Haemorrhoid Treatment

What are the symptoms of haemorrhoids?

There are a number of different symptoms that a person with haemorrhoids may experience. You might experience some or all of these:

• No symptoms: In many cases, the person does not even know they have haemorrhoids and it may not cause them any discomfort or symptoms at all. The haemorrhoids may be incidentally detected during a rectal examination by a doctor or a colonoscopy performed for another reason.

• Bleeding: Haemorrhoids are one of the most common causes of blood during a bowel motion. If you have haemorrhoids, bleeding can range from:

  • Bright red blood on the toilet paper after wiping

  • Fresh blood in the toilet bowl - typically, the fresh blood appears separate to the bowel motion

  • Dripping blood during or after the bowel motion

• Protrusion of a lump from the anus: A lump is often felt to protrude during straining and disappears following. Sometimes, the patient will need to push the lump back in manually. In other cases, the lump may not be able to be pushed back in, and this can be painful.

• Itching and anal discomfort

• Pain: the majority of haemorrhoids are not painful. A painful external haemorrhoid may represent a thrombosed (clotted) haemorrhoid that can benefit from drainage by a specialist doctor.

​

What causes haemorrhoids?

Any factor which leads to increased abdominal pressure can predispose to haemorrhoids:

• Excessive straining to pass the bowel movement

• Hard stools

• Pregnancy: haemorrhoids are common during pregnancy but usually resolve after delivery

• Low fibre in the diet

​

How are haemorrhoids diagnosed?

While haemorrhoids can be suspected based on the presence of some of the symptoms above, they can only be definitively diagnosed (or ruled out) by physical examination along with a type of ‘scope’ to visualise internally – this may take the form of proctoscopy (internal examination of rectum), sigmoidoscopy (internal examination of rectum and lower half of the colon) or colonoscopy (internal examination of entire rectum and colon). Using one of these scopes, your specialist can diagnose haemorrhoids based on their characteristic colour and appearance.

 

Can I try anything at home before seeing a doctor?

Yes, if you suspect you have haemorrhoids based on your symptoms there are several simple things you can try to reduce the symptoms:

• Take a fibre supplement: Psyllium husk is a type of fibre widely available from chemists and supermarkets. Taking it orally every day improves the consistency of the stool, and in many people can eliminate symptoms from haemorrhoids

• Avoid prolonged time sitting on the toilet: Don’t read your mobile phone (or anything else) while sitting on the toilet! 

• Avoid excessive straining: Use a laxative to prevent excessive straining. If this doesn’t work, see your doctor

• Ointments: Ask your chemist for over-the-counter medicated ointments which can help to temporarily relieve symptoms arising from haemorrhoids

​

When do I need to consult a doctor?

It is important to seek a consultation with a specialist gastroenterologist if:

• Your symptoms do not resolve within a week or two after trialling the above measures

• When there is a large volume of bleeding or severe pain

​

What treatments for haemorrhoids can a specialist perform?

Banding of haemorrhoids

Removal of haemorrhoids can be accomplished by a procedure called rubber band ligation. This is usually performed while you are under sedation having a sigmoidoscopy or colonoscopy. While visualising the haemorrhoid and using a special applicator device, A/Prof Sanagapalli will place a rubber band around the haemorrhoid (see below). The rubber band will cut off the blood supply to the haemorrhoid, and after a few days the haemorrhoidal tissue will wither and fall off (you may or may not see it in the bowel motions). 

 

Removal of haemorrhoids by banding is generally a safe and straightforward procedure. Some discomfort and mild pain can last for a few days after the procedure, but severe pain is uncommon. For a couple of days after, you may feel as though you need to pass a motion, as the banded haemorrhoid takes up space in the rectum. Minor bleeding is common and usually settles within the first couple of weeks. In a proportion of cases, haemorrhoids can recur; if this happens, the banding procedure can be repeated. After haemorrhoid banding, it is important to also treat the underlying trigger of the haemorrhoids (usually constipation and excessive straining) to try and reduce the likelihood of them recurring.