Haemorrhoids: What are they, and how can they be treated?

Despite popular belief, haemorrhoids are not the only anal condition that someone can suffer from, but they are usually the first that come to mind. Other common problems are anal fistula and anal fissure.

Haemorrhoids, anal fistulas and anal fissures are the three most frequent conditions a proctologist deals with - so much, that it is estimated that about 40 per cent of the population suffers from at least one of these anal problems.

Here to provide an expert insight into haemorrhoids, including symptoms and treatment, is Ms Cinzia Sammartino, renowned consultant general surgeon who specialises in proctology.

What are haemorrhoids?

Haemorrhoids, commonly referred to as piles, are swellings in the rectum that contain blood vessels. In many cases, haemorrhoids don’t cause any symptoms, and thus, patients may not realise that they have them.

However, in the cases where there are symptoms, the following may present:

• Bright red blood or a mucus discharge after passing stool
• An itchy bottom
• A lump hanging outside the anus
• Soreness, redness or swelling around the anus

What are the different grades of haemorrhoids?

Haemorrhoids are graded into four classes, and not all require a surgical cure:

• Grade 1: Haemorrhoids that only bleed
• Grade 2: Haemorrhoids that are prolapsed, meaning that they exit and re-enter the anus when passing stool
• Grade 3: Haemorrhoids that need to be manually pushed back into the anus by the patient
• Grade 4: Haemorrhoids that can’t be pushed back into the anus.

Grade 3 and Grade 4 haemorrhoids are treated with corrective surgery.

How are haemorrhoids treated?

Common haemorrhoid treatments include:

• eXroid electrotherapy: A state-of-the-art, minimally invasive treatment performed on an outpatient basis. During treatment, a device is used to generate a small current of up to 16mAmp. This current stimulates a chemical reaction in the haemorrhoids, creating an excess of alkali that accumulates to seal off the varicose blood vessel that feeds the haemorrhoids. The current may feel slightly uncomfortable, but it is not painful. There is also no need for anaesthesia – given that there is no cutting, stitching or heating involved – which is one of the main reasons why this treatment is considered low risk. Recovery is immediate, with patients returning to work and resuming their normal activities straight after treatment.
• HALO procedure: A cutting-edge operation that has transformed the surgical treatment of haemorrhoids. During the procedure, a mini Doppler ultrasound probe is used to identify and treat the blood vessels that feed the haemorrhoids so that these shrink. There is no cutting or tissue excision involved, resulting in less pain and tissue damage. This enables a faster recovery compared to conventional surgical treatments of haemorrhoids. The procedure, however, needs to be performed under general anaesthesia.
• Milligan-Morgan’s procedure: The surgical treatment for haemorrhoids, which gives excellent results and eliminates haemorrhoids permanently. However, it is a painful operation that must be treated with painkillers. The wounds can take up to 20 days to heal, but the patient stops feeling pain after 10 days – usually because the area is more relaxed.
• Rubber band ligation: This treatment technique is performed on an outpatient basis. It consists of necrotising (killing) the haemorrhoids so that they fall off after three or four days.

Why are haemorrhoids sometimes confused with anal fissures?

Many patients go to their proctologist with anal pain thinking that they have haemorrhoids when, contrary to widespread belief, haemorrhoids don't always hurt. If there is pain, the problem is usually due to an anal fissure, which is an exaggerated contraction of the internal sphincter that causes a lack of blood supply. This, in turn, produces an ulcer.

The most frequent causes of an anal fissure are stress, anxiety and chronic constipation. An anal fissure can be resolved with medical treatment. If this fails, the second line of treatment are usually Botox injections. Less frequently nowadays, a sphincterotomy which consists of an incision that helps to relax the sphincter, is needed to solve the problem.

Ms Cinzia Sammartino is a highly skilled consultant general surgeon with over 20 years’ experience.

If you require expert treatment and management for haemorrhoids, do not hesitate to book an appointment with Ms Sammartino via her Top Doctors profile today.