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.
External hemorrhoids are visible from then "outside". They may be felt as a persistent lumpiness. This problem does not usually cause bleeding or pain and no treatment is required
Another type of problem is a thrombosed external hemorrhoid. There can be a clot forming in the vein and this gives a painful firm lump that is easily felt. This painful persist for 1-2 weeks. Occasionally the clot needs to be excised to reliev the pressure. The thrombosed or clotted vein shrinks and becomes a skin tag - or redundant, floppy skin around the anus
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 age 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.
Proctesedyl or Ultraproct ointment and suppositories is commonly given. These treatments contain a steroid to reduce inflammatiion and a numbing agent. There is minimal risk but only short-term treatment is recommended (max 4-8 weeks)
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. This could be Molaxole (macrogol) or Magnesium capsules)
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 (hemorroidectomy)
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