Haemorrhoids are one of the oldest afflictions described in surgical history.

Haemorrhoids or piles refer to the blood vessels lining the innermost layer of the canal leading to the anus. We all have them and are thus normal part of our anatomy.

Haemorrhoids act as a cushion in the anal canal and help with continence in particular the ability to retain gas. They’re only abnormal when they start to bother us.

The most common symptoms are bleeding, sensation of lump that may or may not come and go, discomfort and itch.

If you see blood on your toilet paper or in the pan, regardless of what you think it might be, you absolutely must see your doctor to make sure it isn’t something serious and preventable.

Types of Haemorrhoids

Haemorrhoids can be internal or external. Internal haemorrhoids are the blood vessels inside the anal canal and the symptoms from them normally cause painless bleeding (usually on toilet paper or sprays around the toilet pan), lumps, discomfort and itch.

External haemorrhoids are vessels outside the anal canal, and may show themselves as an acute painful lump known as thrombosis of external haemorrhoids, caused by blood clotting. and usually leave a skin tag behind after the clot dissolves.

Internal haemorrhoids cause problems when the supporting tissue around the anal canal weakens and causes the vessels and its lining to bulge out.

Factors that contribute to this include ageing, chronic constipation or diarrhoea, pregnancy, straining at bowel action or spending too much time on the toilet.

How bad your symptoms are usually relate to how far the haemorrhoids have moved downwards. Minimal displacement may result in bleeding only, but if the haemorrhoid prolapses out it can be felt as a lump that initially maybe reducible but eventually may stick out all the time.

What happens then is that the mucous produced by the inner lining of the anal canal is also displaced outside and that can result in a perianal itch.

Treatment options for internal Haemorrhoids

The treatment of simple mild haemorrhoid bleeding – once more serious causes have been excluded by your doctor, for example with a colonoscopy – is usually dietary with high fibre intake such as psyllium husk or Metamucil, increasing fluid intake, using protective ointments and avoiding straining on the toilet.

Remembering that asymptomatic haemorrhoids do not need treatment. Other treatment options depend on your symptoms.

These include injection or banding of internal haemorrhoids with the aim of reducing blood flow and symptoms.  It is possible to stitch and tie off the haemorrhoids, which allows the surgeon to hitch up the prolapse.

Haemorrhoidectomy – removal of the offending blood vessels –  is the most effective treatment but because it’s invasive and can have complications, haemorhoidectomy is usually reserved for severe prolapsing haemorrhoids or for people whose previous procedures have failed.

The procedure involves excising the haemorrhoidal tissue completely, getting rid of the lump completely and in the majority of people, bleeding will cease completely.

Most of these treatments are performed under general anaesthetic, usually as a day procedure. The recovery from haemorrhoidectomy is more prolonged compared to other techniques, and you may need time off work. Pain in the few weeks after surgery is an issue but can be reduced with simple pain relievers.

Treatment options for external Haemorrhoids

While painful, extrenal haemorrhoids rarely require surgical treatment.

Usually the pain peaks by day 3, and in almost all cases, the pain resolves by day 5-7. You may still feel a lump for up to 2 weeks though simple analgesia (stool softeners) are all that is required. Simple evacuation of the clot is not recommended as the clot is likely to reform and bleeding may occur at the site.

If presented within the first 3 days for forming, there there is an opportunity for formal excision of the haemorrhoid, otherwise conservative treatment is the best option. You may be left with an anal tag (a piece of skin that has been stretched by the clot) and that can be removed under general anaesthetic at a later date.

Surgical treatment options

Dr Naseem Mirbagheri performs effective haemorrhoid surgery in addition to other services including colorectal and pelvic floor surgical procedures, anal prolapse surgery, rectocele surgery and small bowel resection, in a number of private and public hospitals around Melbourne:

• St John of God Berwick (private)
• Epworth Eastern (private)
• Epworth Richmond (private)
• Box Hill Hospital (public)