Concerned about haemorrhoids?

Mr Sajal Rai, Consultant General Surgeon.

Haemorrhoids, commonly called piles are lumps or swellings containing engorged blood vessels found just inside or around your back passage (rectum and anus).

Piles can cause the following symptoms:

• Bright red bleeding either on toilet paper or dripping in the toilet pan.
• Itchy bottom (called pruritus ani).
• Slime or mucous discharge from back passage.
• Lumps prolapsing from back passage which may need pushing back.

However, piles may cause no symptoms at all and only those that cause symptoms need treating.

How can you avoid piles developing in the first place?

• Avoid constipation with high fibre diet and drink plenty of fluids
• Avoid straining excessively while opening your bowels.
• Avoid constipating medication like codeine, tramadol, morphine, pethidine. If you cannot avoid taking such medication, counter the constipating effect with fibre, fluids and if needed laxatives.
• Losing weight if you are overweight and exercising regularly.

There are some factors that predispose you to developing piles. These are being overweight, over the age of 45, pregnancy and a family history of piles.

What are your treatment options?

Piles need treatment only if they are causing you significant symptoms. However, any rectal bleeding invariably needs investigating to confirm the presence of piles and more importantly exclude any other cause for the bleeding.

Flexible sigmoidoscopy or a camera test is the first investigation you will be offered. This is done as a day case procedure with or without sedation and usually treatment for piles in the form of banding is done at the same time if appropriate.

Treatment for piles depends on the grade or severity of the piles. They range from Grade 1 (small piles) to Grade 4 (large piles that remain prolapsed outside the anus at all times).

Treatment options are as follows:

• Grade 1 and some grade 2 piles: Increased dietary fibre and fluid intake with avoidance of straining.
• Grade 2 and 3 piles: Banding or a sclerosant injection. Banding cuts off the blood supply to piles and they drop off. Sclerosant injection causes scarring and therefore shrinkage of piles. Injections have now fallen out of favour and banding is the preferred option.
• Grade 2, 3 and 4 piles: If the above measures fail or if the piles are too large then surgery may be the only option left.

Surgery can be of the following types:

• Conventional surgery to cut away or excise the piles leaving a wound.
• Stapling technique where a circular segment of the lining (or mucosa) of the rectum is taken away.
• The relatively less painful THD (Transanal haemorrhoidal dearterialisation) or HALO (Haemorrhoidal Artery Ligation Operation) procedures. These are usually combined with Anopexy to treat prolapsing piles.

These innovative treatments in simple terms it mean an operation using stitches to reduce the blood supply to the haemorrhoids so that they shrink and do not bleed anymore. The procedures are significantly less painful than the conventional operation which usually involves cutting away the piles and leaving a painful wound. Most people are able to return to their normal activities sooner than after conventional surgery for piles. The National Institute of Health and Care Excellence (NICE) recommends this procedure as an effective alternative to conventional surgery and stapling procedures for piles.

The THD and HALO procedures are usually combined with what is called Anopexy which involves using stitches to uplift and fix piles in place so that they don’t prolapse out of the anus on opening your bowels anymore.

THD and HALO procedures with Anopexy are done under a general anaesthetic as a day case and you are able to go home the same day. The procedure uses an Ultrasound probe to locate the blood vessels supplying the piles before they are tied off with a stitch. You are usually asked to take simple pain killers like paracetamol or brufen at home that evening.

These procedures also have the advantage that they can be repeated if needed for any recurrences.

Booking your consultation

If you think you suffer from haemorrhoids or piles, please make an appointment to see Mr Sajal Rai who will go through all treatment options with you including banding, haemorrhoidectomy and THD/Halo procedure including any potential risks and complications and answer all your questions. Mr Rai offers these services at the Spire Regency Hospital, Macclesfield, where he holds regular clinics.

To book a consultation please contact our customer services team on 01625 505 412.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.