What are haemorrhoids?
Haemorrhoids (hemorrhoids or piles) are dilated blood vessels in the lower rectum and anal canal. These blood vessels are normal and present in all people. The haemorrhoidal cushions assist us to maintain continence and avoid stool leakage.
What causes haemorrhoids?
Haemorrhoids are enlarged vascular structures within the anal canal. The causes for enlargement and the subsequent symptoms of haemorrhoids are:
- Straining to defecate
- Prolonged sitting on the toilet
- Child birth
- Liver failure
What symptoms can haemorrhoids cause?
Haemorrhoids can enlarge and cause problems over time. The blood vessels can become engorged and stretch, with weakening of the connective tissue that usually keep the haemorrhoids in their normal position. As the connective tissue weakens, the haemorrhoids can bulge into the anal canal causing symptoms.
Symptoms of haemorrhoids may include:
- Bleeding: Typically this is painless bright red bleeding present on the toilet paper after a bowel motion. Darker bleeding, clots, painful bleeding or heavy bleeding always warrants further investigation
- Pain: Most haemorrhoids are in fact painless. Pain or milder discomfort can occur if the haemorrhoid prolapses out the anal canal and becomes inflamed, or if a blood clot develops within the haemorrhoid (thrombosed haemorrhoids)
- Anal lump: Internal haemorrhoids (i.e. those usually located inside the anus) may enlarge and prolapse outside the anus, often after a bowel motion. Early on they tend to go back to their original position, however over time can pop out more easily and either stay outside the anus, or require manual reduction with a finger. External haemorrhoids are enlarged blood vessels around the outside of the anus and can become enlarged in a similar manner
- Itching or wetness: The skin around the anus can become irritated from mucous leakage from inside the anal canal
- Difficulty maintaining hygiene: Enlarged haemorrhoids with or without skin tags can cause problems with maintaining hygiene in the perianal region. People often describe needing to wipe excessively after a bowel motion, or needing to shower to eradicate residual stool in the area.
What tests are required?
Your colorectal surgeon will take a thorough history of your current symptoms, as well as your overall medical and family history. A clinical examination in the office usually confirms the presence or absence of haemorrhoids. This may include a proctoscopy or rigid sigmoidoscopy to visualise inside the anal canal and rectum. It is extremely important to note that the presence of haemorrhoids does not mean that they are the source of any rectal bleeding. Colon and rectal cancer can cause the same symptoms (bleeding) and as such a colonoscopy or flexible sigmoidoscopy is generally required to exclude any sinister pathology.
What is the best treatment for haemorrhoids?
Like most things, prevention is better than cure. Avoiding constipation and straining along with a healthy diet high in fibre will go a long way to avoiding the development or haemorrhoids. It is also recommended to improve the symptoms associated with established haemorrhoids. A regular (daily) fibre supplement such as Metamucil® or Benefiber® is generally worthwhile, and plenty of water to prevent dehydration. Avoiding long periods of time on the toilet is also essential, as this position causes a tourniquet-like effect preventing venous drainage of the haemorrhoids causing enlargement. So no reading the newspaper and definitely no iPhone or iPad on the toilet!
There are various surgical approaches for the treatment of haemorrhoids. Dr Harris will discuss the different operations with you and tailor the treatment depending on your needs.
Do haemorrhoids cause bowel cancer?
No. There is no association between bowel cancer and haemorrhoids. The symptoms of both are very similar (i.e. bleeding), and as such your surgeon will likely recommend a colonoscopy to assess the bowel to ensure there is no sinister cause for your bleeding before embarking on surgical management of the haemorrhoids.
When to seek a specialist review?
Patients with mild bright red blood per rectum with any of the following should be referred for colonoscopy:
- Bleeding that is heavy, dark red or black, painful or worsening
- Patients with iron deficiency anaemia
- Constitutional ("red flag") symptoms – anaemia, change in bowel habit, weight loss or anorexia
- Those with a family history of colorectal cancer
- Previous colonoscopy performed more than three years prior
- Any other symptoms or concerns the patient or medical practitioner may have
Should I perform a faecal occult blood test (FOBT)?
In the presence of visible bleeding, there is no value in performing FOBT. Please ask your GP for direct referral to a specialist for a colonoscopy.
Can I have my haemorrhoids treated at the time of colonoscopy?
Yes. We have systems in place that allow patients to undergo direct evaluation of the bowel with colonoscopy to exclude any serious pathology, with haemorrhoid surgery at the same time under the same anaesthetic. This is generally more convenient for patients and with minimally invasive techniques allows rapid recovery and return to work.