in Melbourne
Almost everyone has haemorrhoidal tissue. These vascular cushions sit inside the anal canal and help with fine control, sealing the canal and letting you distinguish wind from stool. Problems begin when the tissue enlarges, becomes congested or slips downwards. Only then do symptoms appear.
Estimates of how many adults develop symptomatic haemorrhoids vary widely, partly because so many people manage quietly at home. Studies place the lifetime prevalence somewhere between 30-50% in Western populations. Pregnancy, chronic constipation, prolonged straining, heavy lifting and long periods sitting on the toilet all contribute.
Haemorrhoid symptoms tend to follow a recognisable pattern, though they overlap with several other anal and bowel conditions. Knowing what is typical helps you notice when treatment is needed, as well as to describe things clearly at your consultation.
- Bright red bleeding during or after a bowel motion, appearing on the paper, coating the outside of the stool or dripping into the bowl
- A lump that appears with straining and reduces afterwards
- Itching around the anus
- Mucus discharge
- A sensation of incomplete emptying
- Discomfort or fullness rather than sharp pain
Severe pain is less typical. When anal pain dominates, the cause is often an anal fissure or a thrombosed external haemorrhoid rather than internal haemorrhoids.
Rectal bleeding should never be assumed to come from haemorrhoids, even when haemorrhoids are clearly present.
Bowel cancer, polyps and inflammatory bowel disease can produce identical symptoms, and haemorrhoids are common enough to coexist with all of them. Australian data continues to show bowel cancer diagnosed in younger adults who attributed their bleeding to piles.
Any new or changed rectal bleeding deserves proper assessment, particularly if you are over 40, have a family history of bowel cancer, have noticed a change in bowel habit, or have lost weight without trying.
How haemorrhoids are graded
Internal haemorrhoids are classified by how far they prolapse, using a four-point scale. This grading gives your surgeon a clear overview of the problem and helps narrow the treatment options.
External haemorrhoids sit below the dentate line and are covered by sensitive skin. A clot forming within one causes a thrombosed external haemorrhoid, a tender purple lump that appears suddenly and settles over one to two weeks.
Grading guides treatment, though it does not dictate it entirely. Some patients with grade 2 haemorrhoids are far more troubled by symptoms than others with grade 3.
- Grade 1: They remain inside the anal canal, with bleeding usually the only symptom
- Grade 2: Prolapse during a bowel motion, then return on their own
- Grade 3: Prolapse and need to be pushed back manually
- Grade 4: They remain outside permanently and cannot be reduced
Your consultation begins with taking your history. Dr Naseem Mirbagheri asks about bleeding pattern, bowel habit, straining, diet, fibre intake, previous treatments and family history of bowel disease.
Examination follows, including inspection, digital examination and proctoscopy, which allows direct visualisation of the anal canal. Proctoscopy takes seconds and most patients find it far less confronting than they anticipated.
Colonoscopy is highly recommended when the bleeding pattern, age or family history raises any question about a proximal cause. This is a precaution, not a reflection of suspicion.
Randomised trial evidence shows fibre supplementation reduces bleeding and symptom recurrence meaningfully compared with placebo. Aim for softer, formed stool that passes without straining, supported by adequate fluid. Psyllium and similar bulking agents help when diet alone falls short.
When conservative measures are not enough, several treatments can be performed in a consulting room without anaesthetic.
Rubber band ligation is the most widely used. A small band is placed at the base of the haemorrhoid, cutting off its blood supply so the tissue drops away within a week or two. It suits grade 1 to grade 3 haemorrhoids and evidence supports it as the most effective office-based option. Patients usually feel a dull ache or fullness for a day or so. Bands may be repeated across several visits.
Injection sclerotherapy involves injecting a solution that scars and shrinks the haemorrhoid. It is useful for grade 1 and 2 haemorrhoids, particularly for patients taking blood thinners where banding carries more bleeding risk.
Recurrence after office procedures does happen. A proportion of patients need repeat treatment within a few years, especially if bowel habits remain unchanged.
Surgery is considered for grade 3 and 4 haemorrhoids, large external components, mixed internal and external disease, or symptoms that persist after office treatment.
Excisional haemorrhoidectomy removes the haemorrhoidal tissue. It has the lowest recurrence rate of any treatment. The trade-off is recovery. Pain is significant for the first week to ten days and full healing takes several weeks. Good analgesia, stool softeners and warm baths make a substantial difference.
Haemorrhoidal artery ligation uses Doppler guidance to identify and tie off the arteries feeding the haemorrhoids, often combined with a lifting suture. Pain is generally less than after excisional surgery, though recurrence rates are somewhat higher.
Stapled haemorrhoidopexy lifts prolapsing tissue back into position. Recovery is quicker than excisional surgery, but it is not suitable for every pattern of disease.
Thrombosed external haemorrhoids can be excised under local anaesthetic within the first 48 to 72 hours for rapid relief. Beyond that window, conservative care is usually the better path.
Every procedure carries risk. Bleeding, urinary retention, infection and pain requiring readmission are recognised complications of haemorrhoid surgery. Anal stenosis and changes to continence are uncommon but possible, particularly after extensive excision.
Office procedures carry lower but not zero risk, including delayed bleeding after banding.
Outcomes vary between individuals. No treatment guarantees a permanent result, and haemorrhoids can recur if straining and constipation continue.
Dr Mirbagheri discusses the likely benefit, the recovery involved and the alternatives for your specific situation before any decision is made.
Dr Naseem performs surgical procedures, including haemorrhoid treatments and surgery, at St John of God and the Epworth hospitals in Melbourne, as well as offering consultations from her offices in Richmond and Berwick. If you believe that Dr Naseem is the right surgeon for your particular case, please contact us today to book an appointment.
Alternatively, use our online referral page to fill in the form and attach your referral letter and Dr Naseem’s secretary will be in touch within 24-hours to book an appointment.
