By Dr Choo Weng Yue
MBBS NUS
Haemorrhoids and piles are synonymous. About one in three people in Singapore suffer from haemorrhoids. It comes about when blood vessels in the anus are enlarged and bulging due to chronic straining from difficult bowel movement. This would inevitably lead to internal haemorrhoids.
Another type of haemorrhoids is external haemorrhoids – this usually happens when someone has chronic constipation or constantly strains very hard such as carrying heavy loads during work or strenuous exercise.
The part of the dilated blood vessels that become enlarged also determines the type of haemorrhoids that develop. Enlargement of blood vessels that are higher up the anus, above the dentate line would lead to internal haemorrhoids. Whereas, blood vessel enlargement below that line would lead to external haemorrhoids instead.
The main presenting symptoms are rectal bleeding, anal discomfort and pain, as well as swelling at the anus. Bleeding occurs during bowel movement and it can be mild – appearing as drops of blood during cleaning or in the toilet bowl. Sometimes the bleeding can be copious and this would usually cause alarm and distress to the individual. External haemorrhoids would present as painful lumps at the anal verge. This type of haemorrhoids usually does not bleed but sometimes do when they rupture. It is usually more likely that the bleeding comes from a concurrent presence of internal haemorrhoids. A common cause of severe pain from external haemorrhoids is thrombosis (blood clot) within the haemorrhoid. Sometimes, an individual may feel a burning discomfort or itch around the anus.
Oral medication can be prescribed to treat less severe haemorrhoids. Haemorrhoids that are small or not bleeding profusely rarely require surgery. If there is itch or burning discomfort, specially formulated creams can help to soothe the discomfort. For medical treatment to be effective, avoidance of constipation will help to alleviate the bleeding and pain. A good diet is important to ensure regular and smooth bowel movement. A high fibre diet which comprises lots of fruits and vegetables plus adequate fluid intake is the key to successful treatment. Good toilet habits of not spending too much time sitting on the throne while doing your business and texting, browsing the web on your smart device at the same time will influence the outcome of treatment too.
If the above non-surgical treatment fails, another treatment method is Rubber-band Ligation. As the name suggests, a small rubber band can be applied directly to the base of the prolapsed haemorrhoid using a mechanical metal device. This will successfully remove the haemorrhoid by stopping the blood flow to the ligated haemorrhoid, causing it to eventually shrivel up and fall off. If the ligation is applied correctly and above the dentate line, the patient will feel no pain.
In instances when non surgical treatment methods are unsuitable as in the case of large and prolapsed haemorrhoids, surgical intervention would be required. The different types of surgical intervention will be determined by the colorectal surgeon. Different types of surgery can range from Conventional Excisional Haemorrhoidectomy to the more current Transanal Haemorrhoidal Dearterialization surgery.
Caveats: Not all bleeding from the anus are due to haemorrhoids. Likewise, not all lumps at or near the anus are due to haemorrhoids. Do consult your family doctor in order to get the correct diagnosis and treatment. Your doctor will do a simple examination in the clinic which consists of physical examination, digital rectal examination and sometimes proctoscopy, which may cause slight discomfort. If the diagnosis cannot be determined in the clinic, your doctor will refer you for further assessment which usually comprises of colonoscopy or even CT scan of the abdomen if required.
Do consult your family doctor if you have blood in your stools. You do not have to suffer in silence and hope your symptoms away.
