What is Haemorrhoids:
Haemorrhoids / Piles is enlargement of the endo-vascular cushion (The Blood supply tissues) that lines the anal canal, This may go unnoticed until it reaches a sizable volume when patient starts suffering with clinical symptoms.
Symptoms of Haemorrhoids / Piles:
This may vary from being asymptomatic earlier to bleeding, discomfort, pain, leaking episodes, minor degree of incontenence but as haemorrhoids get bigger, this may be complicated by prolapsing to the outside and causing significant discomfort. Those prolapsed haemorrhoids may get thrombosed and become very tense and very painful.
Grades of Haemorrhoids:
There are Two main types for Haemorrhoids:
Primary Haemorrhoids:
There are 4 different grades of Primary haemorrhoids, those are illustrated in the image below
- Grade 1 Haemorrhoids: Those are internal ones that are often presented with bright red rectal bleeding on tissue papers and on the stool surface
- Grade 2 Haemorrhoids: Those start to prolpase internally in the anal canal.
- Grade 3 Haemorrhoids: Those often prolapse when the patient strains, they may spontaneously retract or the patient may need to push them back following opening bowel.
- Grade 4 Haemorrhoids: Those are permanantly prolapsed haemorrhoids, they often lift the skin in the perianal areas and bulges to the outside, those can not be manually reduced and are often very uncomfortable with significant impact on patient’s quality of life.
Those develop secondary to other causes like Pelvic mass / or tumours including pregnancy but also secondary to anal cancer or lower rectal cancer. If symptomatic, you may need a Colonoscopy prior to starting your treatment to ensure no other cause is responsible particularly if Dark bleeding or Family Cancer
Treatment of Haemorrhoids:
It is extremely concerning that in my own practice, I meet two or three cases of anal cancer or lower rectal cancer that has been wrongly labelled as haemorrhoids / piles, this often result in delayed cancer diagnosis and probable spread of the disease which is a life changing mistake that should be avoided at all cost.
The significant concern in developing haemorrhoidal symptoms is that it can be a secondary rather than primary haemorrhoids, It is extremely important prior to deciding about the treatment of the haemorrhoids to ensure that those are primary rather than more serious secondary ones. This entails a careful examination by an experienced clinician who can usually decide upong detailed examination.
While treatment of haemorrhoids has attracted a lot of business including the use of Laser, Radio frequency ablation and many other modules, however researches have not proven a significant real resolution of the problem on the long term with patients experiencing recurrence of symptoms on the short run and hence the need for further treatment. It is strongly recommended not to have your haemorrhoids treatment on high street shops or through business premises.
- For grade 1&2 haemorrhoids, often injection Sclerotherapy helps to obliterate the blood vesseles and shrink the size of the troublesome tissues. This is often done in outpatient clinic and does not require General Anaesthesia in operative Theatre. Sometimes 2 episodes of injection sclerotherapy may be required.
- For late Grade 2 and early grade 3: Banding of the prolapsing Haemorrhoids using a special instrument that sucks the prolapsed tissues into a tube with deployment of rubber bands at the base of the haemorrhoids. Again this can be done as an outpatient procedure and does not require General anaesthesia in operative Theatre. It may trigger some discomfort that often resolve with ordinary analgesia. sometimes two episodes of banding are required to achieve satisfactory results.
- For late Gr.3 and Gr.4 Haemorrhoids: The outpatient treatment is often not effective and although it may be tried initially as less invasive with less side effects yet operative intervention under General / regional anaesthesia is required. Although this is often followed by local discomfort but this often resolves completely in 4 weeks following operation. This provides the most recognized permanent long term solution for your haemorrhoids / Piles.
- For Secondary Haemorrhoids: Identification of the primary cause and treating it is paramount to the care of the patient.
What to do if I have symptoms:
Please do not delay seeing your GP, If you are struggling to get a GP appointment in teh current circumstances, Please book yourself directly to my clinic via booking office at Nuffield or my Secretary, I am happy to see you without a GP referral and address your concerns and act accordingly but more importantly I will be able to reassure you on your first consultation.
