Haemorrhoids
What are haemorrhoids?
Haemorrhoids are a result of the inflammation of veins supplying the rectum, anal canal and low rectum.
There are two types:
• Internal, which are inside the anus
• External which are under the skin outside the anus
What causes haemorrhoids?
• Straining too much when opening your bowels. This is sometimes caused by constipation.
• Pregnant women are also prone due to the increased weight use of lower rectal muscles and increased pressure in the abdomen due to the foetus.
• Obesity and prolonged sitting down are also associated.
When to suspect haemorrhoids
Symptoms depend on the type of haemorrhoids - internal or external.
Internal: if you have an inflamed haemorrhoid, you may notice scarlet blood in your stools, on toilet paper or perhaps on underwear.
External: an external haemorrhoid would be visible and you may experience a burning sensation, itching, swelling or pain when attempting to open your bowels.
It is often difficult to tell whether it is a haemorrhoid or something else and you should see your GP to discuss this.
How haemorrhoids are treated
In most cases, haemorrhoids can be relieved in a few days.
Some things that may help are:
• Trying to reduce straining while using the loo.
• Using wet tissue/baby wipes when cleaning yourself after a bowel movement.
• Patting the area to reduce friction created by rubbing the area.
Change your diet to soften stools and help to avoid straining by:
• Increasing your fibre intake. Fibre is found in food such as wholegrain bread, cereals, fruit and vegetables.
• Drinking six glasses of water per day and avoiding caffeine. If you feel constipated too, laxatives may also help.
There are also over-the-counter therapies available from your pharmacy. Your surgeon, specialist nurse or pharmacist can discuss these with you.
Medical treatment for haemorrhoids
Eat plenty of fibre such as fruit, vegetables, cereals, wholegrain bread, etc.
Have lots to drink. Adults should aim to drink at least two litres (6-8 glasses) per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens faeces. Most sorts of drink will do, but alcoholic drinks can cause the body to lose fluids (they are dehydrating) and may not be so good. Too much caffeine should also be avoided.
Fibre supplements. If a high-fibre diet is not helping, you can take fibre supplements (bulking agents) such as ispaghula, methylcellulose, bran or sterculia. You can buy these at pharmacies or get them on prescription. Methylcellulose also helps to soften faeces directly which makes them easier to pass.
Avoid painkillers that contain codeine such as co-codamol, as they are a common cause of constipation. However, simple painkillers such as paracetamol may help.
Toileting. Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later. This may result in bigger and harder faeces forming which are then more difficult to pass. Do not strain on the toilet. Piles may cause a feeling of fullness in the rectum and it is tempting to strain at the end to try to empty the rectum further. Resist this. Do not spend too long on the toilet, which may encourage you to strain. (For example, do not read whilst on the toilet.)
Micronized Flavonoid (Diosmin 500mg-Hesperidin) A large meta-analysis of phlebotonics for haemorrhoids in 2012 showed that phlebotonics had significant beneficial effects on bleeding, pruritus, discharge and overall symptom improvement. Phlebotonics also alleviated post-haemorrhoidectomy symptoms.
Flavonoids are an off licensed diet supplement and can be purchased from health shops and major on line providers. (Daflon©, Venarex©,Diosmin)
Surgical treatment for haemorrhoids
The more commonly done procedures include the following:
Injection sclerotherapy - phenol in oil is injected into the tissues at the base of the piles. This causes a scarring (fibrotic) reaction which obliterates the blood vessels going to the piles. The piles then die and drop off, similar to after banding.
Elastic Banding - is a common treatment for grade 2 and 3 piles.
This procedure is usually done by a surgeon in an outpatient clinic, endoscopy or operating theatre. A haemorrhoid is grasped by the surgeon with forceps or a suction device. A rubber band is then placed at the base of the haemorrhoid. This cuts off the blood supply to the haemorrhoid which then dies and drops off after a few days. The tissue at the base of the haemorrhoid heals with some scar tissue.
Infrared coagulation/photocoagulation - this method uses infrared energy to burn and cut off the circulation to the haemorrhoid, which causes it to shrink in size. It seems to be as effective as banding treatment and injection sclerotherapy for first- and second-degree piles.
Diathermy and electrotherapy - use heat energy to destroy the piles. They appear to have similar success rates as infrared coagulation and the risk of any complications is low.
Haemorrhoidectomy (the traditional operation) - an operation to cut away the haemorrhoid(s) is an option to treat grade 3 or 4 piles or for piles not successfully treated by banding or other methods. The operation is done under general anaesthetic and is usually successful. However, it can be quite painful in the days following the operation.
Stapled haemorrhoidopexy - a circular stapling gun is used to cut out a circular section of the lining of the anal canal above the piles. This has the effect of pulling the piles back up the anal canal. It also has the effect of reducing the blood supply to the piles and so they shrink as a consequence. Because the cutting is actually above the piles, it is usually a less painful procedure than the traditional operation to remove the piles.
THD Haemorrhoidal artery ligation - the small arteries that supply blood to the piles are tied (ligated). This causes the haemorrhoid(s) to shrink. As part of procedure Anopexy is performed to reduce the mucosal prolapse oten associated with haemorrhoids. Please visit below web site
http://www.thdlab.co.uk
Strangulated or thrombosed piles
Very painful strangulated or thrombosed piles are not uncommon. The pain may be eased by an ice pack (wrapped in a cloth) pressed on for 15-30 minutes. Strong painkillers and medication to soften the stools may also be needed. Surgery (rarely) is needed to remove the haemorrhoid.
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