Learn more about Haemorrhoids
Did you know that haemorrhoids are so common, that they will cause symptoms in at least 1 in 3 people? Read on for more, and remember that you are not alone!
Haemorrhoids (or ‘piles’) are the enlargement of a small network of blood vessels in the anal canal. They are very common – affecting between 25-50% of the population.
Haemorrhoids can start to lose their attachment to the wall of the anal canal, this allows them to enlarge, and prolapse. As haemorrhoids enlarge, they become fragile and can cause bleeding – this is usually small volume, bright red, and fresh blood on the toilet paper, in the bowl, or on the outside of the stool. Occasionally, blood will leak into the underpants, particularly with passing wind. Bleeding from haemorrhoids can be major, but this is less common.
Whilst haemorrhoids are benign, it is important to exclude more worrying causes of rectal bleeding. This includes rectal polyps or rectal cancer, and unfortunately in young people, rectal cancer is increasing in incidence – we just cannot presume that bleeding is due to haemorrhoids. Bleeding is not normal, and you should see your doctor.
Haemorrhoids can also prolapse, causing a lump when passing a motion, or lumps that are there all the time. These can flare and become irritated, uncomfortable, and they may contribute to soiling or ‘skid marks’. If haemorrhoids get really stuck on the outside, they can become very swollen and painful – this is called “acute thrombosed prolapsed haemorrhoids”.
Unless they do become stuck, haemorrhoids aren’t typically painful – and this is a common misconception. Pain associated with defecation is not usually haemorrhoids, and we need to consider other diagnoses such as an anal fissure.
There are multiple options for treating haemorrhoids – and these aren’t necessarily painful. Dr Morris is an enthusiast for avoiding painful haemorrhoid treatments where possible, and has a range of minimally invasive options that will be discussed if suitable, for you. Please see some of these options below, and in the “Procedures” tab, but your possible options will be carefully discussed in your consultation.
The treatment for haemorrhoids depends on the severity of symptoms and the size or grade of the haemorrhoids.
In minor degrees of haemorrhoids, it is important to avoid constipation and aid the passage of stool. This is done by behavioural measures such as increasing water intake, exercise, dietary fibre in the form of increased fruit and vegetables. A fibre supplement has been shown to reduce bleeding and symptoms by 50%. A fibre supplement eg. psyllium husk, is easily obtainable and palatable, and should be the first measure to reduce your symptoms.
For haemorrhoids requiring intervention, there are options for treatment. Simple options include rubber band ligation – a technique that applies a tight band to the haemorrhoid within the anal canal. This blocks the blood supply, allowing the haemorrhoid to shrink and contract. This is a common technique worldwide, and whilst quite avaiable and effective, can have risks of discomfort, pain and bleeding, and has largely been replaced in Dr Morris’ practice by HET.
A new technique called Haemorrhoid Energy Therapy (HET) is a painless option for many people, utilising the application of a low heat to coagulate the blood vessel supplying the haemorrhoid, allowing the haemorrhoids to shrink and contract. This can be coupled with colonoscopy, so that a colonoscopy to investigate bleeding can have haemorrhoids treated at the same time. This requires no time off work, and almost no restriction of activities after treatment.
Higher grade haemorrhoids may require formal surgery, and Dr Morris discuss the options with you.
HAL-RAR is a well tolerated (and often painless) technique, where an ultrasound is used to guide a stitch to tie off the haemorrhoidal artery. The prolapsing component of the haemorrhoid is then tightened, a little like a ‘facelift of the anus’. This is repeated all the way around the anal canal, and is a common option particularly for women after childbirth, or where incontinence is a particular concern.
An excisional haemorrhoidectomy is reserved for the largest haemorrhoids, and the benefits and drawbacks of this operation will be discussed.
Dr Morris is trained in stapled haemorrhoidectomy, but has chosen not to offer this procedure given the particular risks of this procedure. Whilst other surgeons may offer this procedure, Dr Morris has decided that the risks of possible chronic pain, rectovaginal fistula, rectal dysfunction and infection are not worth the risks for his patients. For patients in whom anal sex is important, the presence of a potentially sharp staple line is of particular concern and should be avoided.
Dr Morris will assess your symptoms, and perform a careful examination to allow a tailored discussion to approach your haemorrhoid symptoms together.
Please consider rectal bleeding as a symptom requiring urgent assessment. There are many causes of rectal bleeding, and we can very quickly delineate the precise cause. Please consider this important symptom a potential warning sign, and see your GP and/or your Colorectal Surgeon. A CSSANZ Accredited Colorectal Surgeon can be found at https://cssanz.org/ and “find a surgeon”.