Haemorrhoids (Piles)

Haemorrhoids are associated with increased pressure or straining. This includes:

• straining during a bowel movement
• chronic constipation or diarrhoea
• obesity
• constant heavy lifting
• long hours standing
• sitting for a long period of time, especially on the toilet
• a family history of haemorrhoids
• pregnancy as the enlarged uterus presses on veins in the colon

Preventing or reducing the risk of haemorrhoids

As haemorrhoids can recur, adopting a few simple lifestyle changes can help to prevent or reduce the risk of it happening again by:

• Don’t delay bowel movement as this allows the stools to dry and harden. This may lead to straining and increase your risk for developing haemorrhoids, or turn painless internal haemorrhoids into painful external haemorrhoids.
• Avoid spending long periods on the toilet, as prolonged seating on the toilet places additional stress on the blood vessels in the anus.
• Consume more fibre to prevent constipation and straining, or consider fibre supplements.
• Drink more water to avoid dehydration, which contributes to dry, hard stools and constipation.
• Exercise often to prevent digestive problems by encouraging the movement of food and waste through your digestive tract. Avoid sports or activities that involve heavy lifting.

There are 3 types of haemorrhoids which each present different symptoms:

• External haemorrhoids cause itching, irritation, pain in the anus and surrounding area. Swelling and bleeding are also common symptoms.
• Internal haemorrhoids usually can’t be seen and rarely cause discomfort. However, straining or irritation during bowel movement can result in bleeding or force a haemorrhoid through the anal opening. This is known as a prolapsed or protruding haemorrhoid, which causes pain.
• Thrombosed haemorrhoids refers to a clot or thrombus that is the result of blood pooling in an external haemorrhoid. It appears as hard lump near the anus that is swollen, inflamed and painful.

Other symptoms may include:

• Blood in your stools
• Itchiness at the anus
• Lump at the anus

Do note that, as these symptoms resemble those of colorectal cancer, you should consult your doctor for a full assessment before you attribute your symptoms to haemorrhoids or piles.

The treatment of haemorrhoids or piles depends on the type and severity of your condition. Your doctor may recommend simple preventative measures such as increasing your fibre intake and drinking plenty of water to allow regular bowel motions without straining.

Home remedies such as hydrocortisone, haemorrhoid cream, tablets or suppositories and over-the-counter pain medications may help provide relief from itching or pain. Warm baths or cold compresses may also help.

If these measures do not help, your doctor may recommend other treatment options such as:

• Oral medications
• Rubber band ligation in which blood circulation to the haemorrhoid is cut off by placing a band around it. The loss of circulation forces the haemorrhoid to shrink. This should only be performed by a medical practitioner.
• Injection therapy in which a chemical is injected directly into the blood vessel to reduce its size.
• Surgery to remove haemorrhoids, known as Haemorrhoidectomy, to remove the excess or protruding tissue that is bleeding. It is performed under local, spinal or general anaesthesia.

Complications from haemorrhoids are uncommon, but those may occur include:

• Anaemia, due to blood loss from chronic haemorrhoids
• Blood clot, known as a thrombosed haemorrhoid, which may need to be lanced and drained if it causes a lot of pain.
• Rupture of a thrombosed haemorrhoid, which leads to more bleeding and pain. However, it usually heals on its own.

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