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Haemorrhoids.

What are haemorrhoids?

Haemorrhoids, also known as piles, is a condition when the veins or blood vessels in the lowest part of your rectum or anus become swollen. If the swollen veins are inside of your rectum, then they are referred to as internal haemorrhoids; if they are noticed around the skin on your anus, then they are termed as external haemorrhoids.

Haemorrhoids can cause irritation, rectal bleeding, and difficulty in passing stool.

Haemorrhoids are usually caused due to strain on the lower rectum and anus during bowel movements or pregnancy. But there are a number of other factors that contribute toward the appearance of haemorrhoids, which calls for haemorrhoids treatment to be just as diverse.

What causes haemorrhoids?

Haemorrhoids have a number of causes, however in many cases the cause is unknown. They often result from straining during bowel movements which can be aggravated by constipation or from the increased pressure on the veins such as during pregnancy.

Other causes:

  • Chronic diarrhoea: Recurring bowel movements can aggravate the veins draining blood from the area
  • Obesity: Similar to pregnancy the increased pressure on the veins draining causes pooling of blood in the haemorrhoids
  • Anal intercourse: Direct trauma to the anal lining can disrupt the normal blood flow to and from the anus.

What are the symptoms?

  • Bleeding, usually during bowel movement. This can be bright red blood and can often present as a sudden ‘splash’ of blood into the toilet bowl.
  • Anal pain exacerbated during bowel movements
  • Skin irritation and itching: This is caused by a low grade inflammatory response in the anal skin.
  • Discomfort: Many people complain of a feeling of heaviness and fullness which can be very unpleasant.
  • Tenesmus: Feeling like one needs to pass stool when there is no stool to be passed.

Bleeding from haemorrhoids can be unpredictable and very embarrassing, soiling clothes and even limiting activities.

Occasionally, haemorrhoids can get complicated:

  • Thrombosed or strangulated haemorrhoid: A clot may form in a hemorrhoid which can cause severe pain.
  • Anaemia: can occur due to chronic or excessive bleeding. These are not dangerous but can be extremely painful.

How common are haemorrhoids?

Haemorrhoids represent the most common condition that affects the anorectal area and is experienced by 1 in 3 people.

They are very common and affect millions of people worldwide.

They are also very common in pregnancy due to pressure effects on the pelvic veins caused by the growing baby.

Types of Haemorrhoids:

These are the two types of haemorrhoids.

Internal haemorrhoids

These lie inside the rectum. They can cause bleeding during passage of stool. Occasionally they can protrude through the anus and cause pain and irritation.

  • Prolapsed haemorrhoids are internal haemorrhoids that have been pushed out of your rectum during a strained bowel movement. They cause significant discomfort and pain.

External haemorrhoids

These occur in the skin around the anal area and can cause itchiness, discomfort, pain and bleeding.

  • Thrombosed haemorrhoids occur when your external haemorrhoids turn into hard lumps around your anus after blood has pooled into them and caused a clot, which is also called thrombus. Thrombosed haemorrhoids are by far the most painful and discomforting of all types of haemorrhoids.

How are haemorrhoids diagnosed?

The symptoms of haemorrhoids are a clue that you may indeed have them. A skilled medical doctor will need to examine you to confirm the diagnosis as well as to classify them according to their severity. External haemorrhoids can be seen on the anus. Internal haemorrhoids may require the passage of a small camera scope which is done under sedation by a specialist.

Sometimes, even after all the prevention techniques and care, you can still get haemorrhoids. Haemorrhoids often can improve with adequate medical treatment but can recur, relapse and can continue to be disruptive.
In this case more definitive treatment is needed to resolve the symptoms

How are haemorrhoids treated?

Prevention:

  • Avoid constipation
  • Increasing fibre in your diet and drinking lots of fluids
  • Exercise
  • Going to the loo as soon as you feel the urge

Symptomatic relief:

  • Over the counter creams, suppositories, ointment, and cold packs. These ointments often contain cortisone and a local anaesthetic agent.
  • Pain medication

Definitive Treatments:

  • There are various haemorrhoids treatment that can cause the hemorrhoid to shrink (sclerothrapy, rubber band ligation and coagulation). These can be performed in the doctor’s office and are effective.
  • THD: the surgeon occludes the supplying artery to the haemorrhoid by tying off its blood supply guided by a Doppler ultrasound probe
  • Haemorrhoids stapling, leaves small staples in the rectal wall
  • Surgery: the bed of haemorrhoidal veins is cut from the rectal wall.
  • Haemorrhoid embolization.
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