HAEMORRHOIDS

Definition of haemorrhoids

Haemorrhoids, also called piles, are enlarged, engorged and inflamed veins in or around the posterior opening of the digestive tract (rectum and anus). They are caused by increased pressure in the veins of the rectum or anus, resulting from straining when trying to have a bowel movement, or any activity causing straining, such as heavy lifting. As pressure increases, blood pools in the veins and causes them to swell, thus stretching the surrounding tissue. Haemorrhoids can be inside and/or outside the anus. They are not dangerous.

The internal haemorrhoids are classified according to their localization:

• 1st degree: small swellings on the inside lining of the anal canal, not visible outside the anus
• 2nd degree: the swellings are larger and stick out from the anus during bowel movement, but return inside afterwards
• 3rd degree: the swellings are similar as above but hang out from the anus and only return inside when pushed bask with a finger
• 4th degree: the haemorrhoids hang permanently down from the anus and can not be pushed back inside.

The external haemorrhoids are small lumps developing on the outside edge of the anus.

Frequency of haemorrhoids

Haemorrhoidal disease is quite common both in men and women as more than half of the population will suffer one time or another from haemorrhoids with figures varying from 58% to 86% depending on the sources. In England, 1123 persons out of 100,000 consult a physician for that reason, as well as 1177 in the USA where the incidence of haemorrhoid reaches more than 10 million people. In Australia, 209,000 people reported having haemorrhoids in 2001.In France one out of 3 persons suffers from haemorrhoids. The incidence increases with age with a peak at about 65 years, with an equal distribution in both sexes.

Symptoms of haemorrhoids

Common symptoms are:

• bright red blood from the anus on toilet paper or coating the stool or in the toilet
• itching around the anus
• pain and discomfort during and after bowel movement
• slimy discharge of mucus
• one or several tender lumps near the anus
• feeling that the bowels have not completely emptied.

Diagnosis of haemorrhoids

Episodes of haemorrhoidal trouble generally appear and disappear fairly quickly, but if the problem lasts or worsens or if there are symptoms such as blood in the stools, it is recommended to see a doctor. After questioning about the current general health, past medical history and symptoms, the doctor will examine the anus and rectum to look for swollen blood vessels that indicate haemorrhoids and will perform a rectal examination with a gloved lubricated finger to fell for any abnormalities. Internal haemorrhoids can normally not be felt in this way but the examination can reveal other problems which will need to be excluded before a precise diagnosis can be made. A thorougher evaluation of the rectum for haemorrhoids necessitates an examination with an anoscope, a hollow lighted tube used for viewing internal haemorrhoids, or a proctoscope, allowing to examine the entire rectum. In order to exclude other causes of bleeding, the doctor may examine the rectum and the lower part of the large bowel (also called colon or sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. The two latter diagnostic procedures also involve the use of lighted flexible tubes inserted through the rectum.

Risk factors

• Constipation with chronic straining
• Chronic diarrhoea eroding the local mucosa
• Pregnancy as the baby may press on the main blood vessels that return blood to the heart and the change in hormone levels can increase the pressure in the veins
• Overweight, increasing the pressure in the veins of the rectum and anus
• Heavy lifting jobs, because they also increase the pressure in the ano-rectal veins
• Eating, drinking and smoking habits: alcohol, spices, coffee, smoking
• Sedentary lifestyle
• Family history of haemorrhoids.

Complications of haemorrhoids

• Strangulation: when a haemorrhoid that sticks out of the body (prolapsed haemorrhoid) swells considerably and the blood flowing into it cannot return to the body
• Thrombosis: when the blood clots in the swollen haemorrhoid, forming a thrombosed haemorrhoid
• Infection: when an abscess forms around the rectum and causes pain and swelling
• Tissue death or gangrene: when there is a lack of blood supply to the haemorrhoid.

Prevention and management of haemorrhoids

The initial treatment of haemorrhoids involves conservative measures to reduce symptoms and help to prevent the development of secondary complications and disease progression:

Conservative treatment

• General preventive measures
• Eat a fibre-rich diet and consider fibre supplements
• Drink at least 1.5 litre of fluid a day
• Avoid spices, coffee, alcohol and smoking
• Empty bowel at regular time or as soon as the urge occurs
• Avoid straining when passing a bowel motion
• Avoid strong laxatives as they may lead to diarrhoea which can worsen haemorrhoids
• Try not to scratch the anal area
• Avoid carrying too heavy weights
• Avoid cycling and horse riding
• Sitting in a shallow bath of warm water for 10-15 minutes several times a day may reduce pain and irritation
• Ice packs may on the other hand help to reduce swelling but do not apply ice directly to the skin
• Avoid toilet tissue with perfumes or colours
• Wear cotton undergarments
• Prevent excess weight
• Exercise regularly (walking, swimming).
• Therapeutic measures
• Oral treatments
• Venoactive drugs (also called venotonics, vasoprotectors, phlebotropics, venotropics, oedema-protective agents) of synthetic or plant origin reduce local inflammation, oedema, pain, discharge, itching and bleeding
• Stool softeners and mild bulk-forming laxatives may help to reduce constipation and straining
• Local treatments
• Antihaemorrhoidal creams or suppositories containing a venoactive drug and a local anaesthetic such as lidocaine provide relief from discomfort and pain
• Some creams contain in addition a corticosteroid such a dexomethasone to reduce inflammation and pain
• Oral and local treatments may be associated without problem.

Interventional treatment

• Rubber band ligation is a common treatment for 2nd and 3rd degrees internal haemorrhoids but can also be used for 1st degree ones. It involves placing a rubber band around the base of the haemorrhoid with a special applicator. As the band cuts off blood circulation, the haemorrhoid will shrink and drop off after a few days. The haemorrhoid is passed with the stool and the band falls off with time
• Sclerotherapy involves the injection of a chemical product into the haemorrhoid to make it shrink
• Light coagulation with infrared rays restricts blood flow by burning of the haemorrhoidal tissue, causing the haemorrhoid to shrink and drop off
• Cryosurgery freezes the haemorrhoids, causing them to shrink and to fall off
• Haemorrhoidectomy is performed when extensive or severe internal (usually 4th degree) or external haemorrhoids may require removal by surgery.

Any medical information on this website is not intended as a substitute for informed medical advice. No action should be taken before consulting with a healthcare professional.

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