Haemorrhoids - commonest cause of rectal bleeding — Health Aware - Mens, womens and children. Fitness and health care

Haemorrhoids are also known as piles. These are enlarged vascular cushions in the lower rectum and anal canal. At least 10% of the population have symptomatic haemorrhoids at some time in their life. Haemorrhoids are the commonest cause of rectal bleeding.

Classical position:

This is corresponds to branches of the superior haemorrhoidal artery.
Occurring at the 3 o’clock, 7 o’clock and 11 o’clock positions with the patient in the lithotomy position.

Symptoms and Signs

May be asymptomatic
Rectal bleeding ( you might see fresh blood on toilet paper or drips of blood during defaecation)
Rectal Prolapse
Anal itchiness (pruritus ani)
Anal pain (this is rare. Pain usually present if there is thrombosis)

Types of haemorrhoids

First degree – piles remain in the rectum but only manifest by rectal bleeding
Second degree – piles prolapse on defaecation but will reduce spontaneously
Third degree – piles prolapse present but require manual reduction

Investigations

Digital rectal examination
Proctosopy – to confirm present of piles and to locate the position of the piles.
Sigmoidoscopy – to exclude other lesions
Barium enema – if there is any doubt what might cause the rectal bleeding
Abdominal examination – to exclude other lesions
Full blood count – to check for haemoglobin level if bleeding is prolonged or heavy

Treatment

No treatment is required if patients has no symptom or the symptom is minor.
Injection of phenol in almond oil (2-3 ml) into the submucosa above the pile. This is suitable for first degree and small second degree piles
Rubber band ligation of piles.
Cryosurgery
Photocoagulation
Haemorrhoidectomy – suitable for large second degree and third degree piles
Thrombosed piles treated by bed rest, pain killer and ice packs. The piles may thrombose with cure. Some will remain as skin tags and need excision.
Subsequent regulation of bowel habit with high fibre diet and bulk laxatives is required.