Haemorrhoids

What are haemorrhoids?

Haemorrhoids are enlarged, bulging blood vessels covered by the lining of the anal canal. There are two types of haemorrhoids that describe their location relative to the anal canal.

• Internal haemorrhoids (inside) develop within the anal canal. They cannot be seen at rest but may bulge out of the anal canal during a bowel movement. They cause painless bleeding. As they enlarge, they may protrude through the anal canal and be seen as external haemorrhoids.
• External haemorroids (outside) are seen external to the anal canal. They are also usually painless but if a blood vessel clots within the haemorrhoid (thrombosed haemorrhoid), can lead to severe pain with a hard lump.

What causes haemorrhoids?

Haemorrhoids are caused by weakening of the supportive connective tissue of the anal canal, leading to a bulge with a thin lining. Other factors include:

•  Aging
•  Chronic constipation or diarrhoea
•  Straining at passing stool
•  Pregnancy
•  Spending long periods of time on the toilet (eg reading)
•  Overuse of laxatives or enemas.

The tissues supporting the vessels stretch, the vessels dilate and the walls become thin and are prone to bleeding with minimal trauma.

What are the symptoms?

The most common symptom of haemorrhoids is painless bleeding. It is usually seen on the toilet paper or sometimes in the bowel especially at the end of the bowel motion.
Other symptoms include itch, lump and discomfort. Pain is unusual and unless there is a thrombosed external haemorrhoid is usually due to another condition such as an anal fissure.

How are haemorrhoids treated?

An important point to note is that the symptoms of haemorrhoids can be due to many other conditions including bowel cancer. You should consult your doctor with subsequent referral to a colorectal surgeon to ensure that the symptoms are properly evaluated and serious disease is excluded. This will often involve assessment with a colonoscopy.
Minor bleeding from internal haemorrhoids can often be managed with simple measures such as fibre supplement, adequate fluid intake and good toileting habits.
On-going bleeding with good bowel habits may require intervention.

The options for treatment include:

•  Rubber band ligation – applied to internal haemorrhoids usually during an endoscopy.
•  Haemorrhoidopexy – involves ligation of the haemorrhoid with a suture.
•  Haemorrhoidectomy – involves removal of the haemorrhoid tissue. This can be performed with cautery, bipolar energy device or with a circular stapler.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.