For Patients General Practice

All You Ever Wanted to Know About Haemorrhoids (But Were Afraid to Ask)

Written by Mr Manoj Sen for Doctify

They may not be something we talk about very often, but haemorrhoids happen. Sitting on the problem (no pun intended) won’t help, especially if they are severe. Being aware of how to identify haemorrhoids and how they are treated is useful knowledge to have in your arsenal (OK, that one may have been on purpose).

Here to talk us through the ins and out of this common problem is top General Surgeon Mr Manoj Sen.

What even are Haemorrhoids?

Haemorrhoids, also widely known as piles, are little anal cushions. They are vascular structures found in every person’s anatomy at the doorway of the anus, which normally help in stool control. When abnormally swollen, are called haemorrhoids.

They initially present with bright red, painless rectal bleeding when we open our bowels, itching around the anus and, later, with discomfort and pain. This is especially true when they hang out (prolapse) after we open our bowels. They are frequently associated with skin tags around the anus.

Why do they happen?

They happen if we persistently strain at stool. So, they happen when we are constipated or when we have persistent runny motions. They can also occur when we spend an inordinate amount of time on the WC during defaecation – so taking a book into the loo with you is not the best idea.

Haemorrhoids are also a frequent side-effect of pregnancy (due to straining) and is also a consequence of being overweight. Persistently lifting heavy weights can be a cause but they have nothing to do with what we sit on.

How do you treat them?

In the very early stages, increasing one’s fibre intake and avoiding straining at stool usually suffices. They are fortunately self-limiting at this early stage; this includes haemorrhoids associated with pregnancy.

When slightly more advanced, rubber banding and injecting a special substance (known as a sclerosant) are the next lines of treatment. The former is usually slightly more successful than the latter. Sealing them with laser, infra-red or extreme cold have been tried in the past but are no longer widely practised today. A variety of creams and ointments are available on the market with very limited and variable success.

When they prolapse (hang out) then surgery is advised This ranges from simply “hitching” them up with special stitches under anaesthesia to downright excising them (also under anaesthesia). The latter is, predictably, more uncomfortable for up to a week following the operation. However, it does have the significant advantage of hardly recurring.

Any treatment is always carried out after prior discussion, counselling and warning of the potential consequences. It is always tailored to the individual patient’s complaints and the stage of the haemorrhoids.

How can you avoid them?

  • Avoid straining
  • Drink enough water
  • Increasing your daily fibre intake
  • Take regular exercise
  • Avoid heavy lifting
  • Lose weight

How common are haemorrhoids?

They are the most common surgical condition along with hernias and gallstones. They occur equally in both sexes and between 50-65% of the population will get them at some point in their lives.

Fortunately, for most of us, they are self-limiting.



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