By Dr. Faozat Aragbaye
Haemorrhoids are swollen veins in the anus and lower rectum, similar to varicose veins. Haemorrhoids may be located inside the rectum (internal haemorrhoids), or they may be under the skin around the anus (external haemorrhoids). Occasionally , a clot may form in a haemorrhoid ( thrombosed haemorrhoid).
Haemorrhoids are very common. Nearly three out of will have haemorrhoids from time to time.
The veins around the anus tend to stretch under pressure and may bulge or swell. Swollen veins (haemorrhoids) can develop from increased pressure in the lower rectum due to:
- Straining during bowel movements
- Sittin for long period of time on the toilet
- Chronic diarrhoea or constipation
- Anal intercourse
- Low fibre diet
- Age between 45 and 65 years
- Space occupying pelvic lesion
- Hepatic insufficiency
Signs and symptoms of haemorrhoids may include:
- Painless bleeding during bowel movements
- Itching or irritation in the anal region
- Pain or discomfort
- Swelling around the anus
- A lump near the anus
Haemorrhoid symptoms usually depend on the location, thus:
- Internal haemorrhoids: These lie inside the rectum. They can’t be seen or felt and they rarely cause discomfort. But straining or irritation can damage the surface of a haemorrhoid when passing stool and cause bleeding. Occasionally, straining can push an internal haemorrhoid through the anal opening. This is known as protruding or prolapsed haemorrhoid and can cause pain and irritation.
- External haemorrhoids: These are under the skin around the anus. When irritated, external haemorrhoids can itch or bleed.
- Thrombosed haemorrhoids: a pool of blood that forms a clot (thrombus) in an external haemorrhoid can result in severe pain, swelling, inflammation and hard lump near the anus.
Physical examination of the anus and the anal region is usually used to diagnose external haemorrhoids. Tests and procedures to diagnose internal haemorrhoids may include examination of the anal canal and rectum:
- Digital examination
- Visual inspection
- Colonoscopy/ flexible sigmodoscopy
- Stool for occult blood
Home treatments can often relieve mild pain, swelling and inflammation of haemorrhoids. Often these are the only treatments needed.
- Eat high fibre diet
- Use topical treatments. Apply an OTC haemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent. Don’t use over- the- counter cream for more than a week unless directed by the doctor.
- Soak regularly in a warm or sitz bath. Soak your anal area in plain warm water 10 to 15 minutes two to three times a day . a sitz bath fits over the toilet.
- Keep the anal area clean. Bathe or shower daily to cleanse the area around the anus gently with warm water.
- Do not use dry toilet paper. To keep the anal area clean after bowel movement, use moist towelettes or wet toilet paper.
- Apply cold. Apply ice packs or cold compresses on the anus to relieve swelling
- Take oral pain relievers to help relieve pains
With these home treatments, haemorrhoid symptoms often go away within a week.
For haemorrhoids with mild discomfort, the doctor may suggest OTC creams ointments, suppositories or pads.
For persistent bleeding or painful haemorrhoids, the doctor may recommend minimally invasive procedures available. These are:
- Rubber band litigation. Two tiny rubber bands are placed around the base of an internal haemorrhoid to cut off its circulation.
- Sclerotherapy. This involves injecting a chemical solution to shrink the haemorrhoid tissue
- Coagulation (infrared, laser or bipolar).
Coagulation techniques use laser or infrared light or heat and this cause small bleeding, internal haemorrhoids to harden and shrivel.
If other procedures haven’t been successful, or considering a case of large haemorrhoid, the doctor may recommend a surgical procedure. These surgical procedures are being considered:
- Haemorrhoidectomy –removal of excessive tissue that causes bleeding.
- Haemorrhoid stapling. This procedure blocks blood flow to haemorrhoidal tissue.
Complications of haemorrhoids are very rare but include:
- Anaemia. Rarely , chronic blood loss from haemorrhoids may cause anaemia
- Strangulated haemorrhoid. If the blood supply to an internal haemorrhoid is cut off, the haemorrhoid may be “strangulated”
The best way to prevent haemorrhoids is to keeping the stool soft, so that it can pass out easily. To prevent haemorrhoids and reduce the symptoms, follow these tips:
- Eat high fibre foods such as fruits ,vegetables and grains.
- Drink plenty of fluids- drink six to eight glasses of water and other liquids (not alcohol) daily to help keep stools soft.
- Consider fibre supplement- for those who don’t get enough of recommended fibre in their diet, there is need to consider fibre supplement.
- Do not strain when trying to pass stool
- Be prompt as you feel the urge for bowel movement
- Exercise – stay active
- Avoid long period of sitting. Sitting too long, particularly on the toilet can increase pressure on the veins in the anus.