Haemorrhoids (Piles)

What are haemorrhoids?

Haemorrhoids or piles is the medical term used to describe dilation or engorgement of the blood vessels (veins) found at the lower end of the rectum or anus. Haemorrhoids can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids). These would be seen as the presence of lumps inside the rectum or around the anus respectively.

What causes haemorrhoids?

Haemorrhoids are usually caused by an increase in pressure within those blood vessels found within the anorectal region (anus and rectum). A number of conditions or factors may contribute to the increase in pressure. 

Some of the contributing conditions or factors are:

• Increased intra-abdominal pressure (e.g. chronic cough, pregnancy, intra-abdominal or pelvic tumours) 
• Excessive straining during defecation from either constipation or even diarrhoea
• Anorectal tumours
• Frequent heavy lifting

Age has been identified as a risk factor for haemorrhoids. This is because as you age, the tissues that support the blood vessels in your anorectal region begin to weaken and can easily stretch. 

What are the symptoms of haemorrhoids?

Some of the commonly occurring symptoms of haemorrhoids are:

• Passage of bright red blood at defecation
• Mucoid discharges
• Swelling at the anus
• Perianal irritation or itch (may develop if anal region is not well cleaned due to the presence of the haemorrhoids)
• Anal pain

How are haemorrhoids diagnosed?

The easiest way to diagnose haemorrhoids is through rectal examination. Your doctor may perform a digital rectal examination (where they insert their fingers into your rectum). This is also to help them rule out other possible conditions.

However, there are some laboratory investigations that may be requested to help confirm the diagnosis of haemorrhoids. Some of these investigations include:

• Proctoscopy
• Sigmoidoscopy
• Anoscopy
• Colonoscopy

Aside from these investigations, a request for a full blood count may also be necessary. This is because the loss of blood through the haemorrhoids may be significant enough and hence result in anaemia.

How are haemorrhoids treated?

When it comes to treating haemorrhoids, the following objectives should be borne in mind:

• Identify and correct anaemia if present
• Treat and relieve any presenting symptoms like pain and itching
• Prevent any further complication

The following lifestyle changes and non-medication related treatment is recommended for people with haemorrhoids:

• Increase your intake of fiber and roughages
• Increase your intake of fluids
• Avoid prolonged straining at defecation (read more on how to manage constipation here)
• For infected haemorrhoids, make use of warm sitz baths 2 to 3 times a day

Some medications too may be recommended for you especially if the presence of the haemorrhoids is affecting your daily activities.

• The use of stool softeners like liquid paraffin 
• The use of soothing agents (with or without steroids) to help relieve anal itching
• Antibiotics may be indicated in the presence of infected haemorrhoids (your pharmacist or doctor will determine the best antibiotic to use)
• The use of iron preparations or blood transfusion (when severe) in the presence of anaemia

There are also surgical options for very bothersome haemorrhoids. Some of the surgical options include:

• Rubber band ligation  (This involves applying a tight elastic band around an internal haemorrhoid to cut off its blood supply. The haemorrhoid then falls off painlessly)
• Haemorrhoidectomy (surgical removal of the haemorrhoids)

Other treatment modalities that may be considered include:

• Injection sclerotherapy (Injection of a haemorrhoid with a chemical that shrinks the blood vessels within the haemorrhoid)
• Infrared photocoagulation (using infrared to destroy the haemorrhoid tissue or its blood supply)

Bibliography

1. Hemorrhoids – Symptoms and causes. (2021). Retrieved 13 July 2021, from https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268
2. Haemorrhoids treatments. (2018). Retrieved 13 July 2021, from https://www.mydr.com.au/gastrointestinal-health/haemorrhoids-treatments/
3. Hemorrhoids – Digestive Disorders – MSD Manual Consumer Version. (2021). Retrieved 13 July 2021, from https://www.merckmanuals.com/home/digestive-disorders/anal-and-rectal-disorders/hemorrhoids?query=hemorrhoids
4. Standards Treatment Guidelines, Ghana, 2017