Loose bowel motions may be due to an infection (gastroenteritis) but if the symptoms persist for more than 3 weeks then other conditions need to be considered. Sometimes the problem is......

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.
    • 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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