What are haemorrhoids?
Haemorrhoids (or Piles) form when the normal tissue lining of the inside of the back-passage (anus) become engorged and enlarged. This lining of the anus is composed of arteries, veins and supporting tissue termed haemorrhoidal cushions and in health it forms part of the mechanism that keeps us continent. They are often a problem that runs in families.
Symptoms
Haemorrhoids tend to either bleed or protrude (prolapse) through the anus though on occasions they can also cause pain when a haemorrhoidal vein develops a blood clot within it. They are exacerbated by constipation or diarrhoea although most people who have haemorrhoids have no problems with either. A high fibre diet and adequate fluid intake is recommended to prevent constipation and straining. Adding a mild laxative such as movicol or normacol can make a big difference.
Diagnosis
Haemorrhoids can be examined in the clinic but it is important to rule out other more serious conditions which can mimic those of haemorrhoids. Many patients will require either a flexible sigmoidoscopy or a colonoscopy to look further at the bowel.
Treatment
Treatment is only required if you are troubled by the symptoms. Many patients can be treated in the clinic rather than by an operation.
Outpatients
The two common methods of outpatient treatment in the UK are injection and banding, if a simple high fibre diet and stool softeners do not work.
Injection reduces the blood supply to the haemorrhoid by inducing a scar. It suits smaller circumferential haemorrhoids that still cause problems despite a good diet. Immediately after the treatment you may feel some discomfort which will fade. Simple analgesics such as Paracetamol may be required. You will pass some blood after the injection which is normal. Cotton wool may be used to improve the view during the injection and this will pass without difficulty when the bowels are empty. Only one or two treatments are generally needed. The effect of the injection tends to wear off with time but can be repeated if indicated. Possible complications include bleeding, recurrence, infection and rarely, irritation of the prostate gland (chemical prostatitis).
Banding involves placing a small rubber band on the lining of the bowel above the haemorrhoid to reducing its size, blood supply and tendency to prolapse. It is much more effective than injections, in the medium term. Cotton wool may be used to improve the view during the examination and this will pass without difficulty when the bowels empty. You may well have some pain after banding, which can be helped with Paracetamol or a very hot bath. Occasionally there may be the feeling of faintness. Bleeding may occur immediately after the bands are placed and for up to14 days afterwards. This late bleeding risk at 10-14 days is about 1%. It normally stops but can be profuse so you should be able to access medical care e.g. not be on a long haul flight or on an exotic holiday. If the bleeding were significant you would need to go to the Emergency Department. Do not take Aspirin, Ibuprofen or similar drugs around this time as they may increase the risk of bleeding. Banding may need to be repeated depending on the haemorrhoid size and response to treatment.
Surgery
If outpatient treatments do not work, or if the patient preference is for an operation, your consultant will discuss the various surgical options with you in more detail. These may include the minimally-invasive haemorrhoidal artery ligation operation (HALO/THD) or haemorrhoidectomy.