What are haemorrhoids?

Haemorrhoids, commonly known as piles, are enlarged veins located in the anus and lower rectum. These swollen veins are comparable to varicose veins and can manifest as either internal haemorrhoids inside the rectum or external haemorrhoids under the skin surrounding the anus.

Where are internal haemorrhoids located?

Internal haemorrhoids are located within the rectum and are typically not visible, often causing no pain or discomfort. However, during bowel movements, you might observe slight bleeding in the toilet bowl or on the toilet paper when straining. In some cases, an internal haemorrhoid may protrude from the anal opening, known as a protruding haemorrhoid, which can lead to pain and discomfort.

Where are external haemorrhoids located?

External haemorrhoids are located on the outer skin of the anus and can cause symptoms such as itching, irritation, pain, discomfort, swelling, and occasional bleeding in the anal area.

What is a thrombosed haemorrhoid?

Thrombosed haemorrhoids are external haemorrhoids filled with blood that have formed a clot. Symptoms of thrombosed haemorrhoids can include intense pain, swelling, and inflammation, often accompanied by a firm, discoloured lump near the anus.

What causes haemorrhoids?

Haemorrhoids can be caused by various factors that lead to increased pressure in the lower rectum, resulting in bulging and swelling of the skin around the anus. These factors include straining during bowel movements, prolonged periods of sitting (especially on the toilet), chronic diarrhea or constipation, obesity, pregnancy, anal intercourse, a low-fibre diet, and frequent heavy lifting.

It is worth noting that haemorrhoids are particularly common during pregnancy, affecting 1 in 3 expectant mothers. Unfortunately, treatment options are limited during pregnancy.

What are the risk factors for haemorrhoids?

One of the risk factors for developing haemorrhoids is the natural aging process, which causes the supportive tissues in the rectum and anus to weaken and stretch. Additionally, pregnancy can also increase the risk as the weight of the growing baby puts added pressure on the anal area.

Is there potential for complications from haemorrhoids?

There are several potential complications that can occur with haemorrhoids. These include anaemia due to continuous blood loss, a strangled haemorrhoid where the blood supply to an internal haemorrhoid is blocked off, resulting in severe pain, and a thrombosed haemorrhoid, which is a blood clot that can be extremely painful. While these complications are not life-threatening, they can cause significant discomfort and may require medical intervention such as draining.

How can you prevent haemorrhoids?

Preventing haemorrhoids is essential. The most effective way to avoid them is by ensuring that your stools are soft and easy to pass. You can take proactive steps to prevent haemorrhoids, such as maintaining a high-fibre diet rich in fruits, vegetables, and whole grains. This will increase stool bulk and reduce the need for straining, which can lead to haemorrhoids.

Other preventative measures against haemorrhoids include:

• Drinking an adequate amount of water, about 6-8 glasses daily, can also help keep stools soft. Limiting alcohol consumption is also advisable. If necessary, over-the-counter fibre supplements can be beneficial for those who do not consume enough fibre in their diet. Supplements like psyllium or methylcellulose can alleviate symptoms and reduce bleeding from haemorrhoids.
• Avoiding straining during bowel movements is crucial to reducing pressure on the veins in the lower rectum.
• Regular exercise can help prevent constipation and decrease pressure on the veins. Additionally, exercise can aid in weight management, which is important for preventing or improving haemorrhoids caused by excess weight. It is advisable to avoid prolonged sitting, especially on the toilet, to minimise pressure on the anus.

When should you seek medical advice for haemorrhoids?

If you notice bleeding during bowel movements or if your haemorrhoids do not improve after a week of home treatment, it is important to seek medical advice. Do not automatically assume that the bleeding is due to haemorrhoids, especially if there are changes in your bowel habits, stool colour, or consistency. Rectal bleeding can be a symptom of various conditions, including certain types of cancer.

How do you know what a haemorrhoid is?

Your healthcare provider may be able to visually identify any external haemorrhoids, but for internal haemorrhoids, an examination of the anus may be necessary. This involves the insertion of a lubricated, gloved finger into the rectum to allow the doctor to check for any abnormalities or growths.

If any irregularities are detected, a colonoscopy may be recommended to provide a comprehensive view of your entire colon.

Is there treatment for haemorrhoids?

Treating haemorrhoids at home can be easily done with over-the-counter topical treatments like hydrocortisone creams or suppositories. These products are safe to use during pregnancy and breastfeeding, providing relief by soothing and numbing the affected area. Additionally, soaking in warm baths or sitz baths a few times a day can also help alleviate discomfort. It's important to keep the area clean after using the toilet to prevent irritation, and over-the-counter pain relief can be taken as needed. These treatments should relieve symptoms, and you should see improvements in a week.

After pregnancy, haemorrhoids usually will go away on their own, though if they don’t get better, your doctor may suggest the following non-recommended treatments during pregnancy, such as rubber band ligation, where tiny rubber bands are placed around the base of internal hemorrhoids to cut off the blood flow; this causes the haemorrhoid to wither and drop off in roughly a week, sclerotherapy where a doctor injects a chemical into the hemorrhoid tissue to shrink it or coagulation techniques where haemorrhoids are treated using laser or infrared light or heat to shrivel the haemorrhoid. These procedures can be uncomfortable and may cause bleeding but can effectively shrink or remove haemorrhoids. In extreme cases, surgery may be required to remove excess tissue causing bleeding. This procedure is typically done under sedation and local anesthetic, providing the most effective treatment for severe or recurring haemorrhoids.

If you are experiencing haemorrhoids, make an appointment with your GP for evaluation and treatment; in the meantime, take steps to soften your stools and reduce any straining.

 References

Australia, H. (2021, August 14). Haemorrhoids during pregnancy. Www.pregnancybirthbaby.org.au. https://www.pregnancybirthbaby.org.au/haemorrhoids-during-pregnancy

Haemorrhoids in Pregnancy and Breastfeeding Mothersafe -Royal Hospital for Women. (2019). https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Mothersafe/documents/haemorrhoidspb20.pdf

Harvard Health Publishing. (2019, February 6). Hemorrhoids and what to do about them - Harvard Health. Harvard Health; Harvard Health. https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them

Mayo Clinic. (2019). Hemorrhoids - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280

‌Treating hemorrhoids during pregnancy. (n.d.). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149