What are haemorrhoids?
Haemorrhoids, also called ‘piles’, are enlarged and engorged blood vessels in the upper portion of the anal canal [back passage]. Normally, we do not know these blood vessels are there; however, if they start to exhibit symptoms, they are known as haemorrhoids.
Symptoms of haemorrhoids
Haemorrhoids are classified into grades I-IV.
- Grade I haemorrhoids usually bleed as the patient goes to the toilet. Typically, the blood is fresh and red and seen to be separate from the stools, usually on the paper. Grade I piles do not prolapse (push out) out of the anal canal.
- Grade II haemorrhoids are larger, and sometimes prolapse from the anus during defaecation; however, the piles return inside once the patient stops defaecating.
- Grade III haemorrhoids prolapse from the anus during defaecation and the patient is able to push them back inside using a finger.
- Grade IV haemorrhoids can permanently protrude from the anus and cannot be pushed back inside.
This technique is still the conventional operative approach to treating haemorrhoids and has been considered the ‘gold standard’ by which most other surgical haemorrhoidectomy techniques are compared. Three tear drop-shaped incisions are created and the haemorrhoids lifted away from the lining of the anal canal. The surgical wounds are left open, separated by bridges of skin and mucosa. A Milligan-Morgan haemorrhoidectomy is thought to provide the most durable results; however, it is known as quite a painful procedure. Much effort has been spent in trying to make the operation more comfortable and it can now be undertaken as a daycase in many instances.
Application of rubber bands to haemorrhoids is probably the most effective non-surgical treatment for haemorrhoids. A special device is inserted into the anal canal and delivers a small, tight rubber band onto the base of the haemorrhoid. This stops the blood flow into the pinched-off portion of the haemorrhoid, which comes off during bowel motions in about a week. Rubber band ligation can be performed at Spire Parkway Hospital as an outpatient procedure and requires little preparation. Often, however, there is the need for more than one procedure to completely resolve a patient's condition.
Injection sclerotherapy is a outpatient-based treatment for internal haemorrhoids. An irritant chemical is injected painlessly by the surgeon to the base of the haemorrhoid. This sets up an inflammatory reaction that leads to the formation of scar tissue that obliterates the haemorrhoid. The patient will usually notice an improvement in the haemorrhoidal symptoms after 7-10 days. The duration of the effect is variable; symptoms may recur after a year or so and whatever treatment a patient has been offered for their haemorrhoids, it is sensible to try and adopt a ‘bowel friendly diet’ for the long term.