What are Haemorrhoids (piles)?

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Haemorrhoids (Piles) are sacs consisting of blood vessel that are present in the lower part of the anus (back passage).  They are normal anatomical structures that help with continence and sensation and are important for differentiating between flatus and stool. Usually haemorrhoids are internal and therefore not visible, however they can enlarge and cause troublesome symptoms.  They can get large due to a combination of straining, pregnancy or constipation (hard stools).

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The common symptoms are:

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• Bleeding during bowel evacuation which is bright red. This generally drips or splashes in the bowl. It may be present on the toilet tissue only.

• Discharge from the back passage

• Prolapse: the piles slip out during bowel evacuation on straining. This is usually graded between 1 to 4.

• Pruritus i.e. itching around the back passage

• Pain: is a very uncommon feature of piles.

 

The bleeding can be alarming but is only rarely a large quantity.

 

What do I do if I have any bleeding?

 

It is important that you see your GP or inform your specialist. Bleeding may not be due to piles and therefore it is important to investigate and rule out other causes of bleeding before assuming a diagnosis of haemorrhoids and treating them.  

 

What treatment is available?

 

General Advice

 

• Increase the fibre in your diet: Increasing your intake of salads, fruit, fibre and bran (Porridge) will help to bulk and soften your stools as long as you also increase your fluid intake. Fybogel is a bulking agent that can also help. This bulks the stool and decreasing the need to straining on the toilet.

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• More fluids: This is extremely important to help keep your stools soft. Fibre and bran intake alone will constipate without adequate fluid intake.

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• Laxatives:  ½ - 1 sachet of Movicol/Laxido per day

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• Toilet training/habit change:

  • Avoid sitting on the toilet for long periods and activities that may encourage this such as reading etc. as this can precipitate piles.

  • Avoid straining and rushing to evacuate in a hurry.

 

Alternative Outpatient Treatments

 

Injections: Grade 1-2 haemorrhoids can be treated with an injection that is specifically injected to minimise pain and treat the haemorrhoid. This sclerosis the haemorrhoid causing it to shrink.  Sometimes may require to be repeated.

 

 

Banding of Haemorrhoids

 

Grade 2-3 haemorrhoids can have a rubber band placed around the pile in the outpatient clinic. This does not require anaesthesia. There should be little or no pain during the procedure.

 

In the consultation room, you will be examined into the back passage area with a small scope (proctoscope). A small device is gently inserted through this and a silicone band is placed onto/above the haemorrhoid. This reducing the blood supply to the haemorrhoid causing it to shrink. This can also be used for prolapsing lining of the anus and can help bring haemorrhoids back and reduce prolapsing.

 

There will be some discomfort for 48 hours after the banding and you will expect some bleeding after the procedure and on-off for around 4-5 days before settling. The band falls out in 8-10 days.  Please take paracetamol for the discomfort.

 

Potential Complications

 

Complications can be both general for any operation and specific for the particular procedure.

Complications are rare but all of the potential ones are listed below.  Smaller haemorrhoids and ones amenable to THD, haemorrhoidopexy and Rafaelo Procedures have less potential complications. Your specialist will be able to go over specific ones with you.

 

General Complications:

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1. Pain: This will start to ease over a few hours but can last a few days. It is easily controlled with paracetamol and can be helped by using laxatives.

2. Bleeding: You will get bleeding for 4 to 5 days after this procedure and will slowly settle. When the haemorrhoid shrinks and can fall off, there can be a significant bleed that can occur in 1 in 100 people requiring further treatment. Contact your surgeon or GP if the bleeding becomes severe.  

3. Faint/light-headed: Shortly after the procedure, you may feel this and usually settles within a few hours to the following day. It is therefore advisable to have someone drive you to and from the outpatient appointment.

4. Infections: This usually causes a high temperature, pus from the anal passage, redness, swelling and increased pain. Antibiotics are used to treat this if it occurs.

5. Discharge may occur for a short while after this procedure.

6. Urination: Rarely there may be some blood in the urine with associated discomfort when passing urine. This usually settles in a few days.

 

Recovery period

 

Following the procedure, you will usually be observed in the department for 10-15 minutes and have your blood pressure taken to ensure you are well enough to leave. You may feel light-headed for this period of time.  It is therefore advisable that someone takes you home.

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Banding will will you a sensation that you want to pass stool. Try not to pass stool for the next few hours to avoid the bands from being dislodged and coming off. As will general treatment of haemorrhoids, avoid constipation. This can be done naturally by increasing fruit, fibre and more importantly liquid in your diet. Also avoiding straining will be important.

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Five in 10 people will have a risk of haemorrhoids returning and will require re-treatment. This risk can be reduced by following the recommendations outlined above.

 

Activities following the procedure

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You should be able to return to work the following day. General advice to reduce recurrence of haemorrhoids are outlined above in the section of general advice for management of haemorrhoids.

 

You will usually have a follow-up after you operation between 4-12 weeks depending on the operation carried out.