DR. Kaushik Kumar

What are haemorrhoids:

Haemorrhoids (commonly known as piles) are condition in which the veins around the anus or inside the rectum become enlarged and swollen. It is very common condition and affect up to 40 % of population.

The normal haemorrhoids are located inside anal canal and anchored to wall with fibrous septa. They help to occupy space in the anal canal, and contribute to anal tone – this helps prevent soiling, leakage, and the involuntary loss of wind. It is when they Haemorrhoids can lose their attachment to the wall of the anal canal, allowing them to enlarge and prolapse. As haemorrhoids enlarge, they become fragile and can cause bleeding.

Haemorrhoid Classification

What are the symptoms of haemorrhoids:

Bleeding is the most common symptoms of haemorrhoid problem. It is usually small volume, bright red, and fresh blood on the toilet paper, in the bowl, or on the outside of the stool. Major bleeding from haemorrhoids can happen but very rare. Whilst haemorrhoids are benign and rarely dangerous, it is important to exclude more sinister causes of rectal bleeding like cancer or polyps

Prolapse is another problem with large haemorrhoids and can occur with defecation, passing wind or even physical activities. Large prolapsing haemorrhoids ( Grade 4) can be uncomfortable and they can cause soiling, mucous discharge, itching around anus and cause difficulty in cleaning difficult, and the combination of leakage and difficulty with cleaning.

Haemorrhoids are usually not painful unless they are stuck on the outside and very swollen – “acute thrombosed prolapsed haemorrhoids”. In case of pain associated with defecation, other conditions should be considered like anal fissure, infection or cancer

What is the treatment of haemorrhoids:

There are multiple options to treat haemorrhoids including non-surgical and surgical.
Small haemorrhoids (Grade 1-2) can be managed by dietary and life style modification including avoid constipation or diarrhoea, avoid straining , increasing fibres & water intake in diet. Simple procedure like Rubber band ligation of haemorrhoids or HET therapy (Haemorrhoid Energy Treatment) can be effective for small haemorrhoids and can be done at the time of colonoscopy.

Large symptomatic haemorrhoids ( grade 3 and 4 typically) may require surgical treatment in addition to dietary and life style modification. Traditionally, haemorrhoid surgery has involved excising or cutting out the haemorrhoid ( Open haemorrhoidectomy or Milligan-Morgan procedure) which although very effective, can be painful with pain and discomfort lasting up to 3 to 4 weeks.

Newer methods like HALRAR (Haemorrhoid artery ligation and Rectoanal repair) and selective stapled haemorrhoidectomy are newer techniques that are very effective in appropriately selected patients. They are associated with less post operative pain and early return to work.