Haemorrhoids

Haemorrhoids commonly present as painless, bright red bleeding, but can also present as perianal itching, prolapse or the sensation of incomplete emptying.

Haemorrhoids are blood vessels that are part of the normal anatomy of the anal canal. One of their functions is to aid in continence, but haemorrhoids may become problematic if they become enlarged. As they enlarge, the blood vessels become more prominent, and the haemorrhoids may prolapse outside the anal canal.

What causes haemorrhoids?

Haemorrhoids are essentially due to weakness of the supporting (connective tissue) of the anal canal. This can be exacerbated in certain conditions

  • Chronic constipation or diarrhoea
  • Straining
  • Pregnancy
  • Ageing

How do I know if I have haemorrhoids?

The symptoms of haemorrhoids can mimic many diseases of the anal canal. They can commonly present as

  • Bleeding
  • A lump at the anus
  • Itching around the anus
  • Sensation of incomplete emptying of the anus after a bowel motion
  • Pain

Haemorrhoids can also undergo acute complications such as necrosis, thrombosis, ulceration and incarceration. Any of these should be reviewed by a Colorectal Surgeon to determine if surgery is required.

The treatment of haemorrhoids is dependant on making the right diagnosis. Unfortunately there are a handful of symptoms that are shared by both serious, life threatening illness and benign self limiting diseases. You should see your GP if you have any bowel signs or symptoms and they may choose to refer you onto a specialist for further evaluation.

Are haemorrhoids serious or life threatening?

The vast majority of haemorrhoids may not require any treatment unless they are causing you symptoms. It is important that your symptoms are evaluated through a directed history and a physical examination to both confirm the diagnosis and exclude other anal / rectal pathology.

There is no association between haemorrhoids and bowel cancer.

You may be referred for a colonoscopy as part of the investigation of your symptoms, especially if you have experienced bleeding.

Do all haemorrhoids need surgery?

Symptomatic haemorrhoids that are diagnosed early may respond to non surgical measures such as dietary modification or rubber band ligation.

Patients in whom these measures fail, or whom have large haemorrhoids, with a significant degree of prolapse, benefit the most from surgery. Haemorrhoidectomy is a very effective surgical technique, with a less than 5% recurrence rate. The most important side effect of haemorrhoidectomy is pain, and patients should be aware that they will usually require narcotic analgesia for 5 days post operatively.