Haemorrhoids

While the exact cause of haemorrhoids remains unknown, a number of factors which increase intra-abdominal pressure, in particular constipation, is believed to play a role in their development.

Anyone at any age can be affected by haemorrhoids. However, they are usually more common in elderly people and during pregnancy. Researchers are not certain what causes haemorrhoids. “Weak” veins – leading to haemorrhoids and other varicose veins – may be inherited. It’s likely that extreme abdominal pressure causes the veins to swell and become susceptible to irritation. The pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do physical labour.

Diet has a pivotal role in causing – and preventing – haemorrhoids. People who consistently eat a high- fibre diet are less likely to get haemorrhoids, but those who prefer a diet high in processed foods are at greater risk of haemorrhoids. A low-fibre diet or inadequate fluid intake can cause constipation, which can contribute to haemorrhoids in two ways: it promotes straining on the toilet and it also aggravates the haemorrhoids by producing hard stools that further irritate the swollen veins.

Most cases of piles (haemorrhoids) are mild, and the symptoms often disappear on their own after a few days. Some people may not even realise they have haemorrhoids, as they do not experience symptoms. However, when symptoms do occur they may include:

• bleeding after passing a stool (the blood will be bright red)
• itchiness around your anus (the opening where stools leave the body)
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
• a mucus discharge after passing a stool
• soreness, redness and swelling around your anus

First, your gastroenterologist will look at the anal area, perhaps by inserting a lubricated gloved finger. Your gastroenterologist may decide to use a proctoscope to examine the ano-rectal region.

If the bleeding occurs more than once or twice, most patients will require a definitive procedure called colonoscopy or flexible sigmoidoscopy under light sedation to identify internal haemorrhoids, and at the same time to rule out other ailments that frequently cause anal bleeding, such as anal fissure, colitis, Crohn’s disease. Colorectal cancer (or bowel cancer) must be excluded in people above the age of 50.

Initial treatment for mild to moderate disease consists of increasing fibre intake, oral fluids to maintain hydration, topical medicines to help with pain, and rest. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Injection of bleeding haemorrhoids by your Gastroenterologist or Surgeon can be useful in many cases to prevent further bleeding. Ask your doctor who is performing the colonoscopy if injection can be done whilst you are under sedation (ie. At the same time as your colonoscopy) to avoid pain during injection. It also avoids the need for repeat sedation for the purpose of injection at another time. In more recent years, gastroenterologists tend to use a medicine called “phenol in oil” to inject the haemorrhoids. This causes a scarring (fibrotic) reaction which obliterates the blood vessels going to the piles.

Banding is a procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off after about a week. Surgery under general anaesthetic (where you are asleep) is sometimes used to remove or shrink large or external haemorrhoids but surgery is often the last resort.

Once you know for certain that rectal bleeding is due to haemorrhoids, you can make lifestyle changes to reduce the strain on the blood vessels in and around your anus to prevent recurrent bleeding. These can include:

• gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, whole wheat pasta and bread, seeds, nuts and oats
• drinking plenty of fluid, particularly water, but avoiding or cutting down on caffeine and alcohol
• not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
• avoiding medication that causes constipation – such as painkillers that contain codeine
• losing weight if you are overweight
• exercising regularly – this can help prevent constipation, reduce your blood pressure and help you lose weight

If your stools are lumpy or if you suffer from constipation, you can ask your gastroenterologists for specific advice.

Obtaining accurate and useful advice from an appropriately qualified Specialist (Gastroenterologist or Colorectal Surgeon) will prevent further long term problems and recurrent bleeding haemorrhoids. You may need further definitive investigation to rule out other sinister conditions. If you are above the age of 50, it is always recommended that rectal bleeding is further investigated rather than assumed to be from haemorrhoids.

You can call our office and talk to one of our receptionists on (Rosebud Endoscopy). Alternatively, you can make a booking online for a formal consultation or colonoscopy by one of our Gastroenterologists.