Haemorrhoids

What are ‘haemorrhoids’?

The term ‘haemorrhoids’ refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed. This usually results from straining to open the bowels but other contributing factors include pregnancy, ageing, and chronic constipation. Haemorrhoids are either inside the anus (internal) or under the skin around the anus (external). They are also sometimes known as ‘piles’.

What are the symptoms of haemorrhoids?

Although many people have haemorrhoids, not all experience symptoms. The most common symptom of internal haemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal haemorrhoid may protrude through the anus outside the body, becoming irritated and painful and this is known as a protruding haemorrhoid.

For external haemorrhoids, symptoms may include a 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.  Haemorrhoids are usually not dangerous or life threatening and in most cases any symptoms will go away within a few days.

Their severity and size are classified into grades 1 to 4:

Grade 1 are small swellings on the inside lining of the back passage. They cannot be seen or felt from outside the anus. Grade 1 haemorrhoids are the most common type of haemorrhoid. In some people they enlarge further to grade 2 or more.

Grade 2 are larger. They may be partly pushed out (prolapse) from the anus when you go to the toilet, but quickly spring back inside again.

Grade 3 hang out (prolapse) from the anus. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.

Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

How common are haemorrhoids?

Haemorrhoids are very common in both men and women. About half of the population have haemorrhoids by age 50. Haemorrhoids are also common among pregnant women because the pressure of the baby in the abdomen, as well as hormonal changes, cause the haemorrhoidal veins to enlarge. These veins are also placed under severe pressure during childbirth. For most women, however, haemorrhoids caused by pregnancy are a temporary problem.

How are haemorrhoids diagnosed?

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs since bleeding here may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate haemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for any abnormalities.

If closer evaluation of the rectum for haemorrhoids is required then an examination with an anoscope - a hollow, lighted tube useful for viewing internal haemorrhoids - or a proctoscope, useful for more completely examining the entire rectum, can be performed.

To rule out other causes of gastrointestinal bleeding, a doctor may sometimes examine the rectum and lower colon (sigmoid) with a sigmoidoscopy or the entire colon with a colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

What is the treatment of haemorrhoids?

The medical treatment of haemorrhoids is aimed initially at relieving symptoms. Measures that are often advised to reduce symptoms include taking a bath several times a day in plain, warm water for about 10 minutes and applying a haemorrhoidal cream or suppository to the affected area for a limited time -  ask a pharmacist about these. A cream  that contains an anaesthetic may ease pain better but you should only use one of these for short periods at a time (5-7 days). If you use it for longer, the anaesthetic may irritate or sensitise the skin around the anus.

Products that contain a steroid may be advised by a doctor if there is a lot of inflammation around the haemorrhoids. Steroids reduce inflammation and may help to reduce any swelling around a haemorrhoid. This may help to ease itch and pain. You should not normally use a steroid cream or ointment for longer than one week at a time.

Very painful prolapsed haemorrhoids are uncommon. The pain may be eased by an ice pack pressed on for 15-30 minutes. Strong painkillers may be needed.

A number of methods may be used to remove or reduce the size of internal haemorrhoids. These techniques include rubber band ligation, where a rubber band is placed around the base of the haemorrhoid, cutting off the circulation and causing the haemorrhoid to shrink away within a few days. Another technique is sclerotherapy where a chemical solution is injected around the blood vessel to shrink the haemorrhoid and – only occasionally - extensive or severe haemorrhoids can be removed by surgery known as haemorrhoidectomy.

How are haemorrhoids prevented?

The best way to prevent haemorrhoids is to keep the stools soft so they pass easily so reducing pressure and straining, and to empty the bowels as soon as possible after the urge to open them occurs. Exercise, including walking, and increased amounts of fibre in the diet help reduce constipation and straining by producing stools that are softer and easier to pass. Good sources of fibre are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fibre supplement such as psyllium or methylcellulose.