Haemorrhoids are the the enlargement of a small network of blood vessels just beneath the lining of the anal canal. They are very common and effect between 25-50% of the population.
THEY CAN CAUSE BLEEDING
When they enlarge, they can cause bleeding. Typically, small volume, bright red or fresh blood, visible on the toilet paper, and occasionally in the toilet bowl or on the outside of the stool. Whilst haemorrhoids are completely benign, it is important to exclude more worrying causes of rectal bleeding.
Haemorrhoids can also enlarge and prolapse, and be present as a lump which comes out when passing a motion, or a lump/lumps that is there all the time. Haemorrhoids aren’t typically painful, but can cause discomfort. Pain suggests an alternative diagnosis, or a complication of the haemorrhoids.
NEW PROCEDURE – RECTO ANAL REPAIR (HAL-RAR)
Haemorrhoidal Artery Ligation – Recto Anal repair (HAL-RAR) is a new procedure, which, with the use of an in-built miniature ultrasound device, the surgeon is able to accurately locate the arteries supplying blood to the haemorrhoid. A stitch is placed around the artery and any prolapsing haemorrhoidal tissue can be repaired at the same time with the use of a long stitch to lift up the tissue. The haemorrhoids will shrink over a few weeks and the symptoms resolve.
THE TREATMENT FOR HAEMORROIDS
The treatment for haemorrhoids depends on the severity of symptoms, and the degree of 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 worsening symptoms by 50%.
For higher grade symptoms, rubber band ligation is a technique that applies a tight band to the haemorrhoid within the anal canal. This blocks the blood supply and the haemorrhoid will essentially ‘die’ and fall off. A new technique called Haemorrhoid Energy Therapy utilises the application of a low heat to cause the same effect.
Higher grade haemorrhoids may require surgery with excision (haemorrhoidectomy) or stitching the feeding artery (haemorrhoidal arterial ligation or HAL). The operation needs to be tailored to the haemorrhoids, but also the overall health of the patient and any other medical concerns.
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. Persistent symptoms after haemorrhoidal treatment needs urgent assessment by a colorectal surgeon.
OTHER CONDITIONS WE TREAT
n anal fistula is an abnormal connection from just inside the anal canal usually extending to the skin overlying the buttock
An anal fissure is a tear in the lining of the anal canal, which may occur following the passage of a hard stool.