Haemorrhoids (piles) are small blood vessels in and around the anal area that distend. They are either 'internal', or 'external' (on the outside of the anus).
Haemorrhoids are a common condition, which can present as a cause of minor bright rectal bleeding, a painful anal lump and pruritus ani. Haemorrhoids are associated with chronic constipation.
Conservative treatments for haemorrhoids include prevention of constipation with lifestyle and dietary modifications–
- Increased water intake
- Increased fibre intake (vegetables and fruits rich in fibre, fibre supplements such as Metamucil or Psyllium husk)
- Regular exercise
- Avoiding irregular toilet habit, straining
- Warm wash after bowel motions
- Avoiding soap and fragrant toilet papers for pruritus ani
Proctosedyl can be used for topical pain relief for haemorrhoids.
There are two common surgical procedures to correct haemorrhoids. Rigid / flexible sigmoidoscopy or colonoscopy may be necessary to exclude other important causes of rectal bleeding such as polyps and bowel cancers. In addition to sigmoidoscopy, rubber band ligations (RBL) can be performed to band the internal haemorrhoids and to reduce the risk of bleeding and further symptoms from haemorrhoids. RBL would not remove external haemorrhoids. This is performed as a day case and usually produces minimal discomfort.
In the case of severe, painful prolapsing external haemorrhoids, haemorrhoidectomy (removal of haemorrhoidal tissue) may be necessary to control the symptoms.
Some discomfort after RBL is not uncommon, but normally patients are able to return to day-to-day activity and return to work within a few days. In comparison, haemorrhoidectomy can be quite painful and may need 3-4 weeks off work to recover from the surgery.
Post-haemorrhoidectomy instructions include
- Regular pain relief including Panadol, Nurofen and / or Endone
- Antibiotics (Flagyl for 5 days)
- Regular fibre supplements and laxatives (Movicol and / or Lactulose)
- Salt bath daily
- Rest, increased fluid intake
- Review in 2-3 weeks time
- Contact Mr Choi’s rooms, if worsening pain, significant bleeding or fever occurs after surgery, for early review and consultation