These are swellings inside the anus containing enlarged blood vessels. They are an enlargement of normal anatomy (anal cushions), that help to maintain continence of liquid stool.
Haemorrhoids are more common in people who spend time straining at stool, so avoidance of constipation is paramount in order to prevent them getting bigger.
Haemorrhoids are common during pregnancy, and often improve after giving birth.
In some cases, haemorrhoids are little more than a nuisance and you may not be too bothered by them. They can cause itching, intermittent bleeding, and can sometimes prolapse when you empty your bowel.
Once a diagnosis of haemorrhoids has been made, it is perfectly safe to leave them alone. Your doctor may want to do further tests to make sure there are no other bleeding points higher in the bowel.
Haemorrhoids often cause little more than discomfort, and treatment should be tailored to your symptoms.
Thrombosis of a haemorrhoid occurs when blood clots in the haemorrhoid, causes a large swelling, and is very painful.
With painkillers and time, this settles back to normal. This normally takes 1-2 weeks. An operation on a thrombosed haemorrhoid can cause irreparable damage, and should be avoided.
A sitz bath is a warm, shallow bath you sit in to relieve pain, burning or itching around your anus and genitals. It is particularly helpful for thrombosed haemorrhoids (very painful attack of blood clotting in your haemorrhoids). Soaking in warm water reduces muscle spasms by relaxing your anal sphincter muscles. Relaxing these muscles improves the blood circulation in your anal canal and helps to break down the clotted blood in the haemorrhoids, which promotes healing and reduces pain.
Topical creams that help can be purchased from your pharmacist. Typically these contain steroid and local anaesthetic. Follow the instructions that come with the medication. You should not use these creams for more than 2 weeks.
The best thing you can do is to treat constipation, ensuring easy to pass stools.
Ensure you take good amounts of water and fibre in your diet. Some people find that measuring the water they need to drink throughout the day, and marking it off on a water bottle, can help.
Fibre supplements such as psyllium husk, help to draw water into the bowel during transit. This helps to bind the stool together but also helping it to be soft and slippery. This should pass easily and not cause further anal trauma.
The position you take when on the toilet, affects the posture of the bowel when emptying. This makes it easier or harder to empty. Raising both feet on a step stool when sitting on the toilet has been shown to help defecation. By making it easier to pass stool, it eases constipation and prevents trauma to the anus and haemorrhoids.
Once haemorrhoids cause symptoms there are a variety of treatments.
Ointments and suppositories can be applied to calm down angry inflamed haemorrhoids. Most people will need nothing more than this.
Rubber banding of haemorrhoids is where a handheld device is used to apply elastic bands to the base of the haemorrhoid, causing it to shrivel up. This is only suitable for small haemorrhoids.
Surgery should only be carried out when recommended by a surgeon, and after a discussion of the benefits and risks.
Haemorrhoidopexy is performed as day surgery, requiring a general anaesthetic. Sutures are placed around the haemorrhoid and inside the anal canal, to correct the prolapsing tissue. Recovery is usually fairly comfortable, but haemorrhoids can return over time.
Haemorrhoidectomy is the surgical removal of the haemorrhoidal tissue, under general anaesthetic, and going home the same day. The haemorrhoids are removed, and the area is allowed to heal over gradually. This takes around 2 weeks, and is very uncomfortable whilst this happens. We would advise taking this time off work to let things settle down. You would normally leave hospital with a short course of antibiotics, strong painkillers, and laxatives. There is a risk of bleeding, scarring, and a small risk of damage to the muscles around the bottom.
Common risks of haemorrhoid surgery include bleeding, pain, and infection. Surgery will leave an internal scar, and the surgeon will be careful to place incisions so that this does not cause narrowing of your anus. Care is taken to avoid any damage to the muscles of the anus, which would affect your continence. The risk of a general anaesthetic will vary from person to person, depending on their general health.
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