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;
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.
Anal fissures are cuts or tears occurring in the anus and will always be extremely painful.
Anal fistula is a small tunnel with an internal opening in the anal canal and an external opening near the anus. It forms when an anal abscess is drained and does not heal completely. An anal abscess is a collection of pus in the deep tissue surrounding the anus.
Internal haemorrhoids cannot be seen or felt. Straining or irritation from passing stool can injure a haemorrhoids delicate surface and cause it to bleed. The patient may notice small or occasionally large amounts of bright, red blood on the toilet tissue or in the toilet bowl water. Usually these internal haemorrhoids do not cause discomfort.
Occasionally, straining can push an internal haemorrhoid through the anal opening. If a haemorrhoid remains prolapsed it can cause pain and irritation and eventually a lot of discomfort.
External haemorrhoids tend to be painful. Sometimes blood may pool in an external haemorrhoid and form a clot (thrombus) causing severe pain, swelling and inflammation.
Haemorrhoids can produce several uncomfortable but not serious problems. A blood clot in a haemorrhoid can cause severe pain and usually demands immediate medical attention. Providing it is seen in the very early stages it can be drained usually in our rooms. Haemorrhoids can ooze fresh red blood, whether located externally or internally. External haemorrhoids can be itchy, especially if the area is moist and irritated.
Haemorrhoids do not develop into cancer. However, both haemorrhoids and cancer can cause rectal bleeding. In fact many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in patients over the age of 30 and especially those over the age of 50 it should always be considered a serious problem until an exact diagnosis is made.
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.
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.
Measures to reduce symptoms include;
If signs and symptoms do not improve then medical attention must be sought.
Preventing recurrence of haemorrhoids will require relieving the pressure and straining of constipation.
Increasing your fibre and increasing your fluids will be recommended. You will be asked to drink at least seven to ten glasses of water a day resulting in a softer, bulkier stool.
Good sources of fibre include fruit, vegetables and whole grains.
A number of methods may be used to remove or reduce the size of internal haemorrhoids. This includes;
Rubber band ligation
During this procedure a rubber band is placed around the base of the base of the haemorrhoid inside of the rectum. The band cuts off circulation and the haemorrhoid withers away within a period of a few days. Pain is likely for a period of 24 to 48 hours after rubber band ligation.
This procedure is performed in our rooms. We may recommend that you use mild pain relievers after the procedure. In a very small number of instances bleeding may occur following rubber band ligation seven to ten days after the procedure is done. This can usually be prevented by not becoming constipated after banding.
Fortunately new procedures have been developed that make the surgery for haemorrhoids much easier with considerably less pain and relatively early return to work. This procedure is known as P.P.H (Procedure for Prolapse and Haemorrhoids). The procedure avoids the need for wounds in the sensitive peri-anal area thus considerably reducing post-operative pain and facilitating a much speedier return to normal activities.
This procedure was first prescribed by an Italian surgeon, Antonio Longo in 1993 and has since been widely adopted throughout the world. Dr Elliot introduced this procedure to South Africa and has performed hundreds of these operations with excellent results.
This operation requires the patient to be hospitalised for approximately 24 hours. The patient's post-operative pain levels are low and thus they are able to resume normal activities within a few days of going home.
Benefits of PPH
For more information on Haemorrhoids / Piles please contact Dr Michael Elliot.