By Dr Joel Enejeta
Haemorrhoids which is also known as piles are enlarged or swollen veins located at the lower part of the rectum or the anus. They have numerous causes although, most times the causes are unknown. They may be caused by pressure effects on the abdomen such as pressure due to pregnancy and also through straining effect of bowel movement (defecation).
Haemorrhoids are very common among adults, out of 10 adults, about 7 will develop haemorrhoids from time to time, most times they are asymptomatic but some may experience bleeding, itching and discomfort.
Sometimes thrombosed haemorrhoids are formed, these are not dangerous but may be very painful which may require draining.
Haemorrhoids may be internal or external depending on their location. It is internal when it is located inside the rectum and external when located under the skin around the anus.
THE FOLLOWING SIGNS AND SYMPTOMS MAY BE OBSERVED WHEN YOU DEVELOP HAEMORRHOIDS
- Painless bleeding during defecation- this may appear as bright red blood and may be minute to observe.
- Itching or irritation around the anus.
- Pain or discomfort
- Swelling around the anus
- A feel of mass around the anus.
The veins around the anus tend to stretch under pressure and may bulge or swell. Swollen veins (haemorrhoids) can develop from increased pressure in the lower rectum due to:
- -Straining during bowel movements
- -Sitting for long periods of time on the toilet
- -Chronic diarrhea or constipation
- -Anal intercourse
- -Low-fiber diet
Hemorrhoids are more likely with aging because the tissues that support the veins in the rectum and anus can weaken and stretch.
Complications of haemorrhoids are very rare but include:
Anaemia. Rarely, chronic blood loss from haemorrhoids may cause anaemia, in which you don’t have enough healthy red blood cells to carry oxygen to your cells.
Strangulated haemorrhoid. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be “strangulated,” another cause of extreme pain.
You can often relieve the mild pain, swelling and inflammation of haemorrhoids with home treatments. Often these are the only treatments needed.
Eat high-fibre foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can worsen symptoms from existing haemorrhoids. Add fibre to your diet slowly to avoid problems with gas.
Use topical treatments. Apply an over-the-counter haemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet.
Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Avoid alcohol-based or perfumed wipes. Gently pat the area dry or use a hair dryer.
Don’t use dry toilet paper. To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol.
Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.
Take oral pain relievers. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) temporarily to help relieve your discomfort.
With these treatments, haemorrhoid symptoms often go away within a week. See your doctor if you don’t get relief in a week, or sooner if you have severe pain or bleeding.
If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel, or hydrocortisone and lidocaine, that can relieve pain and itching, at least temporarily.
Don’t use an over-the-counter steroid cream for more than a week unless directed by your doctor because it may cause your skin to thin.
External haemorrhoid thrombectomy
If a painful blood clot (thrombosis) has formed within an external haemorrhoid, your doctor can remove the clot with a simple incision and drainage, which may provide prompt relief. This procedure is most effective if done within 72 hours of developing a clot.
Minimally invasive procedures
Rubber band ligation of haemorrhoid
For persistent bleeding or painful haemorrhoids, your doctor may recommend one of the other minimally invasive procedures available. These treatments can be done in your doctor’s office or other outpatient setting and do not usually require anesthesia.
Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal haemorrhoid to cut off its circulation. The haemorrhoid withers and falls off within a week. This procedure is effective for many people.
Haemorrhoid banding can be uncomfortable and may cause bleeding, which might begin two to four days after the procedure but is rarely severe. Occasionally, more-serious complications can occur.
Injection (sclerotherapy). In this procedure, your doctor injects a chemical solution into the haemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal haemorrhoids to harden and shrivel.
While coagulation has few side effects and may cause little immediate discomfort, it’s associated with a higher rate of haemorrhoids coming back (recurrence) than is the rubber band treatment.
If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Your surgery may be done as an outpatient or may require an overnight hospital stay.
Haemorrhoid removal. In this procedure, called haemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anaesthetic combined with sedation, a spinal anaesthetic or a general anaesthetic.
Haemorrhoidectomy is the most effective and complete way to treat severe or recurring haemorrhoids. Complications may include temporary difficulty emptying your bladder and resulting urinary tract infections.
Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.
Haemorrhoid stapling. This procedure, called stapled haemorrhoidectomy or stapled haemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal haemorrhoids.
Stapling generally involves less pain than haemorrhoidectomy and allows for earlier return to regular activities. Compared with haemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Complications can also include bleeding, urinary retention and pain, as well as, rarely, a life-threatening blood infection (sepsis). Talk with your doctor about the best option for you.