HAEMORRHOIDS

What are Haemorrhoids ?

Haemorrhoids are prominent clumps of tissue containing blood-vessels which lie within the back passage (the lower rectum or anal canal). They are frequently called piles, although strictly speaking, a pile may refer to any lump occurring around the anus. When haemorrhoids are present, they occur in groups of three, distributed around the inside of the rectum. The symptoms depend on their size. The smallest haemorrhoids cause a loss of bright red blood with the bowel motion or traces of blood on the toilet paper. Larger haemorrhoids can drop down (prolapse) from the rectum on opening the bowels. They can be replaced by upward pressure after going to the toilet. The largest haemorrhoids may stay permanently prolapsed and cannot be pushed back. Occasionally the bleeding can be brisk. Haemorrhoids are usually painless; the complications of haemorrhoids can be painful.

How do Haemorrhoids occur ?

Most people have haemorrhoids but not all have symptoms. The symptoms are common in Western civilization and are more often found in people who eat a low-fibre diet and who suffer from constipation.

Why do Haemorrhoids occur ?

There is probably an inherited predisposition. However, the fact that several members of a family may suffer from haemorrhoids may also be due to similar low-fibre dietary habits. Haemorrhoids cause more trouble when constipation is also present. They can also occur during pregnancy due to the increased abdominal pressure of the developing baby on the pelvic blood-vessels, resulting in engorgement of the piles.

Treatment Involved for Haemorrhoids

Haemorrhoids do not require treatment unless they cause symptoms. In younger patients, symptoms may respond to an increase in dietary fibre, such as fresh fruit, vegetables and bran. Avoiding constipation is very important. Other common forms of treatment available include the following. Injection of the haemorrhoids may be carried out with a chemical called a sclerosant (phenol in almond oil). This produces shrinking of the haemorrhoid. Each of the piles present is injected in turn. Frequently more than one injection session is required. Injections can be repeated at 3 4 weekly intervals. The procedure is performed without need for hospital admission or anaesthetic. Temporary discomfort during injection occurs but this disappears when the procedure has been completed. Banding of haemorrhoids is done by the application of a tight elastic band around them. This procedure can also be performed without either admission or anaesthetic. Discomfort is produced when the bands are applied and lasts for a little while longer than after injections. Not all haemorrhoids are suitable for this treatment. Haemorrhoidectomy involves excision of the piles under general anaesthesia. Only a few patients with large haemorrhoids need this treatment. The operation requires a short period of hospital stay until regular bowel activity has been re-established. This often requires laxatives. A certain amount of pain is to be expected and you may require medicines for pain relief. Twice daily baths are both soothing and necessary to keep the operation site clean. The cut area may take 4 6 weeks to heal completely. Some slight discharge will occur until the wounds have completely healed.

During Treatment for Haemorrhoids

Some bleeding may occur in the first 48 hours after injection treatment. Reading on the lavatory and straining when opening the bowels should be avoided. If the haemorrhoids prolapse, they should be eased back gently into the anal canal. Delayed bleeding may occur 5 10 days after banding of haemorrhoids when the elastic band and the haemorrhoids separate. Bleeding is usually temporary and short-lived. Opening the bowels is usually only painful after haemorrhoidectomy and this may be eased by the use of appropriate laxatives. Local irritation and discomfort may be improved by twice daily baths. It is not necessary to put salt into the bath water as this may make the skin dry and cause irritation. The use of creams and ointments is best avoided.

After Treatment for Haemorrhoids

It is very important that symptoms of rectal bleeding are always reported to the doctor. It is necessary to ensure that the bleeding is due to haemorrhoids and not any other important cause within the bowel. If piles remain untreated and bleeding continues, anaemia will result from the chronic blood loss. Generally speaking, the longer they are left, the less likely they are to respond to simple measures. Large piles can prolapse outside the anal canal and then clot (thrombose). This produces an acutely painful condition an attack of piles . Alternatively, piles that prolapse result in the leakage of mucus from within the back passage. This may cause irritation and inflammation of the skin around the anus.

If Haemorrhoids are Left Untreated

It is important to maintain regular bowel action. The bowel motion should be well formed but soft. Dietary fibre should be increased if necessary to achieve this. Breakfast cereal (supplemented with natural bran) is the simplest method of achieving this. DO NOT ASSUME THAT BLEEDING FROM THE RECTUM IS DUE TO PILES UNTIL YOU HAVE DISCUSSED THIS WITH YOUR DOCTOR.