Haemorrhoids, also known as Piles, are a very common disorder that many individuals have but are reluctant to talk about. The term “haemorrhoid” comes from the Greek “haema” (blood) and “rhoos” (flowing). Haemorrhoids may have been treated as early as 2250 B.C. in Babylon and continue to affect many individuals today.
What are haemorrhoids?
Haemorrhoids are swollen veins in the anal canal. This common problem can be painful, but it is usually not serious. Veins can swell inside the anal canal to form internal haemorrhoids, or they can swell near the opening of the anus to form external haemorrhoids. You can have both types at the same time. The symptoms and treatment depend on which type you have.
What causes haemorrhoids?
There are many factors associated with haemorrhoids:
• Too much pressure on the veins in the pelvic and rectal area causes haemorrhoids in some individuals.
• If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch resulting haemorrhoids.
• Diarrhoea or constipation may also lead to straining and can increase pressure on veins in the anal canal resulting in haemorrhoids.
• Many pregnant women can get haemorrhoids during the last six months of pregnancy. This is because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make haemorrhoids worse.
• Being overweight can also lead to haemorrhoids.
What are the symptoms of haemorrhoids?
The most common symptoms of both internal and external haemorrhoids include:
• Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement.
• Itching.
• Rectal pain. It may be painful to clean the anal area.
Internal haemorrhoids
With internal haemorrhoids, you may see bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may see blood on the surface of the stool.
Internal haemorrhoids often are small, swollen veins in the wall of the anal canal. Internal haemorrhoids can be large, sagging veins that bulge out of the anus all the time. They can be painful if they bulge out and are squeezed by the anal muscles. They may be very painful if the blood supply to the haemorrhoid is cut off. If haemorrhoids bulge out, you also may see mucus on the toilet paper or stool.
External haemorrhoids
External haemorrhoids can get irritated and clot under the skin, causing a hard painful lump. This is called a thrombosed, or clotted, haemorrhoid.
How are haemorrhoids diagnosed?
Following a medical history and examination your doctor might be able to diagnose haemorrhoids, but in some cases further tests might be needed.
Further procedures may be needed to identify internal haemorrhoids or rule out other ailments that frequently cause anal bleeding, such as anal fissure, colitis, Crohn’s disease and colorectal cancer.
Do haemorrhoids cause cancer?
Haemorrhoids have no known relationship to colorectal cancer and are not a risk factor. However, the symptoms of haemorrhoids can be similar to those of colorectal cancer, so if you have symptoms such as rectal bleeding, you should see a doctor.
What are the treatments for haemorrhoids?
Some haemorrhoids may go away on their own, but most require some form of treatment, even if it is just a change in eating habits.
Diet plays a key role in the management of haemorrhoids. A diet rich in high-fibre foods and low in processed foods is essential. Increasing fluid intake to six to eight eight-ounce glasses a day is also important. Dietary changes will be needed even if medication or surgery is prescribed.
Most haemorrhoid treatments aim to minimize pain and itching. Warm (but not hot) sitz baths are the most often suggested therapy: sit in about three inches of warm water for 15 minutes, several times a day, especially after a bowel movement. This reduces the swelling in the area and relaxes spasm of the sphincter muscle. If you are pregnant, discuss any treatment, including dietary changes, with your obstetrician before proceeding.
In most cases a high-fibre diet, combined with sitz baths and analgesics such as Tylenol as prescribed, often reduces discomfort within two weeks. If symptoms persist, your health care provider may suggest one of the following procedures. (Many can be performed in your doctor’s office.) Procedures include: injection, banding coagulation or cauterisation and surgery.
Haemorrhoid removal treatments are very effective, but unless dietary and lifestyle changes are made haemorrhoids may recur.
Home remedies
The following might prove beneficial if you suffer from haemorrhoids:
If you have to sit for long periods, take breaks and stretch your legs every hour. A soft cushion may make sitting more comfortable and ease haemorrhoid pressure and pain.
You can insert petroleum jelly just inside the anus to make bowel movements less painful.
With cotton tip use witch hazel, a soothing anti-inflammatory agent, on irritated haemorrhoids to reduce pain and itching, or use over-the-counter anti-haemorrhoidal creams or ointments.
Resist the temptation to scratch haemorrhoids, as it makes everything worse: the inflamed veins become more irritated; the skin around them becomes damaged; and the itching itself intensifies.
Bathe regularly to keep the anal area clean, but be gentle. Excessive scrubbing, especially with soap, can intensify burning and irritation.
Do not force a bowel movement. Sit on the toilet for no longer that five minutes at a time and avoid straining. It you do not have a bowel movement try again later.
When performing any task that requires exertion, be sure to breathe evenly. It is common to hold your breath during exertion and, if you do, you are straining and contributing to haemorrhoid pain and bleeding.
Conclusion
Haemorrhoids are common ailments. It is estimated that by age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of haemorrhoids. There are many effective options available to treat haemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes. If these are not successful see your doctor.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
