HAEMORRHOIDS - Full extract 

Harry is an accountant. After booking in at the reception desk, he went across the waiting room and stood in the corner. After a while he sat gingerly on the edge of a chair.

While moving house he had been doing a lot of lifting and straining. For the past few days he had an exquisitely painful lump right next to his anus.

Examining him, it was obvious that he had a small thrombosed internal haemorrhoid.

I gave Harry the ususal advice about avoiding constipation and having plenty of bulk and fibre in his diet. He was given some painkillers and a local anaesthetic cream and will be reviewed again shortly.

Haemorrhoids, or piles, are really just prominent veins around the anus. Usually they arise inside the anal canal and extend, to a varying degree, towards the anus. These are called internal haemorrhoids. Less commonly they can arise externally, in the veins outside the anus.

It seems that western diet and lifestyle are the main reasons why haemorrhoids are so very common in our community. As with other bowel problems like diverticular disease and bowel cancer, haemorrhoids are rarely seen in countries where people have plenty of roughage and dietary fibre. Such people tend to have large, regular bowel motions with little effort. They also empty their bowels when the urge comes, rather than putting it off till a more convenient time. Anything that leads to straining or constipation will encourage haemorrhoids to occur. In women, the abdominal distension from pregnancy can also be responsible.

While haemorrhoids can cause a variety of symptoms, it is usually bleeding which causes most alarm. The blood tends to be bright red and may be noticed on the toilet paper or actually drip into the toilet bowl. Such bleeding should never be attributed to haemorrhoids without a thorough examination to exclude more serious causes like bowel cancer.

Haemorrhoids may also cause itching and local irritation.

Sometimes they can be felt as one or more lumps around the anus, especially after a bowel motion.

They can interfere somewhat with normal bowel hygiene and make it difficult to clean the anus properly after a bowel motion.

If haemorrhoids become thrombosed, or blocked with a blood clot, they can become extremely painful. A thrombosed external pile can be incised under local anaesthetic and emptied of clot if seen in the first day or two.

This procedure usually produces dramatic relief. The more common internal piles are not able to be treated with this method. The presence of pain with haemorrhoids may be a clue to some other condition like a split in the skin around the anus or a local infection of some sort.

The history the person gives will often suggest haemorrhoids. However, there are several distinctive signs on examination. There may be an obvious lump around the anus. If thrombosis has occurred the haemorrhoid might be a dusky purple color and quite swollen and tender.

After doing a quick general check the doctor does a rectal examination by inserting a gloved and lubricated finger into the anal canal to check for abnormalities. Then a small metal instrument called a proctoscope is inserted. This allows the doctor to look inside the anal canal and check for haemorrhoids, splits in the anal skin and other abnormalities.

If there has been any bleeding a longer instrument called a sigmoidoscope is used to allow for a thorough inspection higher in the bowel. This is absolutely essential to rule out other causes of bleeding like polyps or bowel cancer. In some cases the doctor might recommend a colonoscopy; under sedation a long flexible instrument with a light on the end is introduced through the anus so the whole length of the large bowel can be examined.

The treatment of haemorrhoids depends on their size and position. Smaller ones are usually left alone and the person is just given advice about plenty of dietary fibre. A soothing cream might be recommended for any local irritation. Some are treated with special injections to shrink them down; this is useful for medium-size haemorrhoids that have been bleeding or causing local irritation. A rubber-banding procedure is another method that might be used. Larger haemorrhoids that prolapse down through the anus usually require surgery to remove them altogether.

Unless haemorrhoids have been surgically removed, they are prone to recur. Constipation and straining should be avoided. A high-fibre diet with plenty of fruit, vegetables and grain foods such as wholemeal and bran is recommended. Sometimes a bulk-forming supplement like Metamucil or Fybogel is useful to keep the bowel motions soft and regular. Drinking plenty of fluids and having adequate exercise are also important.

Health Tips:
* Make sure your diet contains plenty of natural fibre, roughage and bulk. Haemorrhoids is just one of the many health problems you might be able to avoid.

* When you get the urge to empty your bowel, try to go to the toilet as soon as possible - rather than holding off for hours.

* Blood in the bowel motions is a very important sign. Don't ignore it or assume it is due to haemorrhoids. See your doctor as soon as possible for a thorough check

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001