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Haemorrhoids (Piles)

  • What are haemorrhoids (piles)?

    Haemorrhoids

    Haemorrhoids, also called piles, are enlarged blood vessels around the anus. They are described as anal cushions. Blood vessels are normally present in our rectum and anus, but they are considered abnormal when they become enlarged and swollen.

    Types of haemorrhoids (piles)

    There are 2 types of haemorrhoids – external and internal. External haemorrhoids are located under the skin surrounding the anus and may cause pain and irritation. Internal haemorrhoids are located inside the rectum. They are rarely painful; however, straining during bowel movements may cause these internal haemorrhoids to protrude through the anus and lead to pain.

    Internal haemorrhoids are further classified as follows:

    • First degree piles – Internal piles that bleed
    • Second degree piles – Lump at the anus that sticks out after a bowel motion and then disappears straight away after
    • Third degree piles – Lump at the anus that sticks out after a bowel motion but needs to be pushed back by a finger into the anus after
    • Fourth degree piles – Lump that can’t be pushed back into the anus
  • There are different risk factors that lead to the development of haemorrhoids. The most common factors include:

    • Constipation or diarrhoea
    • During pregnancy, due to the pressure exerted by the growing foetus and during labour on the blood vessels around the anus.
    • Excessive straining when passing stools
    • Sitting on the toilet for a long time

    There are also other risk factors that trigger the development of piles, and these include:

    • Being overweight
    • Having a family history of piles
    • Having an intra-abdominal or pelvic tumour (not a common cause)
    • Not having enough fibre in the diet
  • Symptoms of internal haemorrhoids

    Internal haemorrhoids may lead to the following symptoms:

    • Painless bleeding during bowel movements due to bleeding piles
    • Protruding lump during bowel movements, which may go back inside on its own or may be gently pushed back

    Symptoms of external haemorrhoids

    The common symptoms of external haemorrhoids include:

    • Blood in the stool from a bleeding haemorrhoid
    • Pain around the anus
    • Itching around the anus
    • Swelling or lumps around the anus

    In some cases, a blood clot can form in an external haemorrhoid and cause it to become purple or blue. This condition is called a thrombosed haemorrhoid. It is usually associated with severe pain, itching and bleeding.

    When to see a doctor

    Most of the time, haemorrhoids cause mild symptoms and may resolve on its own without treatment. It is best to consult a doctor if you experience any of the following:

    • Blood in the stool or any type of rectal bleeding
    • If the haemorrhoids are causing you pain or discomfort
    • If the symptoms do not go away in a week

    It is important to note that some of the symptoms of haemorrhoids resemble those of colorectal cancer. You need to consult your doctor for a full assessment to make sure you don’t have a serious condition before you attribute your symptoms to piles.

  • After obtaining your medical history and symptoms, your doctor will perform the following examinations to diagnose your condition:

      Physical examination

      Your doctor will examine your anus for lumps, swelling, tears, bleeding, irritation, or other problems.

      Digital rectal examination

      Your doctor will insert a lubricated gloved finger into your rectum to check for lumps, tenderness, bleeding, or other problems in your rectum.

    In some cases, your doctor may perform more thorough tests to diagnose internal haemorrhoids or to rule out more serious conditions. These tests include:

      Anoscopy

      Using a short tube (called anoscope), your doctor will carefully examine your anal canal.

      Sigmoidoscopy

      This procedure also uses a tube (called sigmoidoscope) so that your doctor can visualise your lower colon.

      Colonoscopy

      Using a long, flexible tube (called colonoscope), your doctor will examine your entire colon.

  • Haemorrhoids can be treated using simple home remedies, medications, or surgery. The choice of treatment depends on the type and severity of your condition.

    Home remedies for haemorrhoids

    Simple home remedies are often effective in relieving mild symptoms. These home remedies include:

    • Avoid straining during bowel movements
    • Drink plenty of water
    • Increase your fibre intake
    • Warm sitz baths (soaking your anal area in a tub of warm water) 2 – 3 times a day for 10 – 15 minutes
    • If your haemorrhoids are painful, apply ice packs for 15 minutes to relieve the pain
    • Wear loose, comfortable clothing to help keep the anal area clean and dry

    Medicines and Non-surgical treatment for haemorrhoids

    Your doctor may prescribe medication in the form of creams, ointments, suppositories or tablets to treat small piles. Some common medications used are stool softeners to allow the stool to be passed more easily without straining. Other medications contain steroids or anaesthetics to help relieve your symptoms.

    Surgical treatment for haemorrhoids

    Your doctor may recommend surgery if you have large haemorrhoids or if your symptoms do not improve with medical treatment. Common surgical treatments for haemorrhoids include:

    • A chemical solution injected into the piles, causing them to shrink and fall off (works for first and second degree piles)
    • A special device can be inserted into the anus to tie off the blood vessel that supplies blood to the piles
    • Rubber band treatment (ligation) to treat first or second degree piles. A rubber band is placed over the pile in order to cut off its blood supply.
    • Surgery (haemorrhoidectomy) to cut out third- and fourth-degree piles, using various surgical techniques

    How to prevent haemorrhoids

    With some lifestyle changes, you can prevent haemorrhoids from forming. Here are some simple steps you can do:

    • Avoid sitting too long at the toilet. This increases the pressure at the anus and makes you more prone to develop haemorrhoids.
    • Avoid straining during bowel movements
    • Do not ignore the urge to have a bowel movement. If you delay your bowel movements, your stool becomes hard and dry, making it difficult to pass.
    • Drink plenty of water
    • Eat food rich in fibre, such as fruits, vegetables and whole grains
    • Exercise regularly. Physical activity helps improve your bowel movement.
    • Maintain a healthy weight
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