All you need to know about Hemorrhoids

Dr. Matthew Tytherleigh – Consultant Colorectal and Laparoscopic Surgeon at Abu Dhabi’s tertiary healthcare institution Burjeel Hospital – answers commonly asked questions about Hemorrhoids.

All you need to know about Hemorrhoids

What are Hemorrhoids or Piles?

Hemorrhoids, or piles, are one of the most common colorectal ailments. More than half the population will develop Hemorrhoids at some time in their lives, usually after the age of 30.

External Hemorrhoids comprise of dilated veins underneath the skin at the entrance of the anus. They can swell and cause discomfort. Occasionally, they can become very painful if they thrombose (clot). Internal Hemorrhoids, which develop within the anal canal, beneath the lining, are distinguished by painless bleeding and protrusion during bowel movements. As the Hemorrhoids worsen, they can eventually protrude.

What are the common signs and symptoms of Hemorrhoids?

One of the most common and classical symptoms is painless rectal bleeding during bowel movements. This can appear as a small amount of bright red blood on the toilet tissue or in the toilet bowl. Patients may also complain of discomfort or itching in the anal region. Occasionally, large Hemorrhoids can prolapse out through the anus and can become very painful. However, severe pain on passing a motion is usually due to a different condition called an anal fissure, which is a tear at the anal verge.

When should you see a Colorectal Surgeon?

Hemorrhoids are very common and there are many available effective treatment options. Most people can get relief from symptoms by making lifestyle changes and using simple medications. However, if symptoms are not resolved within a couple of weeks, a Specialist Colorectal Surgeon should be consulted. Bright red bleeding during and after a bowel movement is the most common sign of Hemorrhoids. Unfortunately, similar symptoms can occur with other diseases, such as colitis and cancer. Hence, if the bleeding does not stop with simple measures within a couple of weeks, it is important to be seen by a Colorectal Surgeon.

What are the causes of Hemorrhoids?

Factors that may contribute to and be considered in the prevention of Hemorrhoids are: straining during bowel movements, spending long periods of time sitting on the toilet (reading or playing on smart phone), chronic constipation or diarrhea, pregnancy, and heredity.

How are Hemorrhoids diagnosed?

The simplest way to diagnose these problems is through an examination by a Colorectal Surgeon who deals with these conditions. Digital rectal examination, together with proctoscopy and sigmoidoscopy (simple telescope test to look into the rectum) are used to confirm the diagnosis. Occasionally, a more extensive examination of the entire colon (colonoscopy) is recommended if there are other signs and symptoms of colorectal disease such as an altered bowel habit or if there are other risk factors for colorectal cancer.

How can you prevent getting Hemorrhoids?

Prevention is better than cure! The easiest way to prevent Hemorrhoids is to keep the stools soft, so that they pass easily without the need to strain. Everyone should drink plenty of fluid (at least 2 to 3 litres) each day. A good diet with lots of fibre can help soften the stools and increase the bulk. This will prevent the straining that can cause Hemorrhoids or worsen symptoms. Exercise can help to prevent constipation and may also assist in loss of excess weight that may be contributing to the Hemorrhoids. Most importantly, avoid sitting and straining too long on the toilet. Ideally, only go to the toilet when there is a strong urge to open the bowels, sit for no longer than 3 to 4 minutes, passing stools which are the consistency of toothpaste.

What are the treatments for Hemorrhoids?

Initially, a change in diet and increasing fluids should help. Keeping the area clean and dry is important. Soak the area in plain warm water for 10 to 15 minutes, two to three times a day, especially after opening the bowels. Dry the area with a soft towel, patting rather than rubbing dry. If these changes do not improve the symptoms, medication may be necessary. This usually involves some form of laxative, which softens the stools. If the Hemorrhoids are causing discomfort and itching, a local anaesthetic or steroid cream may help relieve symptoms but this should only be used for a short period of time. With these treatments, Hemorrhoid symptoms often go away within a week or two. If relief does not occur, referral to a Colorectal Surgeon should be sought.

The Colorectal Surgeon has a number of methods to deal with Hemorrhoids. These include procedures undertaken in clinic such as rubber band ligation or injection, which cause the Hemorrhoid to shrivel up. Also, there are a number of surgeries that can be performed including Hemorrhoidal artery ligation, open Hemorrhoidectomy or stapled Hemorrhoidectomy/Anopexy. The Colorectal Surgeon will personalize the treatment depending on the type of Hemorrhoids the patient is suffering from.

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