Are you suffering from piles

Dr Frikkie Rademan, a general surgeon at Mediclinic Durbanville, explains the symptoms and treatment for haemorrhoids.

Haemorrhoids (or piles), are swollen blood vessels that form in the anus and rectum and are most commonly caused by constipation. Excessive straining to open your bowels results in the normal veins becoming enlarged and forced downwards to become haemorrhoids. Other causes include pregnancy, childbirth and hereditary factors.

The most frequent symptoms include bleeding during bowel movements, protrusion during bowel movements, itching in the anal area, pain and sensitive lump(s) around the anus.

To determine whether you have haemorrhoids, your doctor will do a clinical examination. If you’re over 40 and have had any bleeding or changes in bowel habits, you might need a colonoscopy to ensure your bowel is otherwise healthy before any haemorrhoid treatment.

Mild haemorrhoidal symptoms sometimes respond to over-the-counter, non-prescription ointments and suppositories. Although they won’t remove the haemorrhoid, they can relieve discomfort. Most patients are advised to take a high-fibre diet with plenty of fluids to avoid passing hard stools and needing to strain.

You can also get relief by sitting in warm water for a few minutes (sitz bath). Prolapsing haemorrhoids is the term used to describe the protrusion of the haemorrhoid, which happens on bowel opening.  When external haemorrhoids are very swollen and uncomfortable, applying a cold compress can help.

Surgical interventions:

1. Haemorrhoidectomy (Milligan-Morgan) is a surgical procedure that involves cutting off the haemorrhoidal tissue. This is a very effective treatment for large haemorrhoids that prolapse and are associated with significant external tags. The operation requires a general anaesthetic and may cause pain for several days afterwards.
2. Haemorrhoidal artery ligation (HAL) procedure is a technique that involves identifying the blood vessels feeding the haemorrhoid using ultrasound and then suturing them off. Further sutures are used to repair the prolapsing element of the haemorrhoids. HAL is suitable for most prolapsing haemorrhoids or those that bleed. Most cases are carried out under a short general anaesthetic. Patients go home the same day, the procedure is relatively painless, and most people can return to work just 24-48 hours afterwards.
3. LHP (LaserHemorrhoidoPlasty) is a gentle therapy for haemorrhoids performed under anaesthesia. As the energy of the laser is inserted centrally into the haemorrhoidal node, the haemorrhoid can be treated according to its size without causing damage to the surrounding area. No foreign materials (clamps) are needed, and LHP is not associated with risk of stenosis (narrowing of the anal canal). Healing is excellent because unlike conventional surgeries, there are no incisions or stitches.

Although there’s no link between haemorrhoids and cancer, the symptoms of haemorrhoids can be similar to those of bowel cancer. Always seek advice from your doctor about any unusual rectal symptoms, particularly bleeding, to ensure they’re properly investigated and treated.