Haemorrhoids

Haemorrhoids are swollen blood vessels in anal cushions around the anus and rectum. These are located in the lowest part of the rectum and the anus. They swell and the vein walls become stretched, thin, and irritated causing discomfort and bleeding after bowel movement. Haemorrhoids are classified into two general categories: internal and external.
Internal haemorrhoids lie inside the rectum and can’t be obviously seen or felt. Bleeding is the main symptom and they are not usually associated with pain. Internal haemorrhoids can prolapse and in that case can become visible externally. They may also be associated with pain, mucous discharge and discomfort if they are prolapsed. They can also get thrombosed and this condition can be extremely painful.
External haemorrhoids lie within the anus and around anal canal. They are visible as lesions around the anus. They are often associated with discomfort. They can also thrombose and prolapse and may also be associated with pruritis.
Anal bleeding and pain is often associated with haemorrhoids but should be fully investigated to rule out other pathologies like bowel cancer prior to haemorrhoid treatment.
Haemorrhoids are extremely common and a stepwise treatment is recommended. Modification of diet and increased intake of fibre can often settle haemorrhoids related symptoms.

If symptoms persist other treatments are used to manage symptoms.
Injection or sclerotherapy and banding of haemorrhoid are out patient based treatments which are useful in smaller haemorrhoids.
Cauterisation or passing electric current through haemorrhoids can also be used on an outpatient basis.

Surgery:
HALO/THD procedure: also referred to as the painless haemorrhoidectomy, these procedures are associated with less pain and discomfort compared to traditional haemorrhoidectomy. Postoperative recovery is also quicker but long term results are not known. The blood vessel supplying the haemorrhoid is localised using Doppler and is ligated with a suture. This helps to shrink the haemorrhoid and resolve symptoms.
Stapled Haemorrhoidectomy: a ring of tissue is removed using a stapeler and this helps disrupts the blood supply of haemorrhoids in addition to taking lax mucosa away. This is especially useful if a mucosal prolapsed is also present.
Traditional haemorrhoidectomy: the use of traditional haemorrhoidectomy has declined due to the side effects and discomfort associated with this procedure. However this procedure has been around for years and it has good long term results.

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