From diagnosis to treatment, this is what you need to know

Haemorrhoids – or piles –may present as lumps around or within your anus. This is not a condition to be ignored as it has been known to result in severe anaemia from persistent rectal bleeding. If you are suffering from haemorrhoids, it is important for you to read on and understand the symptoms, the severity and possible treatment plans. In case of any emergencies, you should not hesitate to visit your nearest doctor or call us to arrange for a consultation.

#1 What are the causes of haemorrhoids?

Haemorrhoids occur when blood vessels around the anus and lower rectum become dilated and engorged. This usually arise from built up pressures within the pelvis that impede venous blood flow towards the heart. A common predisposing factor is chronic constipation such that prolonged time spent on the toilet bowl and straining to open bowels lead to such increased pressures over time.

It is important to understand that haemorrhoids are not uncommon. If you are living in Singapore and suffering from piles, you are not alone. In fact, based on a previous research article, the prevalence of haemorrhoids in our country could earn Singapore the title of haemorrhoid-capital of the world!

#2 Who is at risk of haemorrhoids?

Given the prevalence of this disease amongst the young and old, haemorrhoids can be considered a lifestyle disease. This is especially as our society moves towards a sedentary lifestyle with decreased fibre intake in our diets. For some, this is made worse by adopting poor habits such as putting off the urge to move the bowel or spending prolonged periods in the toilet reading or being glued to their mobile devices.

Family history is also a major factor for developing haemorrhoids. Those with family members who suffer from haemorrhoids are also at greater risk of developing the same at an earlier age.

Pregnant women are another vulnerable group. It is not uncommon for pregnant women, especially in the later stages of pregnancy, to seek help from their doctor for painful piles. This is due to increasing pressures exerted by the foetus within the pelvis and impeding venous blood flow.
Other less likely risk factors include individuals with a history of liver and heart disease, individuals who sit or stand for prolonged periods.Taxi-drivers or trunk drivers are examples of at-risk occupations because of the prolonged periods that they spend in a sitting position.

#3 What are the symptoms of haemorrhoids?

The symptoms for haemorrhoids are varied and include:

  1. Itch around the anus
  2. Passage of blood during bowel movements
  3. Fresh blood dripping into the toilet bowl or on wiping
  4. Moist mucus on the underwear despite cleaning properly after visiting the toilet
  5. Lumpsfelt around the anus especially after bowel movement
  6. Painful lumps that need to be pushed back into the anus

If you experience any of these symptoms, it may be prudent to consult a doctor.

Patients should not assume that all rectal bleeding are caused by haemorrhoids even though they may be common.It is the duty of your doctor to rule out more sinister conditions such as colorectal or anal cancers. Lumps around the anus can also be the result of viral warts. Hence anyone with bleeding from the anus or anal lumps should seek help sooner rather than later.Book an appointment with Thomas Ho Surgery for a timely consultation and physical examination

#4 What is the difference between internal and external haemorrhoids?

Haemorrhoids are generally classified as internal or external.

External haemorrhoids are most often felt as bulges or lumps at the anus and tend to be persistently present without much discomfort. When thrombosis occurs or blood clots form within them (‘perianal hematoma’), the pain can be very acute and severe. The haemorrhoid becomes a dark, hard lump and extremely sensitive to touch. When this happens, patients often report emergently to the doctor with intolerable pain on sitting and walking.

Internal haemorrhoids, conversely, are hidden within the anus especially when the size remainssmall. Patients tend to experience painless bleeding during bowel movement as the only symptom. When internal haemorrhoids enlarge, they typically descend during bowel movement resulting in discomfort. Patients instinctively attempt to push them back in when cleaning themselves. When the piles enlarge further and are unable to be pushed back in, they may become prolapsed and swollen. This again results in intolerable pain and swelling that requires immediate attention by the doctor.

#5 Can haemorrhoids be treated?

Haemorrhoids can be treated with timely medical intervention. Depending on the size and symptom, treatment can start with oral medications to shrink the piles and improve blood flow, reduce constipation and the effort of defaecation.
Further treatment may be required for larger piles, particularly when they prolapse. Typically, the doctor will recommend rubber band ligation which can be performed in the outpatient setting. A rubber band is deployed tightly around the base of the haemorrhoid to strangulate the blood supply. As the haemorrhoid detaches, it leaves behind a small wound that heals with scarring. Rubber band ligation is usually performed after a colonoscopy examination.

#6 What are the surgical options for treating haemorrhoids?

Beyond medication and rubber band ligation, surgery offers a more definitive treatment option. The most common procedure is conventional haemorrhoidectomy, where the piles are surgically removed using diathermy or advanced bipolar device (less pain).

Another technique is stapled hemorrhoidectomy which acts like a ‘nip and tuck’ procedure. The haemorrhoids are removed through the firing of a stapling device which simultaneously draws excess mucosa upwards to counteract the prolapse.

Both surgical procedures are performed under general anaesthesia and patients will require a period of pain killers and special care instructions after surgery. Discuss with your surgeon the various treatment options including the benefits and risks of surgery.
If you think you have haemorrhoids, do not suffer in silence anymore. Book an appointment with Thomas Ho Surgery soon to nip the problem in the butt (figuratively speaking)!


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