Haemorrhoids
What are haemorrhoids?
Haemorrhoids are vascular cushions of the anal canal. It consist of swollen blood vessels covered by the lining of the anal canal. There are several grades of haemorrhoids. Most commence as internal haemorrhoids (Grade 1). As it enlarges, it bulges into the anal canal and eventually prolapses through the anus, either spontaneously reducing (Grade 2) , requiring manual reduction (Grade 3) or becomes permanently prolapse (Grade 4).
Causes of haemorrhoids
Haemorrhoids are due to weakening of the supportive connective tissues within the anal canal, allowing the lower anorectal lining to bulge. Contributing factors include:
Chronic constipation or diarrhoea
Pregnancy
Straining at defecation
Prolong periods of sitting on the toilet
Symptoms of haemorrhoids
Per rectal bleeding - Bright red bleeding is usually seen on the toilet paper or sprayed into the toilet bowl. Its important to exclude malignant causes of Per rectal bleeding before assuming that its due to haemorrhoids.
Perianal lumps - Prolapsing haemorrhoidal lump may occur during defecation. Usually this is reducible. Acute prolapse is less common, but painful, requiring a surgical opinion.
Perianal pain - Pain is usually due to perianal thrombosis or acute prolapse or the presence of an anal fissure (tear)
Perianal itch - This is common due to mucous discharge
How are haemorrhoids treated?
You should not self medicate with over the counter products.
A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated
Conservative measures should be trialled for 3 months and likely need to continue to ensure good bowel motion
Increase fibre intake and consider additional fibre supplements (1-3x/ day) Increase fluid intake
Consider stool softeners e.g. Movicol to aim for stool with “toothpaste consistency”
Avoid straining during defecation
Surgical management options:
Sclerotherapy injection - Phenol (in oil) is injected into haemorrhoids resulting in scarring, shrinking and shrivelling of haemorrhoids over time. Can be considered in small haemorrhoids. This is a day procedure
Rubber band ligation (RBL) - RBL can be applied to internal haemorrhoids. This is usually performed in conjunction with either a colonoscopy or flexible sigmoidoscopy to exclude other causes of bleeding. Its a day procedure.
Haemorrhoid artery ligation (HAL) - Suture ligation of haemorrhoids is performed to reduce the arterial blood supply, subsequently enable shrinking and shrivelling of haemorrhoids. The aim of this procedure is to assist the haemorrhoids to “shrink up” without removing them. This procedure is performed under general anaesthesia. Its usually considered in patients with large haemorrhoids whilst on blood thinner medications. This operation may be conducted either as a day procedure or overnight stay.
Haemorrhoidectomy - Surgical excision is sometime necessary in treating large or complicated haemorrhoids. This is performed under general anaesthetic. This is usually an overnight procedure. Your anal area will be painful 4-6 weeks post procedure and you may need pain medication. This reinforces the need for good bowel motion and perianal hygiene post operatively.