Haemorrhoid Management

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Haemorrhoids

Haemorrhoids are enlarged cushions of blood vessels around the anal canal which, in their normal state, help control the passage of stool. Factors contributing to their development may include constipation and straining, a low-fibre diet, age, obesity, and other conditions that increase pressure within the abdomen such as pregnancy and chronic coughing. There are two main types, internal and external, described according to whether they arise in the upper or lower parts of the anal canal.

Internal haemorrhoids may descend (prolapse) and protrude through the anus. They may cause bright bleeding during or after passage of stool, mucous discharge and itchiness, or a lump if they prolapse. They are usually painless unless complicated by thrombus (clot) formation and/or strangulation, when swelling causes the tissue to be squeezed and the blood supply impaired which may result in tissue death.

External haemorrhoids may be noticed as a lump around the anus which may itch or cause discomfort. They can become painful when thrombosed.

Anal skin tags are small flaps of skin around the anus that may remain after this skin has been swollen or stretched by haemorrhoids. They may be a nuisance in maintaining hygiene.

An examination is required to assess symptoms which may be due to haemorrhoids and further investigation may be recommended to exclude other conditions.

Management

Management of haemorrhoids depends on the type, size and severity of symptoms.

Conservative

These include measures to reduce constipation, straining and pressure such as a high fibre diet and fibre supplements, stool softeners and an adequate fluid intake. Topical creams, wipes or suppositories containing local anaesthetic or anti-inflammatory type medication may be useful if there is discomfort.

Procedure

These include:

Rubber band ligation

This involves placement of a rubber band at the base of the haemorrhoid to cut off the blood supply. It can be useful for internal haemorrhoids that bleed or prolapse.

Injection sclerotherapy

A chemical is injected into the haemorrhoid to cause it to shrink and shrivel. It is most suitable for small internal haemorrhoids.

Haemorrhoidectomy

This involves excision of the haemorrhoid and associated skin tag. It is useful for larger internal and external haemorrhoids and requires a general anaesthetic.
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