A real pain in the rear

Haemorrhoids, also known as piles, are swollen veins located around the anus or in the lower rectum. The haemorrhoidal veins are located in the lowest area of the rectum and the anus.

About half of the adult population have experienced the symptoms of haemorrhoids by the age of 50. Haemorrhoids can either be internal or external. Internal haemorrhoids develop within the anus or rectum.

Internal haemorrhoids lie far enough inside the rectum that you can’t see them. They don’t usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign they’re there.

Sometimes, though, they prolapse or enlarge and protrude outside the anal sphincter. When this happens, you may be able to see or feel them as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed haemorrhoids may hurt because the anus is dense with pain – sensing nerves. They usually go back into the rectum on their own. If they don’t, they can often be gently pushed back into place.

External haemorrhoids develop outside of the anus. The external haemorrhoids are the most common and the most troublesome. They cause pain, severe itching, lower abdominal bleeding and difficulty sitting. If they move, or prolapse, to the outside (usually when you have a bowel movement), you can see and feel it.

Blood clots sometimes form within prolapsed external haemorrhoids, causing a very painful condition called a thrombosis. If that happens, the haemorrhoid can turn purple or blue, and could possibly bleed. Despite its appearance, it’s usually not serious, apart from the pain. It will go away in a couple of weeks.

Most people can get relief from symptoms by using home treatments and making lifestyle changes. Bleeding during defaecation is the most common sign of haemorrhoids. But there are other causes of rectal bleeding like colorectal cancer and anal cancer.

Don’t assume that bleeding is coming from haemorrhoids without consulting a doctor. Also consider seeking medical advice if your haemorrhoids cause pain, bleed frequently or excessively, or don’t improve with home remedies.

If your haemorrhoid symptoms began along with a marked change in bowel habits or if you’re passing black, tarry or maroon stools, blood clots, or blood mixed in with the stool, consult your doctor immediately.

Symptoms

The commonest symptoms are:

• extreme itching around the anus.
• irritation and pain around the anus.
• an itchy or painful lump or swelling near your anus.
• faecal leakage.
• painful defaecation.
• blood on your tissue after having a bowel movement.

Haemorrhoids are not life threatening and can usually go away on their own or with just correction of dietary habits. Unfortunately, if you have them often, you may develop symptoms of anaemia from severe blood loss that can lead to weakness and shortness of breath.

Causes

The cause is not scientifically proven but the following factors are known to put patients at risk of developing piles:

• straining during a bowel movement.
• low fibre diet.
• straining from lifting too heavy objects.
• complications from chronic constipation or chronic diarrhoea.
• anal intercourse.
• sitting on the toilet for a long time.
• a family history of haemorrhoids.
• Pregnancy. When the uterus enlarges, it presses on the vein in the colon causing it to bulge.

Conditions that cause an increase in abdominal pressure are also known to increase the risk of developing piles, like:

• Obesity.
• Coughing.
• Sneezing.
• Vomiting.
• Holding your breath when doing something physically hard.

Haemorrhoids are more likely to happen as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with ageing.

Diagnosis

External haemorrhoids are easily diagnosed from the history that you will be telling your doctor and from the doctor visually examining the anal opening. The doctor can then confirm the diagnosis by doing a digital rectal exam. During this exam, your doctor inserts a gloved and lubricated finger into your rectum.

Internal haemorrhoids are diagnosed by doing an additional test called a sigmoidoscopy. Sigmoidoscopy involves inserting a small camera into your anus. This small fibre-optic camera, called a sigmoidoscope, fits into a small tube and then inserts into your rectum. From this test, your doctor gets a clear view of the inside of your rectum so that they can examine the haemorrhoids up close.

Your doctor may want to do a more extensive examination of your entire colon using colonoscopy. This might be recommended if your signs and symptoms suggest you might have another digestive system disease, you have risk factors for colorectal cancer or you are older than age 50 and haven’t had a recent colonoscopy.

Treatment at home

• Pain Relief: To relieve pain you can soak in a warm tub of water for at least 10 minutes every day. If pain is very severe see your doctor so treatment can be prescribed. Apply an over-the-counter haemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
• Dietary Fibre: Increasing fibre in the diet prevents constipation which is the commonest cause of haemorrhoids. Good dietary fibre sources include: wheat, brown rice, oatmeal, carrots and bran. Dietary fibre helps create bulk in the intestines, which softens the stool, making it easier to pass.
• Exercise: Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your haemorrhoids.
• Increase your water intake: Drinking adequate water can keep your stool from hardening.
• Avoid straining during a bowel movement: to avoid exacerbating the haemorrhoids
• Keep the anal area clean: Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn’t necessary and may aggravate the problem. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair dryer after bathing. Don’t use dry toilet paper. To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol. Apply ice packs or cold compresses on your anus to relieve swelling.

Medical treatment

Once diagnosis is confirmed, the doctor can prescribe suppositories or ointments that can be used to relieve the pain and swelling associated with the haemorrhoids. If these treatments do not work, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off the circulation of the haemorrhoid by placing a rubber band around it. This causes loss of circulation to the haemorrhoid, forcing it to shrink.

If rubber band ligation isn’t an option, your doctor can inject a chemical into the blood vessel directly. This causes the haemorrhoid to reduce in size. This treatment is known as sclerotherapy.

Surgical procedures

If other procedures haven’t been successful or you have large haemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

• Haemorrhoid removal, also called haemorrhoidectomy. Your surgeon removes excessive tissue that causes bleeding. Haemorrhoidectomy is the most effective and complete way to treat severe or recurring haemorrhoids. Complications may include temporary difficulty emptying your bladder and urinary tract infections associated with this problem.
• Haemorrhoid stapling. This procedure blocks blood flow to haemorrhoidal tissue. Stapling generally involves less pain than haemorrhoidectomy and allows an earlier return to regular activities. Compared with haemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus.

Complications

Complications from haemorrhoids are rare but may include:

• blood clots in the swollen vein called thrombosis.
• bleeding.
• iron deficiency anaemia caused by blood loss.
• Strangulated haemorrhoid.
• If blood supply to an internal haemorrhoid is cut off, the haemorrhoid may be “strangulated,” which can cause extreme pain.

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