Understanding haemorrhoids

Haemorrhoids, also known as piles, are not only a condition but pre-existing blood vessels anchored around the anal canal to protect it. During bowel movements, they act as a cushion and swell. When the anchors securing the blood vessels break away from the canal wall, they shift closer to the surface of the skin and become visible or palpable – and this is what most people mean when they refer to haemorrhoids as a condition. Dr Tarun Singhal, a consultant colorectal surgeon, shares his expertise about this condition that can be treated without shame or judgement.

What are haemorrhoids?

Haemorrhoids can happen to anyone, but people who repeatedly defecate with force, women in labour or in the later stages of pregnancy, and people who do frequent heavy lifting are the most susceptible due to prolonged strain on those blood vessels.

These loose haemorrhoids will manifest as lumps around and inside the rear, and will be accompanied by the presence of bright red blood in stool. If the stool is black or very dark red-brown, the bleeding would stem from further up the gastrointestinal tract and could indicate a more serious issue. Generally, piles should be painless, though there may be a sensation of itchiness or sensitivity. If there is pain, there may be a chance of thrombosis (clotting) in the vessels. In more extreme cases, they may prolapse through the anus after defecation.

How are haemorrhoids treated?

Though uncommon, some of the biggest risks are blood loss over time and infection of the exposed tissue. Overall, haemorrhoids are not a dangerous condition, just unsightly and uncomfortable.

Treatment options include over-the-counter creams and suppositories to alleviate the symptoms of swelling and itching, but won’t make the haemorrhoids retract or reattach to the anal canal walls.

For more intensive solutions to external haemorrhoids, there is banding, where rubber bands are secured around the haemorrhoids to cut off blood flow to them and they will fall off after a few days as dead tissue; or, injections (sclerotherapy) to the piles with a chemical called phenol which also cuts off blood supply, causing them to shrivel up and retract. Both of these treatments are not guaranteed to prevent more haemorrhoids in the future.

Another treatment option is surgery for those who suffer from a lot of haemorrhoids or for a long time, and is considered a last option. Here are two methods:

• Haemorrhoidectomy, where the haemorrhoids are removed and the remaining blood vessels are sealed off. The healing process takes several weeks and depending on the type of surgery, the wounds may be left open to heal.
• Transanal haemorrhoidal dearterialisation (THD), a corrective procedure where sutures are applied around each pile to minimise the blood supply and reduce the size. The protruding cushion is then pushed back so that it doesn’t emerge or push through the anus again. The healing process for this is much more rapid, and normal activities can be resumed after a couple of days.

Your doctors will assess what the best treatment option is for you depending on the severity of the haemorrhoids.

If you are suffering from haemorrhoids and seeking treatment, Dr Tarun Singhal is an accomplished consultant colorectal surgeon available to book via his Top Doctors profile.