Nearly one in two people may develop haemorrhoids at some point in their lifetime. This has become ever more common due to lifestyle shifts today – eating more processed foods and adopting sedentary lifestyles lead to poor bowel habits such as constipation and prolonged time spent in the toilet. The latter is made worse by our addiction to mobile devices. If left untreated, haemorrhoids can lead to serious complications such as severe bleeding and pain. However, with timely intervention, from healthy lifestyle practices to surgical treatment, haemorrhoids need not disrupt your quality of life.

What are haemorrhoids?

Haemorrhoids or piles are the result of engorged,swollen veins within the anal canal. The most common symptoms are

  • Bleeding associated with stool movement
  • Itch around the anus
  • Lumps felt around the anus

In the early stages, these symptoms may be episodic and mild such that patients are often unaware or ignore them altogether.

Why is it important to be certain of the diagnosis of haemorrhoids?

Many serious conditions affecting the colon and rectum can present with the same symptoms listed above. These conditions include polyps and cancers, diverticular disease, inflammatory bowel disease as well as infections affecting the anus. It is important for your specialist to perform a proper examination which must include a proctoscopy and a colonoscopy.

Are there different types of haemorrhoids?

Haemorrhoids are broadly classified as external and internal. External haemorrhoids are evident as lumps felt around the anal opening. These can cause chronic itch or result in sudden severe pain when blood clots form within them. Internal haemorrhoids, on the other hand, are not easily felt and may only be apparent after a bowel movement. Rectal bleeding that is bright red may be the only clue that they are present. Depending on the size, internal haemorrhoids are further graded as first, second or third degree.

Distinguishing the type and degree of haemorrhoids is important as it determines the type of treatment that your specialist will recommend. Small haemorrhoids may be well-treated with medication and lifestyle changes while large haemorrhoids will likely require some form of surgical intervention.

What are the non-surgical options for treating haemorrhoids?

Small or early haemorrhoids are amenable to oral medications, topical ointments or pessaries to reduce the pain and swelling. Such medications work by restoring a normal tone and function of the anal veins. If chronic constipation is present, your doctor may also prescribe some laxatives to regulate bowel movement and reduce the effort of defaecation.
As haemorrhoids tend to be chronic and recurring, an evaluation of your dietary habits and lifestyle is essential to identify factors that may be aggravating the condition.

Other non-surgical treatments include rubber band ligation and sclerotherapy. These are generally performed either in the specialist’s office or after a colonoscopy with the patient under sedation. Rubber band ligation is the more commonly performed procedure and it works by cutting out the blood supply at the base of the haemorrhoid. This results in shrinkage and sloughing off of the haemorrhoid within a few days.

When is surgical treatment necessary?

When haemorrhoids enlarge, there is a tendency to prolapse out of the anus. This may trigger a vicious cycle of further swelling and pain. Blood clots forming within the external haemorrhoid (thrombosed pile) is another cause of severe pain. Both acute situations call for urgent surgery to be performed.

Elective surgery is also performed for grade 2 or 3 piles as these are too large to be adequately treated with rubber band ligation.
Haemorrhoid surgery must be performed under general anaesthesia as the anal canal and skin around the anus is highly sensitive and packed with pain receptors.

What are the surgical options for treating haemorrhoids?

The two common surgical procedures are conventional haemorrhoidectomy and stapled haermorrhoidopexy. In the remaining section, I will describe the procedure and risks of each procedure.

Conventional Haemorrhoidectomy

This involves the complete surgical removal of the haemorrhoids followed by wound closure. To achieve this, electrocautery is used to dissect the vascular bundle away from the underlying anal muscles, ligated and removed.

While this conventional surgical method has high success rates at eliminating the piles, the procedure does involve a degree of pain. Possible complications include prolonged postoperative discomfort, delayed bleeding, urinary retention, and faecal impaction. Some patients may also experience wound breakdown, infection or anal stricture but these are rare occurrences.

Advanced energy devices (such as Ligasure ®) have allowed surgeons to perform conventional haemorrhoidectomy more safely, faster and with much improved postoperative pain.

Stapled Haemorrhoidopexy

Essentially, this procedure involves the use of a circular stapling device to excise a circumferential ring of excess mucosa and hemorrhoidal tissue. It is generally indicated for prolapsed haemorrhoids as it aims to remove the haemorrhoids while performing a mucosal ‘nip and tuck’ to restore a normal anal anatomy. The row of staples has the added benefit of disrupting the haemorrhoidal blood supply. 

This procedure is reported to have less postoperative pain and patients generally recover faster with a shorter downtime.
Nonetheless, some of the complications associated with haemorrhoidectomy are also present with the stapled hemorrhoidopexy procedure. There is also a slightly increased risk of recurrence as the haemorrhoid may not be completely excised.

Need help for your haemorrhoid problem?

If you are experiencing any form of rectal bleeding and discomfort in the anus, contact Thomas Ho Surgery today for a consultation and thorough evaluation. We will discuss in detail the range of treatment and surgical procedures that are more suited to relieve your symptoms and prevent further complications.

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