Haemorrhoids: normal and the abnormal
Hemorrhoids, also called piles, are swellings containing enlarged blood vessels in your anus and lower rectum, similar to varicose veins.
What are haemorrhoids?
Haemorrhoids are a natural part of your body and play an important role in your anal function. Normal haemorrhoids are a cushion-like ring of blood vessels in and around the anus and lower rectum. They actually help ease a bowel movement through the anus and form a seal afterwards, working with the sphincter muscle to prevent leakage from the anus.
Haemorrhoids may cause problems when they become enlarged and swollen where the increased pressure and swelling may result from straining to move the bowel. They are then commonly called piles. They become more congested with blood during a bowel movement, and can tear, sometimes causing bleeding.
What causes haemorrhoids?
Contributing factors to haemorrhoids may include:
Conscious straining to pass a motion due to constipation
Unconscious straining to pass a motion because of poor toilet positioning
Western diet which is typically high in processed food and low in fibre, resulting in constipation
Obesity
Pregnancy and childbirth
Chronic coughing
Vomiting
What are the symptoms of haemorrhoids?
Haemorrhoids usually are not dangerous or life threatening. In most cases, haemorrhoidal symptoms will go away within a few days. Although many people have haemorrhoids, not all experience symptoms.
There are two types of haemorrhoids — internal and external.
Internal haemorrhoids may not be painful. The first sign may be a small amount of bright red blood during or following a bowel motion and itching around the anus. However, an internal haemorrhoid may protrude through the anus to lie outside the body, becoming irritated and painful. This is known as a protruding, or prolapsed, haemorrhoid.
External haemorrhoid symptoms may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external haemorrhoid. In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Excessive production of mucus may also cause itching.
There is no relationship between haemorrhoids and cancer. The symptoms however may be similar to that of bowel cancer so it is important to have any symptoms investigated by a practitioner specially trained in this specialty.
How are haemorrhoids treated?
Symptoms from haemorrhoids tend to come and go. It helps if you keep your bowel movements reasonably soft by ensuring you keep up with your fluid intake and maintain your dietary fibre. Careful cleansing with a warm tissue as soon as you feel any itching can help a look.
Smaller haemorrhoids are often treated without surgery. Measures such as salt or chamomile baths, soothing cream or ice packs may reduce swelling.
Surgical treatment
If your haemorrhoids are bothering you, ask for a referral. The decision for surgical treatment should be discussed with a colorectal surgeon. Most surgical treatments for haemorrhoids can be performed in the surgeon’s office (without anaesthetic). More complex cases may be performed under general anaesthesia.
Minor surgical procedures include:
Rubber band ligation
Where a rubber band is placed around the base of the haemorrhoid causing it to drop off. Neither of these procedures are painful but may cause some discomfort and need to be repeated.
Injection sclerotherapy
Haemorrhoids are injected with a sclerosant causing blood vessels in the haemorrhoids to shrink
Lifestyle changes for prevention of haemorrhoids
Certain changes may help to prevent haemorrhoids, such as:
Controlling constipation
Optimising toilet positioning
Avoiding straining when passing a motion
Adopting a low fat, high fibre diet
Ensuring adequate fluid intake
Using a fibre supplement