What are haemorrhoids?
Haemorrhoids – also known as piles – are swollen veins in the anus and lower rectum. The haemorrhoidal veins around the anus stretch under pressure, causing them to become irritated and swell. There are a number of reasons why this occurs:
- Straining during bowel movement
- Sitting for long periods of time, especially on the toilet
- Chronic diarrhoea or constipation
- Low-fibre diet
- Consistent heavy lifting, especially while holding your breath
- Family history
There are two forms of haemorrhoids: internal and external. Internal haemorrhoids are located inside the rectum; they rarely cause discomfort and may only be noticed when blood appears in your stool. In some cases, straining can push an internal haemorrhoid through the anal opening – this is called a protruding or prolapsed haemorrhoid. These are more painful than internal haemorrhoids as they become irritated by clothing and sitting down.
External haemorrhoids develop under the skin around the anus. These can be seen and felt more easily; this also means that they are more painful than internal haemorrhoids. Sometimes a clot may form in an external haemorrhoid, creating a thrombosed haemorrhoid. Thrombosed haemorrhoids are extremely painful and can turn blue or purple. However, they are not dangerous and should disappear within a week – they can also be removed with surgery.
Haemorrhoids are very common – nearly 75% of adults will have them at some point in their lives. They are particularly common during pregnancy and amongst men and women over the age of 50, as the tissues that support the veins in the rectum and anus are weakened. There is no guarantee that the haemorrhoids won’t return, but the chances of this happening can be lowered with preventative measures.
General symptoms include:
- Painless, bright red bleeding during bowel movements
- Swelling around the anus
- A lump near the anus, which may be sensitive or painful
- Faecal leakage
It’s important to receive an accurate diagnosis from your doctor. Most anal bleeding is caused by haemorrhoids, but these symptoms can also be indicative of more serious issues such as colitis, Crohn’s disease, and colorectal cancer.
There are several ways to diagnose haemorrhoids. External haemorrhoids can usually be diagnosed by visual examination, but the doctor will carry out a digital examination to check for internal haemorrhoids. During the digital exam, the doctor inserts a gloved, lubricated finger into the anus and feels for any abnormal growths. Some internal haemorrhoids are too soft to be diagnosed digitally – in such cases, an anoscope, proctoscope, or sigmoidoscope is used to examine your colon and rectum. This allows the doctor to clearly observe the haemorrhoid up close.
Rubber band ligation
This procedure is used to treat internal haemorrhoids – it only takes a few minutes to perform and usually does not require anaesthetic. The doctor inserts a protoscope into the anus and places a tiny rubber band around the base of the haemorrhoid, cutting off its circulation. This kills the tissue within the haemorrhoid, causing it to shrivel and fall off – this usually takes about one week.
It will feel uncomfortable (like a dull ache), and some bleeding may occur when passing stool. You may feel as though you want to open your bowels, but try and delay this until the following day if possible. You can resume normal activities the next day, but strenuous physical exercise should be avoided. There should be a follow-up appointment a few weeks later, to check that the procedure has been successful.
Surgery may be required if previous procedures have been unsuccessful, or for large internal haemorrhoids and uncomfortable external haemorrhoids. A haemorrhoidectomy will completely remove the haemorrhoidal tissue – this can be done as an outpatient or with an overnight stay in hospital.
This procedure is usually carried out under general anaesthetic and is the most effective way to treat haemorrhoids. The doctor carefully makes incisions around the anus so the haemorrhoids can be cut out, before stitching the area. Stitches may make the area tender and painful.
Recovery time is around 1-2 weeks, with pain medication and warm baths to help soothe any discomfort. There is a 1 in 20 chance of the haemorrhoids returning, which is lower compared to non-surgical treatments. Dietary and lifestyle changes will also help lower the chances of haemorrhoids forming again.