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HAEMORRHOIDS - a patient's guide
Dr Ross Roberts - Surgeon, The Oxford Clinic
What are haemorrhoids?
The anus is lined by spongy tissue which acts as a cushion
to help seal the anus, and to ease the passage of a bowel
motion. When this tissue becomes stretched or swollen, it
is called a haemorrhoid or a pile. Haemorrhoids can develop
whenever there is increased pressure in the veins of the
anus. This can occur with straining from constipation or
heavy lifting, during bad diarrhoea, or during pregnancy
and childbirth.
There are two types of haemorrhoids:
1. Internal - arising from the lining of the lower rectum
and anus.
2. External - arising in the skin at the opening of the
anus.
It is not uncommon to have both internal and external
haemorrhoids at the same time.
What are the symptoms?
The most common symptoms are itching, discomfort and bleeding.
Haemorrhoids may prevent the anus from shutting properly,
resulting in mucus discharge, itching, and sometimes faecal
soiling of your underwear.
When large, they may prolapse through the anus and need
to be pushed back inside. A prolapsed haemorrhoid may become
engorged with blood, in which case a very painful thrombosis
or strangulation can occur.
It is most important that any bleeding from the rectum
is reported to your doctor, even if you know you have haemorrhoids
because it is possible the bleeding may be due to other
more serious causes.
How are haemorrhoids treated?
Small haemorrhoids will often go away with simple conservative
treatment. This involves increasing dietary fibre and fluid
intake to keep bowel motions soft and reduce the need for
straining. Anal itching can be reduced by careful anal hygiene,
and by avoiding rubbing the area with dry toilet paper or
using soap, which removes the natural protective grease
from the anal skin. Instead, clean with a soft tissue moistened
with warm water, then dry the area well by dabbing with
a dry tissue or towel.
Sometimes you may be given an ointment or suppository
to help reduce troublesome irritation. It is not advisable
to use steroid containing ointments for more than a month
or two at a time. If symptoms persist, other treatment may
be recommended, such as rubber band ligation and haemorrhoidectomy.
Most painful haemorrhoids are best treated by haemorrhoidectomy
within a few days of onset.
Rubber Band Ligation
This is an effective and simple method of treating the
less severe type of haemorrhoids and is usually done as
office procedure, allowing the patient to return to work
the same day.
A small rubber band is stretched over the haemorrhoid.
The rubber band will tighten and strangle the haemorrhoid
causing it to drop off in 2 - 5 days. Rubber band ligation
often causes some discomfort or dull ache for about 48 hours,
so don't plan on any major activity for 2 days. Usually
2 or 3 visits are required to treat all internal haemorrhoids
by rubber band ligation. A small amount of bleeding can
be expected when the haemorrhoid drops off. If the bleeding
becomes more severe you should contact your specialist immediately.
Paracetamol, or relaxing in a warm bath should relieve
any pain or discomfort. No special diet is necessary but
it is important to keep your bowel motions soft and regular.
Rarely (1 person in 100,000) severe infection can occur.
In this case, you will suddenly feel very unwell, with fever
and shivering, and may have severe anal pain. If you suspect
this, seek medical help IMMEDIATELY. This is most important,
regardless or the time of day or night, because treatment
with antibiotics is of the utmost urgency.
Sclerotherapy
Another method of treating small internal haemorrhoids
is by sclerotherapy (injections), which is done as an office
procedure, allowing the patient to return to work the same
day. A small amount of irritant fluid is injected into the
haemorrhoid which results in shrinkage and reduction of
the haemorrhoid. Usually 2 visits are required to treat
the haemorrhoids by this method. Sclerotherapy can cause
minor self-limiting rectal bleeding and a dull ache for
up to 48 hours so don't plan any major activity for 2 days.
Paracetamol, or relaxing in a warm bath, should relieve
any pain or discomfort. No special diet is necessary but
it is important to keep your bowel motions soft and regular.
Haemorrhoidectomy
Haemorrhoidectomy is a surgical procedure to remove the
swollen haemorrhoidal tissue. It is done in hospital under
local or general anaesthesia. The resulting wounds are sutured
closed with a dissolving suture, and typically take 10 -14
days to heal. Hospital stay is usually 1 - 3 days.
After haemorrhoidectomy
Do not attempt any heavy lifting or strenuous exercise
for at least one week. Lesser activities such as climbing
stairs, walking and driving may be carried out in moderation.
Constipation can be particularly unpleasant, so it important
to keep the bowel movements soft and regular.
A high-fibre diet is recommended - including plenty of
fruit and vegetables. Drink at least 6 - 8 glasses of water
daily. In addition, it is sometimes necessary to take a
stimulant laxative such as dulcolax for the first week or
two. Some discomfort and a little bloody discharge can be
expected, especially after bowel movements, but this will
diminish as healing progresses. It is important to keep
the area clean and dry. Avoid using dry toilet paper - instead
use a warm flannel or moist soft tissue to keep the anal
area clean and dry. Saline baths (1/2 cup of salt per bath)
several times daily, especially after bowel movements, are
good for hygiene, and are very soothing. If is not possible
to bath, have a suitable basin available to sit in (use
1tbspn. Salt per basin of warm water).
Getting help
Seek medical help if you feel that you are becoming constipated
or if there is excessive or prolonged bleeding.
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