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Haemorrhoids

Haemorrhoids

Haemorrhoids, commonly known as piles, are swollen blood vessels in or around the anus and rectum. The haemorrhoidal veins are located in the lowest part of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements. Haemorrhoids are classified into two general categories - internal and external.

 

Internal haemorrhoids lie far enough inside the rectum that you can't see or feel them. They don't usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign that they are there. Sometimes internal haemorrhoids prolapsed or enlarge and protrude outside the anal sphincter. If so, you may be able to see or feel them as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed haemorrhoids may hurt because they become irritated by rubbing from clothing and sitting. They usually recede into the rectum on their own; if they don't, they can be gently pushed back into place.

External haemorrhoids lie within the anus and are often uncomfortable. If an external haemorrhoid prolapsed to the outside (usually in the course of passing a stool), you can see and feel it. Blood clots sometimes form within prolapsed external haemorrhoids, causing an extremely painful condition called a thrombosis. If an external haemorrhoid becomes thrombosis, it can look rather frightening, turning purple or blue, and could possibly bleed. Despite their appearance, thrombosis haemorrhoids are usually not serious and will resolve themselves in about a week. If the pain is unbearable, the thrombosis haemorrhoid can be removed with surgery, which stops the pain.

Anal bleeding and pain of any sort is alarming and should be evaluated - it can indicate a life-threatening condition, such as bowel cancer. Haemorrhoids are the main cause of anal bleeding and are rarely dangerous, but a definite diagnosis from your doctor is essential.

What causes haemorrhoids?

Anyone at any age can be affected by piles. They are very common, with about 50% of people experiencing them at some time in their life. However, they are usually more common in elderly people and during pregnancy. Researchers are not certain what causes haemorrhoids. "Weak" veins - leading to haemorrhoids and other varicose veins - may be inherited.

It's likely that extreme abdominal pressure causes the veins to swell and become susceptible to irritation. The pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do physical labour.

Diet has a pivotal role in causing - and preventing - haemorrhoids. People who consistently eat a high-fibre diet are less likely to get haemorrhoids, but those who prefer a diet high in processed foods are at greater risk of haemorrhoids. A low-fibre diet or inadequate fluid intake can cause constipation, which can contribute to haemorrhoids in two ways: it promotes straining on the toilet and it also aggravates the haemorrhoids by producing hard stools that further irritate the swollen veins.

How to Get Rid of Haemorrhoids: Causes and Treatments:

Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist.

Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. For patients with constipation,

high fiber diet, adequate hydration and stool softeners may be required. For those with too frequent bowel movements, ant diarrheal medications and diet adjustments may be required. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling.

Once hemorrhoid symptoms develop, a variety of treatment options exist, depending upon the situation and severity of the hemorrhoids.

Internal hemorrhoids are graded by the degree of prolapsed below the pectinate line into the anal canal.

  • Grade 1: the internal haemorrhoid bulges into the canal but does not prolapsed or fall completely into it. These may bleed.
  • Grade 2: the haemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
  • Grade 3: the haemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
  • Grade 4: the internal haemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.

Non-surgical approaches

Grade 2 and 3 hemorrhoids are initially treated the same way, using techniques to destroy the hemorrhoid. These include injecting the hemorrhoid vein to make it sclerose or harden, using rubber bands to choke off the blood supply and make the hemorrhoid tissue shrivel, or other procedures that cause the mucosa to shrivel and die.

Patients who have failed conservative therapy or who have grade 4 hemorrhoids are candidates for surgery to remove the swollen hemorrhoids and the larger external hemorrhoid skin tags. Options include hemorrhoid removal with laser surgery or haemorrhoidectomy (ectomy =removal) using a scalpel. Another alternative is stapled haemorrhoidectomy, where a special staple gun is positioned to remove the hemorrhoid and surround the tissue with a ring of staples to close the area as well as controlling the bleeding.

A thrombosed external hemorrhoid indicates that a clot has formed in the hemorrhoid causing significant pain. Treatment involves cutting into the hemorrhoid to remove the clot and reduce the swelling.

What is the prognosis for haemorrhoids?

The goal is to control hemorrhoid inflammation by diet and hydration so that surgery is no need.