What are haemorrhoids?
or piles are a common problem. Haemorrhoid forms when the veins in the soft
tissue in the anal canal and part of the rectum above it becomes dilated. This
causes a swelling that can sometimes bulge out of the back passage(prolapsing
may cause symptoms such as bleeding, swellling/lumps in anal canal, mucus discharge, itching and pain(especially if thrombosed)
What treatment options are available?
treatment – high fibre diet, avoiding straining(keeping stools soft). Using
haemorrhoid cream/ointment/suppositories(eg Scheriproct, Proctosedyl, Rectinol)
– these usually contain a combination of steroids and local anaesthetic.
of haemorrhoids with sclerosant(5% phenol in almond oil) – there are risks of
causing severe inflammation outside the rectum. Also not that successful for
of haemorrhoids – there are many ways of doing these. It is important to band
above the dentate line of the anal canal to reduce the pain – in fact this is
often painless. (The author prefers to
band multiple times in an imaginary vertical line along the branches of the
rectal vessels contributing to the haemorrhoids – this is so that the supplying
blood vessel is thrombosed and this also helps pull up small prolapsing anal
cushions to a degree. This combines the principles of placating the tissue from
stapled haemorrhoidectomy and ligation of the vessels without actually needing
invasive surgery) Risks – bleeding, recurrence of haemorrhoids in other
areas not banded, discomfort/feeling of needing to go to the toilet, pain – if large
prolapsing haemorrhoid and some component extends below the dentate line)
– there are many different techniques available. Haemorrhoidectomy – open or
closed technique. Haemorrhoidpexy. Stapled techniques. Coagulation diathermy can be
used(as can infrared laser photocoagulation, cryosurgery, harmonic scalpel) Ligation of haemorrhoid artery. Or a combination of the above. (The author prefers surgery only as the last resort - after conservative management or banding has failed. The aim being to excise the
haemorrhoids and any associated skin tags with minimal trauma to surrounding tissue to reduce postop pain. Usually with coagulation diathermy,
closure of the wound, ligation of the pedicle of the haemorrhoids(to ligate the supplying blood vessel - branches of the superior rectal arteries) and pexy(pulling up) of the mucosal cushions. A Spongostan pack is also usually inserted at the end of the procedure. Generally surgery is indicated for large 4th degree haemorrhoids or in
cases where banding has failed. If performed in the Minor Operating theatre with only local anaesthesia - only one haemorrhoid with its associated skin tag is excised at a time and more plication/pexy is performed in that area) Risks of surgery include – pain , urinary retention, bleeding, anal stricture(if too
much intervening tissue is taken, anal fissure, abscess, remaining skin/tissue between the areas excised may swell and feel like lumps after the op. Pain postop can be
severe in some people. It is important to keep one's stools soft during the healing process.