Pain in the upper abdomen that is worse before meals and during the night might be due to a peptic ulcer. The major cause of ulcers is an infection of the stomach by the bacterium Helicobacter pylori...

Anal and rectal problems

Hemorrhoids can be internal or external
Hemorrhoids viewed from the inside - looking back to the anus
Treatment of hemorrhoids by banding

Piles or hemorrhoids

  • Hemorrhoids are swollen veins that are normally present just inside the anus.
    • They can be considered to be normal “cushions”.
    • They can enlarge (because of increased pressure in the veins) simply as the result of straining or frequent defaecation.
    • They are often worse during pregnancy.

  • Gradually this high pressure can lead to enlargement of the veins.
    • Then there is the possibility of some protusion (proplase) of the hemorrhoids at the time of passing a bowel motion.
    • They usually withdraw back again but can stay out (sometimes causing discomfort) and may need to be pushed back.

  • The main symptom of hemorrhoids is bleeding.
    • This is bright red bleeding noted on the toilet paper.
    • Or there is a “dripping” or ”squirting” of blood that can splatter in the toilet bowl.
    • If there is some protusion of inflammation of the hemorrhoids there can be discomfort or pain of defaecation.
    • Usually there is bleeding without pain.
    • Another type of problem is the external hemorrhoids. There can be a clot forming in the vein and this gives a painful firm lump that is easily felt.

Diagnosis and treatment.

  • Rectal bleeding should never be dismissed as simply hemorrhoids without a proper examination.
    • This requires passing a tube into the rectum to examine the bowel (sigmoidoscopy).
    • For people older than 40 years it is important to perform a colonoscopy to have a complete inspection.
    • Colonoscopy may be required at an earlier if there are concerns about the nature of the bleeding or other symptoms.
    • Specialist review may be required.

  • The use of cream and/or suppositories can reduce the associated inflammation and may reduce discomfort and reduce bleeding.
    • Anusol ointment and suppositories are commonly given.
    • Some continued bleeding can be accepted so long as a thorough examination has been performed.
    • Discomfort around the anus may be an associated symptom (see pruritis ani).

  • Reducing straining by treatment of constipation is the important approach.
    • Increased fibre is usually the best approach but other treatments as outlines in the constipation section will also be helpful.
    • However there are other ways of improving bowel habit if fibre causes problems such as bloating.
    • If diarrhoea and bowel frequency is the problem then appropriate diagnosis and treatment is requires.
    • Avoid prolonged sitting and straining on the toilet.

  • If the bleeding continues then surgical treatment is required.
    • This can be simple injection treatment or banding which can be performed in an office setting.

  • If there is significant prolapse of the hemorrhoids or failure of simple treatment then an operation under general anaesthetic may be required.


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