Haemorrhoids

We all have haemorrhoidal vessels, but we don’t all have haemorrhoids. Some 50% of people over the age of 50 years have some degree of symptomatic haemorrhoids.

There are external haemorrhoidal vessels covered by skin which can become external haemorrhoids. There are internal haemorrhoidal vessels covered by the lining of the rectum, known as mucosa, which as its name suggests secretes mucous, and is easily traumatised by stretching and can bleed.

Haemorrhoids all form due to some form of straining, but are often associated with constipation, diarrhoea, inadequate fibre in the diet, pregnancy, obesity and liver disease.

The most common symptoms associated with haemorrhoids are bleeding (from internal) and prolapse (can be internal and/or external) haemorrhoids. Itch may be a symptom, and pain is less often associated with haemorrhoids and may indicate an anal fissure or an acute thrombosed external haemorrhoid (also known as a perianal thrombosis).

For most patients with simple and symptomatic internal and/or external haemorrhoids, appropriate advice on dietary fibre and water intake, along with bathroom and defecatory habits, are the mainstay of initial and longstanding focus, whether interventional haemorrhoidal treatments are required or not.

The treatment of haemorrhoids depends on whether they are internal and/or external, and whether they are bleeding and how much they are prolapsing.

Many patients present having used various creams, which though they can bring some relief of symptoms, may also become the cause of symptoms.
Treatments include; Rubber band ligation, Injection scleortherapy, Haemorrhoidectomy and Haemorrhoidal artery ligation.

Further details are best discussed with your doctor.

A thrombosed external haemorrhoid or perianal thrombosis may require drainage or haemorrhoidectomy depending on length of symptoms, whether the thrombosis is simple or complex, and its size.

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