Haemorrhoids are the engorged vessels of the anal (backpassage) canal. As it enlarges, it bulges into the anal canal and eventually it may prolapse (protrude) through the anal canal.  External and skin tags usually represent the stretched skin arising from the prolapsed internal haemorrhoid.  Perianal thrombosis (clot) is extremely painful lump at the edge of the anus.  Haemorrhoids do not lead to or associated with cancer.

Internal haemorrhoids are due to weakening of the supportive tissues within the anal canal and cause veins within the haemorrhoids to enlarge.  Risk factors are: chronic constipation or diarrhea, pregnancy, straining or anything that increases intra-abdominal pressures (obesity, weightlifting etc). 

Symptoms of haemorrhoids may be:

  • Bleeding – is the most common symptom, usually seen on toilet paper.  At times blood may drip into the toilet bowl.  PR (backpassage) bleeding should always be investigated to exclude cancer.

  • Lumps – may develop durin a bowel motion.  It is usually reducible.

  • Discomfort or Pain – some discomfort is common, but severe is either due to thrombosed haemorrhoid or anal fissure (split in the lining) or squamous cell carcinoma (SCC type of cancer). 

  • Itch (pruritis ani) – is usually due to discharge

 
Treatment

A consultation with a GP or a surgeon is necessary to exclude more serious causes of the bleeding.  These investigations may include sigmoidoscopy or colonoscopy or CT colonography. 

  • Increasing fibre and fluid in the diet and avoiding straining and prolonged sitting on the toilet is used.  Increase in fibre is usually in form of Metamucil or similar bulking agent.  Ointments like Ultraproct may be helpful as well.  These treatments often completely resolve mild symptoms.

  • Injection with phenol in oil can be used for mild internal haemorrhoids as well.

  • Rubber band ligation is used for larger internal haemorrhoids.  This obstructs the blood supply for the haemorrhoid and it shrivels and falls off.

  • Stapled haemorrhoidectomy – alternative to traditional haemorrhoidectomy.  I do not perform this procedure.  This procedure is performed less and less due to possible complications.

  • Haemorrhoidectomy – surgical excision of large or complicated haemorrhoids.  This is performed under general anaesthesia.  I also usually perform bilateral pudendal block (numb the pudendal nerves with local anaesthetic).  Following this surgery patients often require laxatives in form of Metamucil and lactulose as well as significant analgesia (Panadol + neurofen/voltaren  + Tramadol or codeine).