What are Haemorrhoids?
Haemorrhoids, also known as piles, are part of anal canal. They cause a trouble when they become enlarged, swollen, inflamed or bleeding. Under the normal circumstances they act as cushions composed of vessels and surrounding tissue that aid the passage of stool.
Grade I: Haemorrhoids bulge into the lumen of anal canal but do not protrude out of the anus.
Grade II: Haemorrhoids prolapse upon defecation but spontaneously reduce.
Grade III: Haemorrhoids prolapse upon defecation, but must be manually reduced.
Grade IV: Haemorrhoids prolapsed and cannot be manually reduced.
What types of haemorrhoids do we know and what are the symptoms?
There are two types of haemorrhoids (external and internal) which are differentiated via their position with respect to the dentate line.
External haemorrhoids are those that occur outside the anus. They could be sometimes painful, and often accompanied by swelling and irritation. Itching, although often thought to be a symptom of external haemorrhoids, is more commonly due to skin irritation. External haemorrhoids are prone to thrombosis. This happens if the vein ruptures and/or a blood clot develops within the haemorrhoid.
Internal haemorrhoids are those that occur inside the rectum. Internal haemorrhoids are usually painless and most people are not aware that they have them. Internal haemorrhoids, however, may bleed when irritated or enlarged. Normally, the bleeding is limited to small stains of fresh blood on the toilet paper, but more severe bleeding may occur during passing a hard stool. When internal haemorrhoids are large, they may prolapse outside the anus.
Internal haemorrhoids can be further graded by the degree of protrusion from the anus (prolaps). Pictures are taken during the endoscopy.
How common are haemorrhoids?
Haemorrhoids are very common in both men and women. About half of the population have haemorrhoids by age 50.
What are the causes?
A number of factors may lead to the formations of haemorrhoids including irregular bowel habits, constipation, diarrhea, exercise, pregnancy, nutrition (low-fiber diet), increased intra-abdominal pressure (prolonged straining), obesity, sitting for long periods of time and aging.
How are haemorrhoids prevented?
The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining and to empty bowels as soon as possible after the urge occurs. Exercise including walking, high fibre diet and adequate water intake help reduce constipation and straining by producing stools that are softer and easier to pass.
How are haemorrhoids diagnosed?
A thorough evaluation and proper diagnosis is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.
Anus and rectum will be will examined for swollen blood vessels that indicate haemorrhoids. A digital rectal exam will be performed to feel for abnormalities. Closer evaluation of the rectum for haemorrhoids requires an exam with a proctoscope, a hollow tube useful for viewing internal haemorrhoids.
To rule out other causes of gastrointestinal bleeding, the entire colon will be examined with colonoscopy.
What is the treatment?
Small haemorrhoids can get better even without medical treatment. If they are caused by constipation, the aim of the treatment is to achieve regular soft stools. A softer stool makes emptying the bowels easier and lessens the pressure on haemorrhoids caused by straining. The most important measurement is a change of diet with the addition of more fibre and roughage particularly green vegetables, fresh fruit, wholegrain cereals and bran. Fluid intake should be increased to 8 to 10 glasses (2L) of fluid daily.
The patient is also advised to avoid straining when passing a stool. Sitting in a shallow bath of hot water for 15 minutes several times a day, will reduce the pain.
Relatively small haemorrhoids can be treated using creams or suppository together with medication venotonic (Daflon).
3.Rubber Band Ligation
More severe cases need to be treated by a specialist. One possible treatment is rubber band ligation. Rubber band ligation is performed as outpatient procedure and does not require hospital admission. The procedure involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid, which eventually falls off after a few days. Cure rate has been found to be about 87%. This technique is effective for treating moderate size haemorrhoids.
Who Shouldn’t Get This Procedure?
Rubber band ligation is not appropriate for treating large or bulky haemorrhoids. Haemorrhoids that are previously treated with sclerotherapy are difficult to band, and therefore should not be treated with this procedure.
If the haemorrhoids are too large and they protrude through the back passage and cannot be manually reduced, the treatment requires surgical removal or ‘haemorrhoidectomy’. Following any treatment for haemorrhoids, it is very important to avoid constipation and straining or the condition may recur.