Haemorrhoids (or piles) are vascular internal cushions that reside in the anal canal. They are, in fact, a normal part of our anatomy and have a small role in maintaining bowel continence (control).
These are true haemorrhoids that can cause symptoms such as rectal bleeding, prolapse (protrusion), itch and perianal discomfort. Bleeding is usually bright red, painless and separate from the stool. Uncomplicated internal haemorrhoids can be graded as follow
Severe pain is not usually a feature of internal haemorrhoids unless they become prolapsed and strangulated (lose blood supply) or thrombosed ( a clot develops in the vein).
This is a painful external perianal lump that develops acutely usually after straining at stool or during exrercise(but not always). It is not a true haemorrhoid but often referred to as one. It is different from an internal haemorrhoid that prolapses and becomes external.
People often have excess skin at the anal verge and they quite often mistake these for haemorrhoids. They arise usually from previous haemorrhoids (or other perianal conditions) that have stretched the perianal skin. They often cause no symptoms and do not require treatment. Some people are bothered by them and find it hard to clean the perianal area after a motion. The only treatment is surgical excision.
As noted above, all people have haemorrhoids. There are risk factors that lead to haemorrhoids becoming symptomatic. Any change in healthy bowel habits can lead to symptomatic haemorrhoids. This includes straining to defaecate, constipation, spending a long time on the toilet, excessive loose motion. Very strenuous exercise is another risk as well as pregnancy because of the weight of the uterus and hormonal changes.
Haemorrhoids can usually be diagnosed by inspection of the anal area, a digital examination and proctoscopy (a small scope into the anus). As ‘haemorrhoidal symptoms’ such as bleeding can be also present in more sinister pathologies such as colorectal cancer, a colonoscopy is usually recommended especially in patients over 40 years.
In all cases, it is important to correct abnormal bowel habits and a poor diet low in fibre. Bulking agents such as Metamucil, psyllium husk or benefiber are often all that is required to correct constipation. People should only defaecate when they have a strong urge and spend as short amount of time as possible on the toilet. Regular exercise and a good fluid intake (1.5 – 2L/day) is important.
There are multiple over the counter topical creams, ointment and suppositories that contain a mixture of local anaesthetic, steroid and antiseptic. Such agents include proctesydyl, rectinol and anusol. These can relieve irritation, itch and swelling temporarily. They have not been shown to be greatly effective in trials and should not be used long term.
There are multiple procedures described to treat haemorrhoids. These include