Haemorrhoids

Haemorrhoids are often describes as "varicose veins" of the anal canal; this is incorrect.

What are haemorrhoids?

Haemorrhoids are engorged blood vessels covered by the lining of the lower rectum just above the anal canal.  As a haemorrhoid enlarges, it bulges into the anal canal and may eventually protrude at the edge of the anus (prolapse).  This may be associated with anal skin tags.

The associated skin tags actually represent the remnants of stretched skin arising from prolapsed internal haemorrhoids at the anal verge.  They may also be from a previous perianal thrombosis.

A perianal thrombosis (clot) is a painful and exquisitely sensitive lump on the edge of the anus, and is often mistaken for a prolapsed internal haemorrhoid.

How common are haemorrhoids?

Haemorrhoids are one of the most common ailments known.  Approximately 75% of people will have haemorrhoids at some point in their life.  Haemorrhoids are most common among adults aged 45 to 65.  Haemorrhoids are common in pregnant women.

What causes haemorrhoids?

Internal haemorrhoids are caused by a weakening of the supportive connective tissues in the anal canal.  This allows the lower rectal lining to bulge.  Contributing factors may include:

  • ageing;
  • chronic constipation or diarrhoea;
  • straining at bowel action;
  • pregnancy;
  • Sitting on the toilet for long periods; and
  • faulty bowel action.

Contributing factors may cause veins within a haemorrhoid to become enlarged.

Symptoms

Bleeding – the most common symptom of haemorrhoids is bright red blood on the stool, on toilet paper, or in the toilet bowl after a bowel movement.  The blood may drip or spray into the toilet bowel.  Never assume that bleeding is always due to haemorrhoids.

Lumps – prolapse may occur during a bowel action.  This is usually reducible.  Acute prolapse, although less common, is painful and may require an early surgical appointment.

Itching (pruritus ani) – this is quite a common symptom and is due to mucous discharge from the lower bowel lining covering the haemorrhoid.

Discomfort and pain – moderate discomfort is normal, but severe pain may indicate a complication such as perianal thrombosis or acute prolapse, or the presence of an anal fissure (split).

Haemorrhoids and cancer

There is no known relationship between haemorrhoids and cancer.  However, the symptoms of haemorrhoids and bowel cancer can be very similar, and it is important that all symptoms, especially bleeding, be investigated by a colorectal surgeon.

Treatments

Proper evaluation of your symptoms is imperative.  You should see your General Practitioner who will refer you to a Colorectal Surgeon.

Possible treatments include:

Injection – an injection with Phenol (in oil) can often stop bleeding if the haemorrhoids are small.

Rubber band ligation – the majority of haemorrhoids are treated this way, and the treatment is especially appropriate for larger haemorrhoids.  Neither general nor local anaesthetic is required, as there are no nerve fibres in the lower bowel lining.  Rubber bands constrict the blood supply and cause the haemorrhoid to separate from its attachment to the bowel wall.  This is often combined with injection.

Stapled haemorrhoidectomy – This procedure involves the use of a specially devised staple gun inserted through the anus.  It enables removal of haemorrhoids without open wounds.  This procedure requires a general anaesthesia and is most useful for treating large haemorrhoids with a significant prolapse component.
It is an alternative procedure to a traditional haemorrhoidectomy.

Haemorrhoidectomy – often, surgical excision will be necessary when treating large of complicated haemorrhoids.  This procedure is performed under anaesthesia, and will be conducted in a hospital or day car centre.

Other treatments – may include Doppler ultrasound ligation, laser removal, and infrared coagulation, but these have not demonstrated superior results to those above.

Cryotherapy – freezing probe.  This is not recommended.

As always, discussion with your Colorectal Surgeon will determine which treatment is best for your particular case.

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