Dr Naseem Mirbagheri:
Haemorrhoids are one of the oldest afflictions described in surgical history. Haemorrhoids, or piles, refer to the blood vessels lining the innermost layer of the canal leading to the anus. We all have them and they are just a normal part of our anatomy.
Haemorrhoids act as a cushion in the anal canal and help incontinence, in particular, the ability to retain gas. They’re only abnormal when they start to bother us. The most common symptoms are bleeding, sensation of a lump that may or may not come and go, discomfort, and itch.
Now before I go on, I need to stress that if you see blood on your toilet paper or in the toilet, regardless of what you think it might be, you absolutely must see your doctor to make sure it isn’t something serious or preventable.
But getting back to haemorrhoids. Haemorrhoids can be internal or external. Internal haemorrhoids are blood vessels inside the anal canal and the symptoms from them normally are painless bleeding, usually on the toilet paper, or it may spray on the toilet pan. It can cause lumps, discomfort, and itch.
On the other hand, external haemorrhoids are vessels outside the anal canal, and may show themselves as an acutely painful lump, due to the blood clot. It may leave you with a skin tag after the clot dissolves. Internal haemorrhoids cause problems when the supporting tissue around the anal canal weakens and causes the vessel and its lining to bulge out.
Factors that contribute to this include ageing, chronic constipation or diarrhoea, pregnancy, straining at bowel action or spending too much time on the toilet. How bad your symptoms are usually relate to how far the haemorrhoids have moved downwards. Minimal displacement may result in bleeding only, but if the haemorrhoid prolapses out, it can be felt as a lump that initially may be reducible, but eventually may stick out all the time. What happens is that the mucus produced by the inner lining of the anal canal is also displaced outside, and that can result in perianal itch.
The treatment of simple haemorrhoids or bleeding, once more serious causes have been excluded, is usually dietary, with high fibre intake, such as psyllium husk or Metamucil, increasing fluid intake, and using protective ointments. And importantly, avoiding straining on the toilet, remembering that asymptomatic haemorrhoids do not need treatment.
Other treatment options depend on your symptoms. These include injections or banding of the internal haemorrhoids for the aim of reducing blood flow and symptoms. We can also stitch and tie off the haemorrhoids, which allows us to chop the haemorrhoids if they’re prolapsing out.
Haemorrhoidectomy, which is a removal of the offending blood vessels, is the most effective treatment available, however it’s invasive, and does have a few complications. The procedure involves excising the haemorrhoid or tissue completely, getting rid of the lump, and in the majority of people, bleeding will cease. This treatment is performed under general anaesthesia, usually as a day procedure.
The recovery from haemorrhoidectomy is more prolonged compared to other techniques such as injection or banding, and you really need to take some time off for it. Pain a few weeks after surgery is an issue, but can be reduced with simple pain relievers.
For external haemorrhoids, if you have a sudden painful lump, you can get immediate relief from the pain by removing the clot, and this is best done in the first three days, when the pain is at its worst. Most people, however, absorb the clot without surgery, and it’s possible to look after this condition with simple painkillers as well. However, you may be left with an anal tag, which is a piece of stretched skin from the clot, and this can be removed under general anaesthesia at a later date.
For more information about haemorrhoids or if you have any concerning symptoms, please see your GP or specialist, and remember, never assume that bleeding is harmless, and always get it checked out.