Haemorrhoids, also known as piles, are abnormal dilated blood vessels within the anal canal.
These blood vessels exist as part of the normal anatomy of the anal canal, however can become
pathological or symptomatic when they become dilated.
Factors or conditions which can precipitate this dilatation include
any cause of increase in persistent intra-abdominal pressure.
Factors such as pregnancy or childbirth are extremely common.
Other factors include chronic coughing, persistent lifting or heavy exercise.
They can become problematic when they become symptomatic.
Often patients do not engage the services of a medical doctor
due to the perceived embarrassment surrounding the condition itself.
However, symptoms such as bleeding which could be very distressing for the patient,
itching around the anal canal, wetness around the bottom or prolapse
can then precipitate a visit to the doctor.
Prolapse or thrombosed haemorrhoids often engage the appearance of a bunch of grapes
at the external anal verge can be an extremely uncomfortable condition for the patient.
Often the patient will then need to seek the advice of a medical doctor for immediate treatment.
It is important to remember that anal bleeding is not always attributable to benign conditions
such as haemorrhoids. Indeed, presentation of bleeding from the back passage to the GP
practise is a common phenomenon. It is important to undergo an examination of the back passage
to exclude other more serious conditions such as anal malignancy or rectal malignancy or
indeed diseases such as inflammatory bowel disease.
If your doctor feels that a more concerning pathology is the cause of your symptoms
or indeed no clear diagnosis has been made,
a hospital specialist may be the next port of call.
At that point, investigation with a camera through the back passage (known as a sigmoidoscopy)
is often the gold standard investigation for unexplained or concerning rectal bleeding.
It is a feature of haemorrhoids that they are often intermittent or wax and wane.
Indeed, some patients may notice that they have a particular flare-up after childbirth,
and then may have no such problems for another 20 or 30 years.
Typical factors which contribute to a flare-up include straining a stool, persistent lifting or a chronic cough,
indeed patients then are able to manipulate their toileting technique, adjust their dietary intake
or fluid intake - which helps quiesce their symptoms.
This can often be a cyclical pattern where patients can have periods of relative ease
with their hemorrhoid symptoms, followed by a more flared-up condition.
Recurrence rates for hemorrhoidal disease following hemorrhoidal intervention is widely
varied in its reporting in the literature. It's important to know that the vast majority
of hemorrhoidal disease cases can be managed in the community by your doctor.
The cornerstone of management includes adjustment of toileting techniques to avoid straining of stool or
spending prolonged periods of time at the toilet, usage of laxatives is very important
to assist with stool consistency and again to avoid straining.
It's also important to avoid contributing factors such as chronic persistent lifting or heavy exercise.
Occasionally, despite these measures, symptoms may persist, recur or become more problematic.
In these instances, it would be appropriate for your doctor to refer into the hospital for specialist opinion.
The cornerstone management of hospital assessment would include excluding any other
course for the bleeding from back passage as well as discussion regarding surgical interventions
for hemorrhoidal disease. Options for surgical intervention are now quite varied and are
more patient friendly in terms of being more minimally-invasive causing less patient discomfort
postoperatively and a faster return to work. Recurrence rates associated with the newer,
more minimally invasive techniques are similar to the more traditional forms of hemorrhoid surgery.
This is important to know as as a result, patient morbidity is less with a similar recurrence rates
and as such is much more attractive to the patient seeking surgical intervention.