Introduction
- Haemorrhoids, commonly known as piles, are swollen and inflamed veins in the rectum and anus that cause discomfort, pain, and sometimes bleeding.
- They are categorized into internal or external haemorrhoids, depending on their location.
- Contributing factors include straining during bowel movements, pregnancy, obesity, and chronic constipation or diarrhea.
- Management focuses on lifestyle modifications, medical treatment, and surgical interventions for severe cases.
Types of Haemorrhoids
- Internal Haemorrhoids
- Located inside the rectum.
- Usually painless but may cause bleeding during bowel movements.
- External Haemorrhoids
- Found under the skin around the anus.
- Can cause pain, itching, and swelling.
- Thrombosed Haemorrhoids
- Occur when a blood clot forms in an external haemorrhoid, causing severe pain and swelling.
Causes of Haemorrhoids
- Increased Pressure on Rectal Veins
- Straining during bowel movements.
- Sitting for prolonged periods on the toilet.
- Chronic Conditions
- Constipation or diarrhea.
- Obesity.
- Pregnancy and Childbirth
- Increased pressure on pelvic veins.
- Age-Related Changes
- Weakening of rectal and anal tissues with age.
- Dietary Factors
- Low-fiber diet leading to hard stools.
Symptoms of Haemorrhoids
- Internal Haemorrhoids
- Painless bright red rectal bleeding during or after bowel movements.
- Prolapse of the haemorrhoid outside the anus.
- External Haemorrhoids
- Pain, itching, or irritation around the anus.
- Swelling or lumps near the anus.
- Bleeding if the haemorrhoid is injured.
- Thrombosed Haemorrhoids
- Severe pain and swelling.
- Hard lump near the anus.
Complications of Haemorrhoids
- Anemia: Chronic blood loss leading to iron deficiency.
- Thrombosis: Clot formation causing intense pain.
- Infection: Infected haemorrhoids leading to abscess formation.
- Strangulated Haemorrhoids: Prolapsed haemorrhoid with restricted blood supply.
Diagnosis of Haemorrhoids
- Medical History and Physical Examination
- Symptoms like bleeding, pain, and prolapse.
- Visual Inspection
- External haemorrhoids or prolapsed internal haemorrhoids.
- Digital Rectal Examination (DRE)
- To assess for internal haemorrhoids or other rectal conditions.
- Proctoscopy/Anoscopy
- Direct visualization of the rectum and anal canal.
- Additional Tests
- Colonoscopy or sigmoidoscopy if bleeding is suspected to be from another source.
Treatment Options for Haemorrhoids
1. Lifestyle and Dietary Modifications
- Increase Fiber Intake
- Eat high-fiber foods: Fruits, vegetables, whole grains.
- Fiber supplements (e.g., psyllium, methylcellulose).
- Stay Hydrated
- Drink 6–8 glasses of water daily to soften stools.
- Avoid Straining
- Don’t delay bowel movements.
- Regular Exercise
- Helps maintain regular bowel habits and prevent constipation.
2. Medications
Medication | Brand Name | Manufacturer | Cost Range |
---|---|---|---|
Topical Anesthetics | Lidocaine | Xylocaine | AstraZeneca |
Hydrocortisone Cream | Preparation H | Pfizer | $10–$30 per tube |
Oral Pain Relievers | Paracetamol, Ibuprofen | Tylenol, Advil | Johnson & Johnson, Pfizer |
Flavonoids | Diosmin + Hesperidin | Daflon | Servier |
3. Minimally Invasive Procedures
- Rubber Band Ligation
- A small band is placed around the base of the haemorrhoid to cut off blood flow.
- Sclerotherapy
- Injection of a chemical solution to shrink haemorrhoids.
- Infrared Coagulation (IRC)
- Heat treatment to shrink haemorrhoidal tissue.
4. Surgical Treatments
- Hemorrhoidectomy
- Surgical removal of severe or large haemorrhoids.
- Stapled Hemorrhoidopexy
- Staples reposition prolapsed haemorrhoids and cut off their blood supply.
Monitoring Parameters
- Monitor stool consistency and frequency.
- Assess pain, swelling, or bleeding resolution.
- Follow up on the effectiveness of dietary and lifestyle changes.
Patient Counseling Points
- Educate on the importance of a high-fiber diet and hydration.
- Advise on proper toilet habits: Avoid prolonged sitting and straining.
- Explain how to use medications or topical treatments.
- Encourage weight management and regular exercise to reduce pressure on rectal veins.
Use in Children
- Rare in children; ensure evaluation for underlying causes like constipation.
Use in Pregnancy
- Common due to increased pelvic pressure; focus on conservative management like dietary changes and topical treatments.
Use in Elderly
- Ensure gentle stool softeners and evaluate for comorbid conditions.
FAQs About Haemorrhoids
Q1: What causes haemorrhoids?
- Increased pressure on rectal veins due to straining, obesity, or pregnancy.
Q2: Can haemorrhoids go away on their own?
- Mild haemorrhoids may resolve with dietary and lifestyle changes.
Q3: How are haemorrhoids treated?
- With dietary changes, topical treatments, medications, or surgery for severe cases.
Q4: Are haemorrhoids dangerous?
- Not usually, but complications like anemia or thrombosis can occur.
Q5: What foods help prevent haemorrhoids?
- High-fiber foods such as fruits, vegetables, and whole grains.
Q6: Can haemorrhoids recur?
- Yes, without proper dietary and lifestyle adjustments.
Q7: Is surgery necessary for haemorrhoids?
- Only for severe or recurrent cases that do not respond to other treatments.
Q8: Can sitting for long periods cause haemorrhoids?
- Yes, prolonged sitting increases pressure on rectal veins.
Q9: Are haemorrhoids contagious?
- No, they are not infectious.
Q10: Can I exercise with haemorrhoids?
- Yes, low-impact activities like walking or swimming are recommended.
Q11: Is it normal to have bleeding with haemorrhoids?
- Yes, but persistent or heavy bleeding should be evaluated.
Q12: How can I prevent haemorrhoids?
- Eat a high-fiber diet, stay hydrated, and avoid straining during bowel movements.
Q13: Can haemorrhoids lead to cancer?
- No, but rectal bleeding should always be evaluated to rule out other conditions like colorectal cancer.
Q14: What is the best over-the-counter treatment?
- Topical creams like hydrocortisone or lidocaine for pain and itching relief.
Q15: When should I see a doctor for haemorrhoids?
- If symptoms persist despite home treatment or if there is significant bleeding or pain.