MFF0022: Hæmorrhoids

There are so many possibilities but the only obvious one is hæmorrhoids.

Hæmorrhoids are swollen veins in the distal rectum and anus. They’re sort of like varicose veins of the legs. If you’ve ever seen varicose veins, you’ll know about the obvious serpentine appearance. Just imagine these swollen snakes in your rectum and anus. As your rectum get stretched, the walls become thin and the veins can become irritated, especially as the rectum fills with faeces and defecation occurs.

If you have prominent piles in your anus and they get irritated, you can experience really annoying anal pruritus or itching.

If you have really prominent piles you can feel them as a lump in your anus and they can prolapse through the anus. Sometimes you can push them back in.

You can think about piles in stages. They can start with prominent vessels but no prolapse. Prominent vessels which prolapse but they reduce spontaneously. They may prolapse when you strain to stool and you can reduce them manually. Finally, you may get them so bad that you have prolapsed piles and cannot push them back in.

If the veins clot or thrombose the swelling can be more severe and the pain can become intense. The pain becomes more intense when you strain to stool or when you sit.

As you can imagine, hæmorrhoids can be a cause for blood in the stool, fresh blood on toilet paper and active bleeding. Obviously, if you ever see blood in your stools you must make an appointment to see your doctor.

If you know you have piles, there are various ways to treat them and prevent them from getting worse.

  • A diet high in fibre is important.
  • Hæmorrhoid creams can be helpful.
  • Soaking your anus in a plain warm water bath for 10 to 15 minutes three times a day can bring relief.
  • Your anus should be kept clean. Daily bathing should occur as a minimum.
  • Use moist towelettes rather than dry toilet paper.
  • A cold ice pack may relieve pain and irritation of your anus. I’m not sure using an ice block is helpful though.

Sometimes procedures are necessary like sclerosing the veins or ligating the base of a hæmorrhoid with a small rubber band.

Sometimes surgical removal is necessary.

One procedure I remember doing as a boy was to have an anaesthetist place the patient under a general anaesthetic and slowly insert four fingers of each hand to dilate the anus and break down strictures that may have formed. This was known as a four finger dilatation and was a relatively common procedure on surgical lists when I was a lot younger. I don’t think it is done anymore.

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