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Haemorrhoids / Piles

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Haemorrhoids, also called "piles", are swollen, inflamed veins around the anus or lower rectum. Haemorrhoids are either inside the anus or under the skin around the anus, and are often the result of chronic (long-term) straining to have a bowel movement).

Other factors that may lead to haemorrhoids are;

  • Pregnancy
  • Family history
  • Aging
  • Chronic constipation or diarrhoea

Haemorrhoids are very common in both men and women. It is estimated that about half of all individuals will have haemorrhoids by the age of 50. The most common symptom of haemorrhoids is bright, red blood covering the stool, on the toilet paper or in the toilet bowl. Symptoms usually go away within a few days. Haemorrhoids can be recurrent and are more likely to occur in those having symptoms in the past.

Haemorrhoids are also common in pregnant women. The pressure of the foetus on the pelvis, as well as hormonal changes, can cause the haemorrhoidal tissue in the anus to enlarge. These vessels are also placed under severe pressure during childbirth. For most women however haemorrhoids caused by pregnancy are a temporary problem.

Causes and risk factors

Haemorrhoids can develop from any increase in pressure in the veins in the lower rectum. Predominant sources of increased pressure include constipation and straining, diarrhoea, sitting especially on the toilet or standing for a very long time such as in a job, obesity, a poor diet especially high in red meat and low in fibre, pregnancy and childbirth. Family history plays a part as well.

Symptoms and signs

Many anorectal problems including fissures, fistulae, abscesses, or irritation and itching (pruritus ani) have similar symptoms and are incorrectly referred to as haemorrhoids.

Diagnosis

A thorough evaluation and proper diagnosis is important at any time bleeding is seen from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive disease such as colorectal cancer, bleeding ulcers, inflammatory bowel diseases such as Crohn's disease and ulcerative colitis and of course anal fissures. The anus and rectum will be examined in the rooms to look for swollen blood vessels that indicate haemorrhoids and also a digital rectal exam with a gloved lubricated finger to feel for abnormalities.

We will use an anorectal ultrasound probe to assess the size and nature of the haemorrhoids. To exclude any other cause for gastrointestinal bleeding you will usually be given two fleet enemas and we will pass a video endoscope into the rectum/lower colon and left colon to exclude any other causes.

Treatment

Medical treatment is directed initially at relieving symptoms. If the patient is constipated, laxatives must be given and the patient must not be allowed to strain at stool.

 

For more information on Haemorrhoids / Piles please contact Dr Michael Elliot.