Haemorrhoids

The term haemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed and bulge out into the anal canal. Haemorrhoids may result from straining to move stool when the stools are hard. Other contributing factors include pregnancy, ageing, chronic constipation and anal intercourse. Haemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

Symptoms

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as haemorrhoids. Haemorrhoids usually are not dangerous or life-threatening. In most cases, haemorrhoid symptoms disappear within a few days. 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. This is known as a protruding haemorrhoid.

Symptoms of external haemorrhoids may include a painful swelling or hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external haemorrhoid. In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucous may also cause itching.

Diagnosis

A thorough evaluation and proper diagnosis by the doctor is important at any time when there is bleeding from the rectum or blood in the stool. Bleeding 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 abnormalities. Closer evaluation of the rectum for haemorrhoids requires an exam with an endoscope, a hollow, lighted tube useful for viewing internal haemorrhoids, or a proctoscope, useful for more completely examining the entire anal canal. To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

Treatment

Medical treatment of haemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include:

  • Warm tub baths several times a day in plain, warm water for about 10 minutes.
  • Application of a haemorrhoidal cream or suppository to the affected area for a limited time.
  • Preventing recurrence of haemorrhoids will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fibre and fluids in the diet.

Eating the right amount of fibre and drinking six to eight glasses of fluid (not alcohol) may result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on haemorrhoids caused by straining. Eliminating straining also helps prevent the haemorrhoids from protruding.

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 husk (Metamucil) or methylcellulose (Citrucel) and more recently Benefiber. In some cases, haemorrhoids must be treated endoscopically or surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit. A number of methods may be used to remove or reduce the size of internal haemorrhoids.

These techniques include:

  • Rubber band ligation. A rubber band is placed around the base of the haemorrhoid inside the rectum. The band cuts off circulation, and the haemorrhoid withers away within a few days.
  • Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the haemorrhoid.
  • Infrared coagulation. A special device is used to burn hemorrhoidal tissue.
  • Hemorrhoidectomy. Occasionally, extensive or severe internal or external haemorrhoids may require removal by surgery known as hemorrhoidectomy.

The best treatment, however, is prevention. Keeping stools soft will decrease pressure and straining. Do not resist the urge to empty your bowels, for if you do, you increase the likeliness of developing constipation and haemorrhoids. Exercise, including walking, and increasing the fibre content in your diet helps to reduce the likelihood of developing constipation and straining, by producing stools that are softer and easier to pass. At times special medications may be needed.