum and haemorrhoid banding can be done in clinic.
Occasionally, if endoscopic treatment is not possible, surgery (known as haemorrhoidectomy) may be needed.
Once haemorrhoids are successfully treated, it is important to put steps in place to prevent them recurring. Prevention of constipation through dietary changes, drinking water, gentle laxatives/stool softeners is of utmost importance. Healthy toileting practices such as avoiding ‘straining’ and sitting for long periods on the toilet are also important to implement.