Haemorrhoid

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Haemorrhoids, also known as piles, develop from distension and engorgement of blood vessels which normally supply blood to the back passage or anal canal. There are several risk factors which are known to predispose individuals to the condition, such as long standing constipation, low fibre diet, being overweight or obese, pregnancy, and spinal cord injury. It is a common condition as 40% of adults are thought to experience symptoms of piles in their lifetime. Typical symptoms are:
  • Bright red bleeding – This is particularly noted after a bowel movement and can be associated with varying degrees of blood loss.
  • A swelling that protrudes out of the anus typically after a bowel movement. They may spontaneously resolve or may require manual reduction. Alternatively, the haemorrhoids may remain permanently in a prolapsed state.
  • Pain – significant exacerbation of pain around the back passage may suggest that the blood within the prolapsed haemorrhoid may have clotted. This is also known as a thrombosed haemorrhoid.
  • Itching around the anus which may be associated with soreness or mucus discharge.

During your clinic consultation, we will ask you about your symptoms and we will perform a physical examination. The condition can be diagnosed in clinic by examining the anus using a small instrument inserted through the anus to allow visualisation of the anal canal, a process known as proctoscopy. Some patients may be advised to undergo further tests such as a colonoscopy (examination of the entire length of the large bowel using a flexible camera) to exclude other abnormalities which may develop in the colon and rectum.

There are several effective ways of minimising symptoms associated with haemorrhoids by simply adopting some lifestyle and dietary modifications. These include:
  • Increasing the amount of fibre and fluid in the diet to make the stools soft, thus reducing the need to strain during bowel movement.
  • Regular exercise
  • Avoiding medications that can cause constipation.
Some patients may also benefit from medications such as:
  • Stool softeners to aid passage of softer motions
  • Short term use of medications specific for piles.
If the symptoms persist despite these measures, surgery may be an option. It is important that surgery to haemorrhoids are tailored to individual patient’s symptoms and needs. There are various treatments available, many of which have been developed in the past 10 to 15 years. Some surgeries are less painful than traditional surgical treatments and may allow earlier return to normal function.  

This is suitable for small internal piles or those that spontaneously reduce. A small rubber band is placed over the pile, cutting its blood supply. This procedure may produce slight discomfort and urgency for a few days which will gradually subside. The band and the shrunken pile will normally fall off after 3-5 days, leaving a small scar at its base. Minimal bleeding can be expected when the band and pile fall off. Commonly, banding may need to be repeated for better effect. Banding can be done in the procedure room without needing anaesthesia or ward admission.

Open haemorrhoidectomy is a surgical procedure that involves removal of the internal and external components of the haemorrhoid. The wound will be allowed to heal gradually over the course of a few weeks. The procedure does result in pain, and studies have shown a longer recovery period compared to newer techniques. However, haemorrhoidectomy is an effective procedure for haemorrhoids and may be used where previous treatments may have failed. Anaesthesia is required, and patients are expected to be admitted in the ward for a few days after surgery.

This procedure is a relatively new procedure, where the piles are ablated using heat generated by LASER energy through a small cut. This process causes shrinkage and clotting of blood within the piles in the short term, and healing by a degree of scarring in the long term. As this technique is minimally invasive, it is generally associated with less pain compared to open haemorrhoidectomy. It is hoped that the procedure may allow earlier return to normal activities. Anaesthesia is normally required and ward admission is shorter compared to open haemorrhoidectomy.

If surgery is indicated, we will discuss with you the options and recommend the most appropriate treatment for your condition.