I’m sure someone would say, “No, I don’t”. But the truth is, every healthy individual has haemorroids. These are swellings within the lowest part of the rectum and upper anus which consist of a confluence of blood vessels and connective tissues. They’re always there; even in the unborn child. They only become problematic when they protrude out of the anus (prolapse) or become strangulated, thrombosed or bleed.
Up to 4% of the general population experience symptoms of pathological haemorroids but almost 70% of them are too embarrassed to seek medical attention. Symptoms can range from mild itching and pain, to severe engorgement, bleeding and infection. Haemorroids can be categorized as internal and external, depending on the level of protrusion.
What are the causes and risk factors?
-Prolonged sitting: resulting in obstruction to blood flow
-Pregnancy and vaginal childbirth: effects of hormones and pressure from the enlarged abdomen.
-Lack of erect posture
-Chronic constipation: regular straining
-Prolonged use of stool softeners
-Higher socioeconomic status
-Other huge intra-abdominal masses
-Chronic liver disease
-Spinal cord injury
-Loss of rectal muscle tone: as occurs in old age
-Previous rectal surgery
-Inflammatory bowel disease, including ulcerative colitis, and Crohn disease
Treatment depends on the type and severity. It can be conservative, medical or surgical.
-Avoid constipation: consume at least 25g of fibre daily (obtainable from fruits, vegetables and whole grains), drink lots of water (at least 3 litres daily)
-Weight loss: regular exercise and low-fat, low-carb diet
-Avoid prolonged sitting on the toilet: for those of you who love reading or texting in the toilet!
-Avoid prolonged sitting at work: take intermittent short walks
-Improved anorectal hygiene
-Warm bath: treat yourself to a nice soothing time in the bathtub!
-Stool softeners: to avoid straining during defecation which worsens the symptoms
-Analgesics: to relieve the pain
-Approved herbal remedies: such as witch hazel (Hamamelis water)
-Vasodilators: to reduce the spasm and engorgement
-Local anesthetic ointments and injections: to relieve pain and discomfort
-Anti-pruritic: to relieve itching (eg. Calamine lotion)
-Treatment of underlying cause: such as liver disease and portal hypertension
-Only 5-10% of haemorroids will require surgical intervention: severe, recurrent symptoms that are refractory to conservative and medical treatment.
-There are many options but the ultimate is the removal of the haemorroids (haemorroidectomy)
-Recurrence rate is very low (less than 5%) compared to medical treatment (10-50%)
-Complications are rare when done by expert surgeons.