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Reviewed by Mr Robert Diggory, consultant general surgeon and Dr John Pillinger, GP
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What are haemorrhoids?
Haemorrhoids are small, blood-filled swellings caused by dilated
varicose veins.
Initially, they are located just inside the anus (internal haemorrhoids) but
can sometimes protrude (external haemorrhoids). Haemorrhoids are not
dangerous.
Constipation and
prolonged straining when using the toilet are thought to contribute to the
formation of haemorrhoids by increasing the pressure in the veins.
What are the symptoms of haemorrhoids?
Haemorrhoids may be present for many years but remain undetected
until symptoms appear. They can cause anal bleeding and itching and also pain
and discomfort.
Normally, the bleeding is limited to small stains of fresh blood
on the toilet paper, but more severe bleeding can sometimes be present when
stools are passed.
A lump may also be felt in the anus and large haemorrhoids give
a sensation that the bowel hasn't emptied completely.
If you observe blood in your stools, and have the symptoms
mentioned above, you should visit your doctor for a check-up.
If haemorrhoids are present ,the doctor will then perform an
examination to find out if there are any other possible causes of the bleeding
that may be more serious. The doctor will feel the anal canal, and inspect the
mucous membrane of the rectum and lower part of the large intestine using an
examination tube called a proctoscope or
sigmoidoscope.
How are haemorrhoids treated?
Some haemorrhoids can get better without medical treatment. This
can happen if they are caused by
constipation. The
doctor may recommend a change of diet with the addition of more fibre and
roughage particularly green vegetables, fresh fruit, wholegrain cereals and
bran. Drinking 8 to 10 glasses of fluid daily is advisable.
The person is also told to avoid straining when passing a bowel
motion. Nobody should strain to push out a stool. The feet can be placed on a
low foot stool to aid the bowel movement. Sitting in a shallow bath of hot
water for 15 minutes several times a day, will reduce the pain.
In the case of a pile protruding from the back passage, which
has become swollen and painful, a day's bed rest with an ice pack applied
to the anal area should be helpful. A pack of frozen peas wrapped in a tea
towel is ideal for this purpose. Never allow the ice to come directly into
contact with the skin and only use this treatment for 20 minutes in an hour for
a limit of three hours a day.
Relatively minor haemorrhoids can be treated using
creams available directly from your
local pharmacy or on prescription. A few days' treatment is usually
enough, and then the irritation will settle spontaneously.
More severe cases need to be treated by a specialist. One
possible treatment is rubber band ligation. Rubber band ligation can be
performed in the doctor's surgery or outpatient clinic and does not
require hospital admission. The procedure involves placing a small rubber band
at the base of the haemorrhoid with a special applicator. The rubber band cuts
off the blood supply to the haemorrhoid, which eventually falls off after a few
days. Injection of a substance that makes the blood in the haemorrhoid clot is
another option (sclerotherapy).
The most serious cases are third-degree haemorrhoids. These
protrude through the back passage and can require surgical removal or
'haemorroidectomy'. Such operations are successful in 90 per cent of
cases. However, many third-degree haemorrhoids shrink and become symptom-free
without surgical treatment.
After surgery
After haemorrhoids have been removed, small skin tags can
develop beside the back passage. In some cases they will be slightly painful or
itchy and if so they can also be surgically removed by a minor operation.
Following any treatment for haemorrhoids, it is very important
to avoid constipation and straining or the condition may recur.
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Based on a text by Dr Erik Fangel Poulsen, gynaecologist and Dr Per Grinsted, GP
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Last updated 02.06.2005
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