Sometimes a patient comes to you and is embarrassed to talk about his pain, although even a healthy person has piles, or haemorrhoids. For some the topic of haemorrhoids may be uncomfortable to explain to his physician so they may suffer rather than ask for a help. However, haemorrhoids are so common that most people have them at some point in their lives.
Haemorrhoids are normal blood vessels inside and outside of the anal canal. They just help us to preserve continence and prevent our stools from leaking out. Not everyone will develop symptoms from enlarged haemorrhoids, however, they start to become bothersome when they swell and this may result in bleeding, pain and itching and here we can term it as haemorrhoidal disease.
There are two types of haemorrhoids, the external haemorrhoids as they grow very close to the anus opening and internal haemorrhoids located just inside the lower rectum, however, internal haemorrhoids (which we all have) can become problematic, when they are swollen or inflamed.
Broadly speaking the exact cause of haemorrhoids isn’t entirely clear, but seem to be that anything that puts pressure on the veins in the lower body can lead to haemorrhoids, for instance like straining during a bowel movement, sitting on the toilet for long, constipation or diarrhoea, being overweight, pregnancy, and age which causes tissues to become weaker.
Despite knowing that 80 per cent of all people suffer from the symptoms of enlarged haemorrhoids at some point in their lives, still there is a perception that all haemorrhoid treatments are painful and have the possibility of creating severe complications. Such misconceptions keep people from seeking an evaluation till unfortunately the haemorrhoids get dramatically enlarged and more difficult to treat with non-invasive management.
We classify problematic internal haemorrhoids into four grades, ranging from grade one which have no prolapse (which refers to them protruding out of the anus) and are usually painless to grade four which have prolapsed piles and cannot be pushed back manually and usually they are the most painful type. Nevertheless, haemorrhoids can often be confused with anal skin tags, which are benign growths of excess skin around the anal canal; hence rectal examination is essential and critical to some point, however, some time to confirm the diagnosis of the internal haemorrhoids, a physician may use a proctoscope to examine the lower part of the rectum.
On the other hand, occasionally haemorrhoid bleeding can mimic other dangerous diseases like colorectal cancer. So, if you are over age of 50 and having rectal bleeding, I suggest a colonoscopy to make sure nothing else is going on. As such colonoscopy is the gold standard of checking the colon and rectum to confirm the cause as the treatment and outcomes of piles and cancer are vastly different.
Interestingly, the treatment of piles briefly comprises 3 aspects: lifestyle modifications, medications and surgery. And we need to realise that treatment should be individualised depending on the severity of symptoms. As such treatment is aimed at reducing the swelling and returning the piles to their normal size and position in the anus and not removing them entirely, because doing so would cause the patient to have stool incontinence. Adding to that, lifestyle modifications which include, for example, relief of constipation or diarrhoea, ensuring you do not strain excessively or sit for too long on the toilet bowel (usually not more than 10 minutes). Although, if the medical management failed or for instance patient having grade three to four haemorrhoids, the most effective therapy appears to be surgical intervention.
At the end, if you feel that you are having haemorrhoids, remember that you are not alone and it doesn’t always require surgery and management does not have to be terrible, so stop suffering in reticence.
Dr Yousuf Ali al Mulla, MD, Ministry of Health, is a medical innovator and educator. For any queries regarding the content of the column, he can be contacted at: