Diagnosing and managing haemorrhoids
Haemorrhoids, commonly referred to as piles, are a condition that many people experience but few feel comfortable discussing. While often mild and manageable, haemorrhoids can cause significant discomfort and distress when left untreated. In this article, consultant general and colorectal surgeon Mr Adam Stearns explains what haemorrhoids are, how they are diagnosed, and the range of treatments available that can help patients towards relief and recovery.
What are haemorrhoids?
Haemorrhoids are swollen veins in the lower part of the rectum or anus. They are a normal part of human anatomy, but they can become problematic when they swell or prolapse. There are two main types: internal haemorrhoids, which occur inside the rectum, and external haemorrhoids, which develop under the skin around the anus.
A common misconception is that all anal discomfort or bleeding is caused by haemorrhoids. In reality, similar symptoms can be due to fissures, infections, or, in rare cases, bowel cancer. Another myth is that only older people or those with poor hygiene get haemorrhoids. In truth, haemorrhoids can affect anyone, including young adults, especially if there is chronic constipation, prolonged straining, pregnancy, or a family history of the condition.
When do haemorrhoids become an issue?
Not all haemorrhoids require medical intervention. Many people have small haemorrhoids without symptoms. However, haemorrhoids become a concern when they cause discomfort, bleeding, or interfere with daily activities.
Common symptoms include:
- Bright red bleeding during or after bowel movements
- Itching or irritation around the anus
- A lump or swelling near the anus
- Pain or discomfort, particularly when sitting
- Mucus discharge or soiling
If bleeding is persistent, painful, or associated with weight loss or changes in bowel habits, it is important to seek medical advice promptly, as these could be signs of more serious conditions.
How are haemorrhoids diagnosed?
Diagnosis usually begins with a consultation and physical examination by a GP or specialist. The doctor will ask about symptoms, bowel habits, and medical history. External haemorrhoids are often visible, while internal haemorrhoids may require a rectal examination or a procedure called proctoscopy, which involves inserting a small, lubricated tube to view the inside of the rectum.
In some cases, especially if bleeding or other symptoms raise concern, further tests such as flexible sigmoidoscopy or colonoscopy may be recommended to rule out other causes.
How are haemorrhoids managed?
Management depends on the severity of symptoms and whether the haemorrhoids are internal or external. Initial treatment often involves lifestyle changes and self-care, including:
- Increasing dietary fibre intake and fluid consumption
- Avoiding straining during bowel movements
- Using over-the-counter creams, suppositories, or pain relief
- Taking warm baths to soothe discomfort
For persistent or severe haemorrhoids, especially when conservative measures fail, surgical intervention may be necessary. Surgical options include:
- Rubber band ligation: A common outpatient procedure where a small band is placed around the base of an internal haemorrhoid to cut off its blood supply, causing it to shrink and fall off.
- Sclerotherapy: An injection that causes the haemorrhoid to harden and shrink.
- Infrared coagulation or laser therapy: A non-invasive method using heat to destroy the haemorrhoidal tissue.
- Haemorrhoidectomy: A more extensive surgical removal of haemorrhoids, typically reserved for large or external haemorrhoids causing significant symptoms.
- Stapled haemorrhoidopexy: A procedure that repositions and staples the haemorrhoidal tissue inside the rectum, often with less post-operative pain than traditional surgery.
All surgical methods are generally safe and effective, though recovery time and discomfort can vary depending on the technique used.
