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Haemorrhoids

Haemorrhoids (also known as piles) are one those common human afflictions that cause a great deal of pain and embarrassment. Often, patients try ignoring them because they find it difficult to discuss their problem with a doctor. Let me assure you now, as a GP, that there is nothing to be shy about. There is no need to endure the pain and discomfort associated with haemorrhoids if a doctor can provide you with treatment.

What are haemorrhoids?

The anus has three small cushion-like structures that help ensure you remain continent. These cushions are made of skin and blood vessels. If these blood vessels become congested with blood, those cushions swell and may hang out of the anus. These swollen cushions are called haemorrhoids.

Haemorrhoids can be classified into three main types:

First degree: These are swollen cushions that remain within the anal canal.
Second degree: These are swollen cushions that come out when one opens their bowels, which return after the stool has been passed.
Third degree: The cushions remain outside and do not return into the anal canal.

Why do we get haemorrhoids?

Remarkably, this is still not fully understood. What we do know, however, is that haemorrhoids are far more common in individuals who strain when opening their bowels and those who suffer from constipation. It is also more common where there is an increase in pressure in the veins that make up the vascular cushions. This can occur with pregnancy and some forms of liver disease.

How do I know I have haemorrhoids?

Haemorrhoids can sometimes be felt. They may be discovered when showering or going to the toilet. In many cases, they present with either itching around the anus, fresh blood on wiping and sometimes pain on opening ones bowels or sitting. They feel like small lumps, or grape-like protrusions, around the anus.

If you are passing bright red blood from the anus, it should never be assumed to be due to haemorrhoids. You should always visit your GP. Never let embarrassment get in the way of excluding more serious causes of bleeding.

How are they treated?

The golden rule in medicine is that prevention is better than cure. To avoid haemorrhoids, ensure your diet is high in fibre (eat more bran, fruits and vegetables) and fluids. Avoid straining and spending long amounts of time sitting on the toilet. If you have haemorrhoids already, follow this preventative strategy mentioned in order to prevent further deterioration.

Other strategies for treating haemorrhoids can be split in to either medical or surgical methods. Surgery is usually a last resort and reserved for patients where preventative and medical management has failed.

To help treat the itch, wash the area after opening your bowels and then dry gently. Washing the anus should not be done with soap; this can irritate already inflamed skin. Products like aqueous cream are advised. For haemorrhoids that have prolapsed (or fallen), these can be pushed gently back in by your doctor, and this can alleviate pain. In most cases, GPs will prescribe topical creams and ointments to reduce inflammation. These treatments usually contain a local anaesthetic to help numb pain. Occasionally pain is caused by spasm of anal sphincter, this is sometime treated with special creams that help relax the muscle, or in some specialist centres with Botox injections.

Surgery is usually a last resort. Surgical methods can involve injecting an irritant solution (sclerotherapy) in to the haemorrhoids. This shrinks the haemorrhoids by destroying the veins in the cushions. Another approach is called banding. This method involves a rubber band like structure that is placed in such a way that it kills the blood supply to the haemorrhoid causing it to shrivel. If the above fails, a surgeon can completely remove the haemorrhoids in a procedure referred to as a haemorrhoidectomy.

I must reiterate, that haemorrhoids is a common problem, and it is very treatable. You should not feel embarrassed to approach your GP if you are suffering from this condition. There is no need to suffer when help is readily available.

Dr Shazan Chughtai MB BS

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