What are Haemorrhoids (Piles)?
We all have haemorrhoidal tissue inside the anal canal. It consists of blood vessels and connective tissue and plays an important role in maintaining continence. When this tissue enlarges and causes symptoms, it is referred to as haemorrhoids.
Types of Haemorrhoids
Internal Haemorrhoids: These develop inside the anal canal and are covered by the lining of the bowel, which is not sensitive to touch. They typically cause painless rectal bleeding. Occasionally, they may prolapse and become clotted, leading to severe pain.
External Haemorrhoids: These develop near the margin of the anus and are covered by sensitive skin. They usually cause painless lumps at the anal margin. However, if they become clotted, they can lead to severe pain.
What Causes Haemorrhoids?
Several factors can contribute to the development of haemorrhoids, including:
- Increasing age
- Chronic constipation or diarrhoea
- Pregnancy
- Straining during bowel movements
- Spending long periods on the toilet (e.g., reading)
- Heavy weight lifting
These factors cause the veins to swell and the supporting tissue to stretch. This leads to haemorrhoids protruding and, in some cases, the vein walls bursting, causing bleeding.
What Are the Symptoms of Haemorrhoids?
- Bleeding during bowel movements – often occurring at the end of defecation, sometimes spraying onto the toilet bowl.
- Anal itching
- Prolapse of haemorrhoidal tissue during bowel movements
- Painful anal lumps
Do Haemorrhoids Lead to Cancer?
No. There is no connection between haemorrhoids and cancer. However, rectal bleeding can occur due to haemorrhoids as well as other digestive tract diseases. Therefore, it is essential not to assume that haemorrhoids are the sole cause of symptoms. A specialist assessment is necessary for an accurate diagnosis.
How Are Haemorrhoids Treated?
Mild symptoms often resolve with conservative management, including:
- Increasing dietary fibre (e.g., fruits and vegetables)
- Using fibre supplements (e.g., Metamucil or Benefiber)
- Drinking more fluids
- Engaging in regular exercise
- Adopting healthy bowel habits:
- Avoiding straining during bowel movements
- Going to the toilet when the urge arises
- Limiting time spent on the toilet (e.g., no reading while on the toilet)
- Sitting in a warm water bath for ten minutes to relieve pain from thrombosed (clotted) haemorrhoids
Procedures for More Troublesome Haemorrhoids
More severe cases may require additional treatment, often performed as outpatient procedures:
Rubber Band Ligation: Small, tight rubber bands are placed around the roots of internal haemorrhoids. These bands cut off the blood supply, causing the haemorrhoids to shrink and fall off within a week.
The procedure may cause mild discomfort and some bleeding. In rare cases, significant bleeding can occur, requiring medical attention. This procedure is often performed at the end of a colonoscopy to ensure that haemorrhoids are the cause of rectal bleeding and no other conditions are missed.
Injection Therapy: A sclerosing agent is injected into haemorrhoids to shrink them. This procedure is mostly painless but can occasionally cause serious infections. Due to its limitations, I do not typically recommend this method.
Surgery for Haemorrhoids (Haemorrhoidectomy)
Only about 10% of haemorrhoid cases require surgery. Haemorrhoidectomy is reserved for:
- Large prolapsing haemorrhoids
- Symptomatic large external haemorrhoids
- Haemorrhoids that do not improve after repeated rubber band ligation
Haemorrhoidectomy is highly effective, and recurrence is rare. However, the procedure is associated with more pain and a higher risk of complications compared to non-surgical treatments. The operation is typically performed under general anaesthesia and may require a hospital stay, though in some cases, it can be done as a day procedure under local anaesthesia with sedation.
What is Stapled Haemorrhoidectomy?
Stapled haemorrhoidectomy is a newer technique designed to reduce postoperative pain. The procedure involves inserting a circular stapling device through the anus under anaesthesia. This device removes excess haemorrhoidal tissue while repositioning and stapling the remaining tissue higher up.
The procedure is effective and causes less pain than traditional haemorrhoidectomy. However, it has a higher recurrence rate and is not suitable for large external haemorrhoids.
