Haemorrhoids

Large Bowel Conditions
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Haemorrhoids categorised as either internal or external resulting from dilated venous plexus
Haemorrhoids, also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins

What are haemorrhoids?

Haemorrhoids (Piles) are dilated blood vessels, typically veins, within the anal canal as a result of straining. These blood vessels which are located within the anal cushions play an important role in the control of defecation. Haemorrhoids are graded depending on their location within the anal canal and whether or not they are protruding through the anal sphincter.

The four internal Haemorrhoid grades
Haemorrhoids are graded depending on their location within the anal canal and whether or not they are protruding through the anal sphincter

How do haemorrhoids present?

Haemorrhoids typically present with painless PR bleeding following constipation as these blood vessels have become dilated and to the increased pressure associated with straining when constipated they ‘burst’ and bleed, commonly bleeding is dark red in colour. Although this is a worrying feature, it typically self-resolves and is usually not life threatening however patients on blood thinning medication (anticoagulation) such as warfarin and heparin should seek medical attention as a precaution.

Another manner in which haemorrhoids may present is when patients experience a lump that protrudes on defaecation and then either returns inside or remains outside of the anal canal, and this is used in grading the severity of the haemorrhoids. Another feature could be that a patient notices soiling their under garment as the anal cushions which keep the anal canal shut have become affected. Patients may also experience pruritus ani (itchy sensation of the back passage).

Patients may feel embarrassed when experiencing these symptoms; however seeking early medical advice is key in preventing this condition progressing in severity, as if caught early management is straight forward.

What are the risk factors associated with developing haemorrhoids?

Haemorrhoids are associated with constipation, diets low in fibre and low water intake. Other conditions that increase intra-abdominal pressure have been linked to the development of haemorrhoids; these include pregnancy, ascites, and large abdominal tumours.

 

How are haemorrhoids diagnosed?

After taking a detailed history, the first investigation performed is a PR examination, this involves doctors examining the anal canal which is a quick examination to perform and involves the insertion of a gloved finger into the back passage to see if lumps can be felt. Following this an endoscopic examination may be performed, which allows visualisation of the anal canal. If there is suspicion that the haemorrhoids are related to an underlying undiagnosed pathology then investigations will be specific to the suspected pathology, and may include CT scanning.

Proctoscope examination for colorectal conditions e.g. haemorrhoids
Procedural management options include cryotherapy which involves freezing the haemorrhoid. A proctoscopic examination allows visualisation of the anal canal

Management of haemorrhoids

There are two management options in treating this condition which is dependent on the severity, size and location of the haemorrhoid.

Doctor explaining the lifestyle changes in the management of haemorrhoids
Conservative management of haemorrhoids includes diets high in fibre, adequate hydration, exercising, stool softeners, and topical analgesic creams

Conservative management includes diets high in fibre, adequate hydration, exercising, stool softeners, and topical analgesic creams can be used if pain is experienced.

Procedural management includes; placing a band around the haemorrhoid, thereby closing off the blood vessel completly. Another option is cryotherapy which involves freezing the haemorrhoid.

Therapeutic treatment of haemorrhoids using elastic band ligation
Procedural management options include banding which involves placing a rubber band at the base of the haemorrhoid

Surgical management which is typically only used in severe cases includes: excision or stapling in order to removal the haemorrhoid.