Haemorrhoids or piles have long been a source of jokes and sniggers. As children some of us remember been exhorted by grandparents not to sit on concrete steps or otherwise we would get piles and the way this was threatened was to suggest the onset of an extremely serious and embarrassing illness. In fact suffering from haemorrhoids is not usually serious but neither is it a laughing matter. In this article we will look at the causes, symptoms, treatment and ways of reducing the risks of developing haemorrhoids.
So what exactly are haemorrhoids? They occur when the veins that lie under the mucous membranes in the lowest part of the rectum and anus become swollen and distended. They are similar to varicose veins some people have in their legs. There are two types – internal or external. The internal ones are situated at the base of the rectum and are covered with the same types of cells which line the intestine. There are four grades of internal haemorrhoids;
Grade 1 - not prolapsed.
Grade 11 – prolapsed on straining but reduce spontaneously.
Grade 111 – prolapsed on straining and can be reduced manually.
Grade 1V – permanently prolapsed.
External ones develop under the skin of the anus and are covered with cells like skin. People may have both internal and external haemorrhoids at the same time.
The simple cause of all haemorrhoids is an increase in the pressure in the small vessels that make up the haemorrhoid causing then to distend with blood. There are certain risk factors which are likely to increase the likelihood of this happening; obesity; diarrhoea; colon cancer; previous rectal surgery, constipation which causes straining and may be the result of a low fibre diet. Pregnancy, as not only does the enlarged uterus increase the pressure on the rectum and anus, but also the hormones may weaken the muscles in this area. Prolonged sitting on the toilet is associated with haemorrhoids; spinal cord injury. It should be noted that, in spite of our grandparents’ threats, sitting on concrete steps is not a known risk factor.
The symptoms of haemorrhoids may be negligible - in fact many people are unaware that they have them - to quite intense and irritating. They include; bleeding on defecation – this is painless and the blood is fresh and bright red and coats the stool rather than mixed with the stool; it is often first noticed on toilet paper; anal itching and irritation; pain or discomfort; swelling around the anus; a lump near the anus which may be uncomfortable; lLeakage of faeces or mucous.
While these symptoms are unpleasant they are not dangerous. However, there can be complications including thrombosis, which is very painful, ulceration of external or prolapsed haemorrhoids or, rarely, excessive bleeding which can lead to anaemia. As rectal bleeding can be a sign of more serious conditions such as cancer it is wise to see a doctor for a diagnosis. This will usually involve the doctor taking a history, a physical inspection and maybe a digital rectal examination. Sometimes a proctoscopy is required when a proctoscope is used to examine the anal cavity or rectum, either at the GP surgery or in hospital.
There are a variety of treatments available for haemorrhoids depending on the severity of the symptoms. If symptoms are mild some lifestyle changes may be sufficient to improve them. According to the National Institution for Health and Care Excellence (NICE) the sufferer should be advised to minimize constipation and straining. This can be done by increasing fibre in their diet through eating more fruit and vegetables and by drinking at least 6-8 glasses per day. Cleaning the peri-anal area carefully reduces the risk of irritation. Bulk forming laxatives, analgesics such as paracetamol or topical haemorrhoid creams may be helpful.
For more severe symptoms other treatments are available. These include non-surgical treatments such as rubber band ligation in which a rubber band is placed round the base of the haemorrhoid causing it to become necrotic and slough off. Injection sclerotherapy when the haemorrhoid vessel area is injected with phenol in oil which makes it shrivel and coagulation techniques where laser or infrared light or heat is used to cause small internal haemorrhoids to harden and shrivel.
Finally, if these treatments fail or are not suitable, surgery may be considered. The haemorrhoids can be removed either under local or general anaesthesia. While it is an effective treatment there are certain problems associated with haemorrhoidectomy including pain, bleeding, urinary retention and urinary tract infections. Another surgical procedure is haemorrhoid stapling. Here staples are used to block the blood supply to the haemorrhoids. People recover more quickly from this operation and suffer less pain but there is a greater chance of recurrence.
As can be seen, suffering from haemorrhoids is no laughing matter. They can be unpleasant and irritating companions and life is definitely better without them. Some actions can be taken to reduce the likelihood of acquiring them. The first is to eat a healthy diet with lots of fruit and vegetables. Not only will this lessen the chance of piles but also improve your heart health. Secondly – keep active. Being sedentary slows down the natural action of the gut so increases the risk of constipation. Again, you will be doing your heart good as well. Thirdly, ditch the habit of taking ‘War and Peace’ into the toilet with you. Straining is bad, so wait until you feel the urge to defecate and then go as quickly as you can and don’t sit about waiting. With a few changes to your lifestyle you may be able to avoid developing haemorrhoids altogether or at least reduce their impact on your life.