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Haemorrhoids

WHAT ARE "PILES" OR HAEMORRHOIDS AND WHAT CAUSES THEM?

A common or colloquial term for haemorrhoids is piles. Unfortunately this is a general term often used to describe different types of perianal problems. Sometimes haemorrhoids also are described as "varicose veins of the anus." These terms are misleading and can cause some confusion even amongst health care professionals.

Haemorrhoids are areas of tissue which arise from so called anal cushions which are a normal part of the back passage and help with the maintenance of continence to gas and liquid stool. They help create a water tight seal of the back passage and prevent leakage.

Haemorrhoids occur in the western world because diets do not contain enough fibre and prolonged passage of firm stools, accompanied by repetitive straining causes the cushions to expand and gradually fall into the anal canal. This then sets up a vicious circle as patients feel the small haemorrhoids in the back passage and mistake this sensation for a small amount of stool which needs to be passed. This encourages further straining by the patient making the haemorrhoids worse.

Over a period of months or even years the haemorrhoids gradually expand or enlarge and begin to cause problems.

Other factors associated with haemorrhoids are:  Chronic constipation or diarrhoea, pregnancy, Faulty bowel function due to overuse of laxatives or enemas. Spending long periods of time on the toilet (e.g., reading).

Conditions which are commonly confused with haemorrhoids are anal fissure, perianal haematoma, perianal fistula and anal skin tags.

WHAT ARE THE SYMPTOMS OF HAEMORRHOIDS?

Early small haemorrhoids develop within the upper anal canal where it meets the rectum. They are usually painless and are covered by intestinal lining (mucosa). Painless bleeding and protrusion (prolapse) during bowel movements are the common symptoms.  Some itching and mild discomfort can be experienced.

Larger haemorrhoids protrude with bowel movements and return to their inside location and go back without help, more severe prolapse and the haemorrhoids need to be pushed back in, some may protrude all of the time.  The discomfort and bleeding is more marked as they become larger.



Rarely, large haemorrhoids can cause severe pain if they are completely prolapsed, cannot be reduced or pushed back inside, and develops a blood clot within them. This is the most severe from and is called thrombosed haemorrhoids.

DO HAEMORRHOIDS LEAD TO CANCER?

No. There is no relationship between haemorrhoids and cancer.

However, the symptoms of haemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other diseases of the colon and rectum. It is important that all symptoms are investigated by a doctor. It is important not to simply rely on over-the-counter medications or other self treatments.

Seeing a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed should be recommended.

HOW ARE HEAMORRHOIDS TREATED?

Small haemorrhoids causing mild symptoms can often be relieved by taking a high fibre diet of fibre and fluids in the diet. Good sources of dietary fibre include bran cereals, whole grain breads, fruits and vegetables.

Eliminating excessive straining reduces the pressure on the haemorrhoids and helps prevent them getting worse. Indeed understanding the nature of the sensation above can help.

Larger haemorrhoids with persistent bleeding or prolapse may need treating by rubber band ligation. This method works effectively on haemorrhoids that protrude with bowel movements.

Rubber Band Ligation

A small rubber band is placed over the haemorrhoid, cutting off its blood supply and ultimately resulting in a small scar which helps prevent prolapse. The haemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding, but can be performed safely in clinic.

Haemorrhoidectomy

Haemorrhoidectomy is a surgical procedure to remove the haemorrhoids.

This is the best method for the permanent relief of large haemorrhoids. Removal of excessive tissue that causes the bleeding and protrusion it is a procedure which is performed under general anaesthetic usually as a day case but an over night stay may be needed.

Stapled haemorrhoidectomy is an alternative and may be more effective in patients with circumferential prolapsed haemorrhoids.

Laser techniques or arterial ligation techniques are available but may not be as effective over standard operative techniques.

A consultation with a colorectal surgeon will allow discussion of the most appropriate treatment in each individual case.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666