Haemorrhoids (Piles)

Haemorrhoids, also known as piles, are normal blood vessels within the anal canal. In their normal state, they act as cushions that help maintain continence and assist with bowel control. Haemorrhoids only become a problem when they enlarge, swell, or prolapse (move downwards) within the anal canal.

Haemorrhoids are very common and can affect people of all ages. Common symptoms include:

• Bright red bleeding during bowel motions

• A lump or swelling around the anus

• Itching or irritation

• Discomfort or aching

• Mucous discharge

• Difficulty cleaning after opening the bowels

The severity of symptoms usually relates to how far the haemorrhoids prolapse.

Internal Haemorrhoids

Internal haemorrhoids develop inside the anal canal and commonly cause painless bright red bleeding, often noticed on the toilet paper or in the toilet bowl after opening the bowels.

As internal haemorrhoids enlarge, they may prolapse outside the anus during bowel motions. Initially, they often return back inside on their own, but over time they may require manual reduction or remain permanently prolapsed. Larger prolapsing haemorrhoids can also cause irritation, mucous leakage, itching, and hygiene difficulties.

Internal haemorrhoids are commonly classified as:

• Grade I — bleeding without prolapse

• Grade II — prolapse that returns spontaneously

• Grade III — prolapse requiring manual reduction

• Grade IV — permanently prolapsed haemorrhoids

External Haemorrhoids

External haemorrhoids occur beneath the skin around the anus. Occasionally, a blood clot can form within an external haemorrhoid (thrombosed external haemorrhoid), resulting in a sudden painful lump near the anus.

Pain and swelling usually improve over several days as the clot settles, although a residual skin tag may remain after healing.

What Causes Haemorrhoids?

Factors that can contribute to haemorrhoids include:

• Constipation

• Straining during bowel motions

• Prolonged sitting on the toilet

• Chronic diarrhoea

• Pregnancy

• Ageing

• Low fibre intake

Assessment

Rectal bleeding should always be medically assessed, even if haemorrhoids are suspected, as other bowel conditions — including Colorectal cancer — can cause similar symptoms.

Assessment may include examination of the anal canal and, depending on your symptoms, age, and medical history, further investigation with sigmoidoscopy or colonoscopy.

Treatment

Treatment depends on the severity of symptoms and degree of prolapse.

Conservative Management

Many haemorrhoids improve with simple measures aimed at improving bowel habits and reducing straining, including:

• Increasing fibre intake

• Drinking adequate fluids

• Avoiding prolonged sitting on the toilet

• Stool softeners if required

• Improving bowel regularity

Surgery

A variety of techniques exist for the management of haemorrhoids, including rubber band ligation, sclerotherapy, HAL-RAR and haemorrhoidectomy. Surgery may be recommended for symptoms that do not improve with conservative treatment. The most appropriate treatment depends on the type and severity of the haemorrhoids as well as individual patient factors.