Haemorrhoids

What are haemorrhoids?

Haemorrhoids consist of engorged blood vessels covered by the lining of the anal canal. As they enlarge they begin to prolapse into the anal canal and may protrude from the canal and cause external skin tags in the anal region. There are internal and external haemorrhoids. External haemorrhoids are noticeable around the anus and covered in skin. Internal haemorrhoids are located higher in the anal canal and covered by the lining of the anal canal. There are 4 stages of development of internal haemorrhoids:

• 1st Degree: Prominent haemorrhoid (blood vessels) with no prolapse
• 2nd Degree: Haemorrhoids prolapse on straining and spontaneously retract when straining ceases
• 3rd Degree: Haemorrhoid prolapses on straining requiring manual reduction
• 4th Degree: Haemorrhoid is prolapsed and unable to be manually reduced

What causes haemorrhoids?

Internal haemorrhoids are due to a weakening of the supportive connective tissues within the anal canal allowing the lower rectal lining to bulge. Contributing factors include:

• Increased intra-abdominal pressure
  • Pregnancy
  • Prolonged straining
  • Chronic Cough
  • Obesity
• Constipation
  • Low fibre diet
  • Insufficient fluid intake
  • Inactivity
  • Irregular bowel habits
  • Medical conditions
• Pelvic floor dysfunction

What are the symptoms?

• Bleeding
  • Most common sign
  • Seen on the toilet paper, occasionally in the toilet bowel
  • Need to exclude other causes
• Lumps
  • Prolapse may only occur during a bowel action or at other times
  • Usually reducible
• Discomfort- Pain
  • Usually minimal pain
  • Thrombosed haemorrhoid (clotted blood) occurs over a short duration and is commonly associated with significant pain
• Itch (pruritus ani)
  • Common, secondary to mucous discharge
• Mucous Discharge

Do haemorrhoids lead to cancer?

No. There is no relationship known between haemorrhoids and cancer. However the symptoms of haemorrhoids may be very similar to those of bowel cancer. It is important that all symptoms, especially bleeding, are investigated.

How are haemorrhoids treated?

You should not rely on self medication. A consultation with your general practitioner and subsequent referral to a surgeon will ensure that your symptoms are properly evaluated and effective treatment is prescribed which may include a combination of medical and surgical management.

Prevention

• Ensure adequate fibre and fluid intake
• Avoid excessive straining
• Avoid contributing factors

Non-Surgical treatment

• Topical ointments may reduce pain

Surgical treatment

• Rubber band ligation
  • Appropriate for internal haemorroids
  • A rubber band is placed at the base of the internal haemorrhoid, obstructing the blood flow and causing the haemorrhoid to fibrose and detach
  • Performed in the surgeons rooms or hospital
• Haemorrhoidectomy
  • For the treatment of larger haemorrhoids
  • Involves formal surgical excision in the hospital under anaesthesia