Haemorrhoids are as old as man him(her)self. The complaint is common affecting up to 5-10% of the adult population. The actual haemorrhoid is tissue (blood vessels muscle fibres, connective tissue, mucosa, anal skin) that is normally present but abnormally larger or looser or both. The tissue enlarges with straining and blood within the vessels is forced out through the mucosa as stools passes, compressing the haemorrhoid. If the haemorrhoid moves down enough then a lump is felt and sometimes this lump stays out causing discomfort, if it is forced out and clots off then severe pain can result (acutely thrombosed, prolapsed haemorrhoids). Itching can occur with hidden or overt prolapse when the anal canal becomes less than water-tight.
Symptoms then are:
- Blood dripping or splashing into toilet when defeacating
- Blood on toilet paper (bright red)
- Prolapse of small lumps with defeacation that may go back in spontaneously or need to be pushed back.
- Pain with prolapse or irritated haemorrhoids
- Imperfect continence or control if haemorrhoids are large and prolapsing
This usually consists of bedside examination including a “glove” examination and sigmoidoscopy. Further tests such as colonoscopy and anal ultrasound and physiology may be recommended under certain circumstances.
High fibre trail: Haemorrhoids in their early stages can be controlled with fibre to avoid straining.
Office procedures: Banding of haemorrhoids or injection are treatments the can be done in the office without major preparation. Both treatments function in principle to cause fixation of the haemorrhoid and avoid sliding with banding also able to reduce some of the tissue bulk.
Surgery: Operative excisional haemorrhoidectomy is an operation with 100 years of experience behind it and is a reliable and safe way to treat larger haemorrhoids. It requires in-hospital treatment and usually a 1 night hospital stay. Healing time occurs over 5 weeks.
Stapled haemorrhoidectomy is a technique 10 years old which treats haemorrhoids by excising tissue above the haemorhoid in the lower rectum thereby interrupting its blood supply and causing fixation at this point. It also requires in-hospital treatment with a 1 night stay. Healing time is a week or less.
Haemorrhoid artery Ligation and Rectoanal Rectopexy (HAL RAR) is a technique whereby the arterial signal to the haemorrhoid is localised with a doppler probe, the vessel is then sutured and the haemorrhoiod below this vessel is suture-hitched upwards. There is no excision of tissue. The procedure can be done as a day case. Generally there is 4-5 days of discomfort only.