Haemorrhoids

Patient Information

What are Haemorrhoids?

Haemorrhoids, or ‘piles’, are the normal blood vessels in the rectum and anus (back passage) that have become enlarged. They may be painful and may cause bleeding and itchiness.

There are two types of haemorrhoids: external (outside) and internal (inside).

External Haemorrhoids

External haemorrhoids are located on the outside of the anus and are covered by skin. When this skin is enlarged, they are called ‘skin tags’. They may be itchy and uncomfortable, and maintaining adequate hygiene around the bottom may be difficult. A lump may felt around the anus. External haemorrhoids may thrombose, which means that a blood clot forms in the blood vessels under the skin tag and this may cause severe pain and a tender lump on the outside of the anus.

Internal Haemorrhoids

Internal haemorrhoids are located inside the back passage in the area where the rectum joins the anus and are covered by the mucous lining of the rectum. They are enlargements of the normal cushions of blood vessels that help to keep the sphincter of your anus tightly closed. Internal haemorrhoids are not usually painful. They most commonly present with bleeding after passing a bowel motion or on wiping. Occasionally, internal haemorrhoids may come down (prolapse) through the back passage and a lump coming down when you have a bowel motion may be felt with painless bleeding. Internal haemorrhoids may be divided into 4 types depending on their severity. Internal haemorrhoids can be very painful when they completely prolapse and cannot be pushed back inside. Prolapsing haemorrhoids often produce mucus and may leave your underclothes stained.

Causes

The exact cause of haemorrhoids is often unknown, however, the factors below may contribute to their development:

Ageing
Chronic constipation or diarrhoea
Pregnancy and childbirth
Straining during bowel movements
Lifting heavy weights incorrectly
Family History
Spending a prolonged period of time on the toilet
Obesity

Treatment

Haemorrhoids may be treated initially with a change in lifestyle. If this fails to improve the symptoms, then surgical management may be recommended.

Simple lifestyle changes include:

A high fibre diet that includes vegetables, fruit, grains and cereals.
Drinking plenty of fluids – at least a litre a day is recommended.

The aim is to prevent constipation and straining which can contribute to haemorrhoids. Your General Practictionner may have already prescribed certain laxatives to soften your bowel motions and make you more regular. Topical preparations such as suppositories and ointments are also useful to control the symptoms of an acute flare-up.

Surgical treatment:

There are various treatment methods available in New Zealand to treat haemorrhoids. The treatment plan depends on the symptoms, type(s) of haemorrhoids identified, and degree of haemorrhoid prolapse.

Rubber Band Ligation (‘Banding’)

This treatment is used on larger internal haemorrhoids that prolapse with bowel motions. This procedure may be done in the clinic, without sedation. This procedure may also be done with sedation or a general anaesthetic, the latter being if surgery is required to remove external haemorrhoids at the same time(skin tags).

Banding involves placing a tiny rubber band over the haemorrhoid using a device called a Ligator, cutting off its blood supply and causing it to fall off in a few days. Generally, you will not notice that you have passed the rubber band/haemorrhoid into the toilet. The inside wound usually heals up within a few weeks.

The procedure may cause some minor bleeding. It is also associated with a dull anal ache which is usually managed with Paracetamol. It may also cause a sensation of a fullness in the back passage which will make you feel like having a bowel motion and may last a few days. It is important to ignore this sensation as much as possible as repeated attempts to pass the banded haemorrhoids may make them swell further.

Phenol injection

This is used for small, minor internal haemorrhoids and causes them to shrivel up over the course of a few weeks. It is less frequently performed than ‘banding’ but does have equivalent results. The injection is done at a clinic visit. It is a quick and relatively painless procedure. The injection is placed into the haemorrhoid itself, and therefore minor bleeding for 48 hrs after the procedure is very common

Excisional Haemorrhoidectomy surgery

This is the surgical removal of haemorrhoids and is required for haemorrhoids that form clots inside them; prolapsing haemorrhoids that cannot be pushed back into the rectum; haemorrhoids that do not respond to ligation; haemorrhoids that keep bleeding; and haemorrhoids associated with troublesome skin tags.

The haemorrhoid and its overlying skin are removed and either left open to heal or stitched closed with dissolving stitches. This surgery may cause postoperative pain for two to four weeks, which is managed with pain-relieving medication, and gentle laxatives. You should be able to return to normal activities within a few weeks. It is important to note that pain and minor bleeding is expected with this surgery and a week off work is usually recommended.

This surgery, is the most common operation that is done and has an excellent success rate and reduced recurrence rate of haemorrhoids.

Other surgical techniques are available, and would be recommended by your surgeon depending on your symptoms and examination findings.