Haemorrhoids – Piles

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

  1. Internal Haemorrhoids
    • Located inside the rectum.
    • Usually painless but may cause bleeding during bowel movements.
  2. External Haemorrhoids
    • Found under the skin around the anus.
    • Can cause pain, itching, and swelling.
  3. Thrombosed Haemorrhoids
    • Occur when a blood clot forms in an external haemorrhoid, causing severe pain and swelling.

Causes of Haemorrhoids

  1. Increased Pressure on Rectal Veins
    • Straining during bowel movements.
    • Sitting for prolonged periods on the toilet.
  2. Chronic Conditions
    • Constipation or diarrhea.
    • Obesity.
  3. Pregnancy and Childbirth
    • Increased pressure on pelvic veins.
  4. Age-Related Changes
    • Weakening of rectal and anal tissues with age.
  5. Dietary Factors
    • Low-fiber diet leading to hard stools.

Symptoms of Haemorrhoids

  1. Internal Haemorrhoids
    • Painless bright red rectal bleeding during or after bowel movements.
    • Prolapse of the haemorrhoid outside the anus.
  2. External Haemorrhoids
    • Pain, itching, or irritation around the anus.
    • Swelling or lumps near the anus.
    • Bleeding if the haemorrhoid is injured.
  3. 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

  1. Medical History and Physical Examination
    • Symptoms like bleeding, pain, and prolapse.
  2. Visual Inspection
    • External haemorrhoids or prolapsed internal haemorrhoids.
  3. Digital Rectal Examination (DRE)
    • To assess for internal haemorrhoids or other rectal conditions.
  4. Proctoscopy/Anoscopy
    • Direct visualization of the rectum and anal canal.
  5. 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

MedicationBrand NameManufacturerCost Range
Topical AnestheticsLidocaineXylocaineAstraZeneca
Hydrocortisone CreamPreparation HPfizer$10–$30 per tube
Oral Pain RelieversParacetamol, IbuprofenTylenol, AdvilJohnson & Johnson, Pfizer
FlavonoidsDiosmin + HesperidinDaflonServier

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.