Introduction
The word ' Haemorrhoid' is derived from the Greek words for 'blood' and 'flow', which describe the primary symptom. The anal opening is kept closed by three 'anal cushions', or haemorrhoids, which press against each other to prevent leakage of faecal material between bowel movements. These cushions may swell or detach from the lining of the bowel, resulting in problematic haemorrhoids.
Symptoms
The main symptom of haemorrhoids is bleeding from the anus, and is generally painless bleeding. In addition, people with haemorrhoids may also experience:
- discomfort if the haemorrhoids protrude outside the anus (prolapse).
- Leakage of faecal material from the anus (which in turn may cause itchiness and/or a burning sensation) - a mild form of faecal incontinence.
Causes
Factors known to make haemorrhoids become problematic include constipation (and related factors such as low fibre diet and repeated straining during bowel movements), diarrhea, heavy physical labour and pregnancy. However, many people develop haemorrhoids when none of these factors are present. Although suspected, there is no evidence that sitting on the toilet for a long time or sitting on hard floors increase the risk of developing haemorrhoids.
Tests & Diagnosis
The first step in diagnosing haemorrhoids is a physical examination which involves a visual examination and, in most cases a digital rectal examination (where the doctor gently inserts a gloved and lubricated finger into the anus). Anoscopy may be used to allow visualisation of the inside of the anus using a device (anoscope) equipped with a light.
In some cases, either a colonoscopy or a flexible sigmoidoscopy (which allows the rectum and the lower section of the colon to be examined) may also be required to determine whether symptoms are being caused by another condition.
Haemorrhoids are classified by level of development into four 'grades'. These help medical professionals decide on the best type of treatment. These grades are:
Grade 1
There is no prolapse and haemorrhoids remain inside the anal canal.
Grade 2
'Spontaneous reduction' – this is where haemorrhoids protrude (i.e. prolapse) from the anal opening only when defecating and return inside the anal canal after defecation.
Grade 3
'Digital reduction' – this is where haemorrhoids prolapse permanently outside the anal opening but can be pushed back in with the fingers.
Grade 4
The next stage beyond Grade 3 where haemorrhoids remain permanently prolapsed and cannot be pushed back in.
Treatment
It is important to have any of the symptoms of haemorrhoids investigated by your doctor, as they may be caused by more serious conditions. Where lower grade haemorrhoids are diagnosed, non-surgical treatment may be the best option. This normally includes a combination of diet change (to incorporate a higher proportion of fibre), avoiding straining on the toilet, taking stool softeners / laxatives, and using haemorrhoid creams obtained from the pharmacy to be used for a short period of time.
Where these approaches do not work, or where haemorrhoids are higher grade, a range of surgical options should be considered.
