Haemorrhoids
What are haemorrhoids?
Haemorrhoids, also known as piles, are soft fleshy lumps just inside the back passage (anus). They bleed easily usually causing fresh bright-red bleeding when a motion is passed. They do not usually cause pain but can cause itching. When large, they can pass through the anus (prolapsed pile), feeling like a lump when cleaning after going to the toilet.
Haemorrhoids develop gradually, often over a long period of time. They are associated with constipation, often run in families and can be made worse by pregnancy.
Surgery will help to treat the haemorrhoids with an aim to relieve the symptoms that haemorrhoids can cause.
Treatment for Haemorrhoids
Conservative measures:
By ensuring stool is soft, the passage of stools is easier and therefore less straining is required to pass a motion. This results in the haemorrhoids getting smaller. By eating more fibre, drinking plenty of fluids and avoiding straining or spending too much time sitting on the toilet significantly reduces the symptoms from haemorrhoids.
Surgical Management of Haemorrhoids:
Banding:
This method of treating haemorrhoids aims at reducing the blood supply to the haemorrhoid itself. It can be done as an outpatient without the need of general anaesthesia. A small plastic instrument called a proctosope is inserted into the anal canal and small rubber bands are applied near the haemorrhoids. The bands trap the blood supply of the haemorrhoids which then shrink down. The bands are applied in an area of the back passage which has very few sensory nerves and therefore the patients should not feel pain.
The bands fall away after a few days and the area heals within a few weeks.
This procedure can cause discomfort in the first 24-48hrs post application and bleeding especially the first 24-48hrs and again in about 7-10 days after the procedure. Sometimes the procedure will have to be repeated to achieve the best results.
Digital Haemorrhoidal Artery Ligation (DGHAL or HALO):
DGHAL or HALO is performed under general anaesthetic. This operation is designed to eradicate piles without the need for cutting. The operation uses a miniature ultrasound device to locate the blood vessels supplying the haemorrhoids. The aim of the operation is to cut off the blood supply to the haemorrhoids. This is achieved by placing a stitch around each blood vessel. Over the following few weeks to months, the piles shrink away and the symptoms resolve. Pain is to be expected for several days after the operation and this is usual.
Occasionally, for bigger haemorrhoids the surgeon may suggest a modification of the HALO procedure called RAR (Rectoanal repair). This is where further stitches are used to draw up larger haemorrhoids which may prolapse or hang down through the anal canal. These stitches are then tied to the original stitch, thereby hitching the haemorrhoid back into position and thereby encouraging it to shrink and hold back into position up inside the anus. While this procedure works well, the hitched stitches do cause some pain in the aftermath of the operation and normally we would advise to have two weeks off work. The pain is still usually a bit less and with a quicker recovery than the alternative, which is a conventional open operation.
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Basingstoke Colorectal & Peritoneal
The Hampshire Clinic
Basing Road
Basingstoke RG24 7AL
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01256 354747