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Haemorrhoid disease

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Professor Lovat
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HaemorrhoidsHaemorrhoids are blood vessels that reside in the anal canal (in and around the bottom) in healthy individuals. When they can become inflamed or swollen they can cause a disease known as piles (haemorrhoid disease).

Classification of haemorrhoid disease

The haemorrhoid vessels exist in two groups: internal and external, separated by the dentate line.

Internal haemorrhoids lie deep within the rectum and in a diseased state, do not typically cause pain or discomfort, although they do bleed. This is because there are few nerves in this portion of the body. They are rarely visible from the surface of the skin.

External haemorrhoids lie within the anus, and are closer to the skin surface. In the diseased state, they can become visible from the body surface and can also cause significant discomfort, or pain.

Despite their apparent severity, swollen haemorrhoids are rarely problematic as the disease usually resolves itself within a matter of days.

Causes

Haemorrhoid disease is very common and as many as 50% of people experience them at one time or another. They are more common, however in:

  • Older people
  • Pregnant individuals
  • Obese individually
  • People who excessively strain on the toilet
  • People who excessively cough or sneeze
  • People who eat a low-fibre diet

Signs and symptoms

There are several signs and symptoms associated with haemorrhoid disease, including:

  • Bright red bleeding from the anus – the blood will normally be noticed on toilet paper although will sometimes also be visible in the toilet bowel. If the blood is dark then it is very important that you contact your doctor as this can be a sign of a more significant disease
  • Itchiness or soreness around the anus
  • A lump around the anus
  • Difficulty in passing stools without feeling a sensation of pain or tenderness
  • A mucous discharge

 Diagnosis

Although haemorrhoid disease normally resolves within a few days, and is not especially serious it is important to speak to your doctor if you notice rectal bleeding as:

  • It can be a sign of a more serious condition, such as colon cancer (especially if the blood is a dark shade of red)
  • Excessive blood loss can cause anaemia

The doctor will normally ask a few questions before performing a physical examination, such as the length of time rectal bleeding has been present, the colour or shade of the blood and if you feel any discomfort when on the toilet.

The doctor may then perform a rectal examination. This will involve the doctor examining your bottom to see if there are any visible swellings. They may also examine you internally to assess for signs of inflammation or swelling – this is called a digital (finger) rectal examination.

The doctor may also use a proctoscope (a thin tube with a light on the end) to visualise better the inside of your anus. A small tissue sample (biopsy) may be performed so it can be tested in a laboratory.

Treatment

Haemorrhoid disease normally resolves within a matter of days, and does not cause any long-term issues. However, there are several treatments that may be used to ease the discomfort associated with it, including:

  • Diet and lifestyle: Increasing the amount of fibre in the diet can often help prevent future occurrences of haemorrhoid disease. Not straining on the toilet, and not wiping the bottom excessively, can also help minimise symptoms and prevent disease recurrence
  • Over-the counter creams: a number of different topical (skin) creams can be purchased from the pharmacy without a prescription. Discuss with your pharmacist the possible options. Painkillers such as paracetamol may also help to relieve the pain associated with swollen haemorrhoids. It is advised not to take painkillers such as aspirin or ibuprofen as these can affect blood clotting mechanisms
  • Corticosteroid creams: If the inflammation around your bottom is severe, your doctor may prescribe a steroid-based cream to reduce the inflammation. These creams should not be used for long periods of time as they can, in the long-run, cause skin irritation.
  • Surgery: although not a first-line therapy, surgery is used to treat about 10% of cases of piles. Surgical methods include

1)  Cutting out the inflamed haemorrhoids under general anaesthetic

2)  Haemorrhoidal artery ligation (HALO) to reduce the blood flow to the haemorrhoids – this will ultimately cause the inflamed vessels to shrink in size. We do not currently offer this treatment at the London Gastroenterology Centre. (Please also note that this treatment is entirely different to the HALO Radiofrequency ablation treatment for Barrett’s oesophagus, which we do offer!)

3)  Laser surgery – the diseased blood vessels will scar and harden and no longer cause rectal bleeding or pain

Who can help me with haemorrhoid disease?

Our top private consultants at the London Gastroenterology centre have years of experience in dealing with gastrointestinal problems and are experts in the investigations needed such as colonoscopy. If you would like to book an appointment with us, please call 020 7183 7965.

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