Haemorrhoids

Peri-anal Conditions

This area of surgery relates to a number of conditions around the anus which can be embarrassing and may lead to patients not seeking medical advice and treatment. In many cases, failure to get treatment can lead to serious consequences.  However, if seen and treated early, complications can be avoided. 

Haemorrhoids (Piles) are probably the most well-known condition, but there are also other conditions lesser known, which could be affecting patients, for example: Peri-anal Skin Tags, Peri-anal Haematoma, Fissure in Ano, Fistula in Ano, Anal Polyps or Tumours.

Haemorrhoids

What are Haemorrhoids?

We all have small haemorrhoids! These are the anal equivalent of lips around your mouth and are designed to keep the contents of the gut inside the bowel / mouth!! Haemorrhoids become a problem if they become excessively enlarged. This can lead to bleeding and in more severe cases, prolapse.

The exact cause of haemorrhoids is unknown; contributing factors include ageing, constipation / diarrhoea influenced by diet, faulty bowel function, prolonged straining bowel movement or pregnancy

Haemorrhoids and their symptoms are one of the most common afflictions in the world. They can occur at any age and affect both men and women.

Although rarely fatal, they can be painful, embarrassing and disabling. Haemorrhoids are graded by degree of prolapse and this grading determines the most appropriate treatment method.

First degree (internal) haemorrhoids are merely swelling with visible dilated vessels on the surface of the haemorrhoidal cushion within the anal canal.

Second degree haemorrhoids prolapse with defecation but return spontaneously or with manual replacement.

Third degree haemorrhoids are those which have prolapsed and cannot be returned inside despite attempts to reduce them.  Sometimes haemorrhoids can prolapse acutely and become strangulated. This results in marked pain and swelling of the haemorrhoid.

Treatment

Haemorrhoids tend to get worse with time and are best treated as early as possible. Depending on the severity of the haemorrhoids, symptoms such as itching and discomfort may be alleviated by over the counter creams and ointments.

The majority of first degree and some second degree haemorrhoids can be treated in the surgical outpatient clinic without the need for general anaesthetic. In these cases, it is possible to apply a small rubber band onto the haemorrhoid to cut off its blood supply and thus shrink it back to its normal size (some surgeons prefer to inject phenol (an irritant) into the haemorrhoid to achieve the same effect). Only the most severe cases require general anaesthetic surgery.

Large second degree and third degree haemorrhoids do require surgery. This can only be performed in cases where the condition has become chronic. Acute prolapsed / strangulated haemorrhoids should be allowed to settle down before surgery is attempted. A haemorrhoidectomy is the surgical removal of the haemorrhoid.

 

Conventional treatment methods include:-

  • Cryotherapy
  • Infrared coagulation

 

Differential Diagnosis

Whilst haemorrhoids are the commonest anal condition with these symptoms, your doctor should ensure that there is not another cause for your symptoms. Possible rarer causes for the above symptoms include:-

Peri-anal Skin Tags

This is a condition which consists of small areas of loose skin protruding from the anal canal. Normally these are a result of a patient having had haemorrhoids which have "shrunk" leaving behind a small area of loose skin. These can be uncomfortable, irritating and lead to problems with personal hygiene. They can be removed very easily.

Peri-anal Haematoma

This condition is often misdiagnosed as a "thrombosed pile" but is actually an acute condition resulting from the rupture of a small blood vessel under the skin adjacent to the anal canal. Typically the patient will give a history of sudden pain and development of a painful lump whilst they were straining on the toilet. 

Fissure in Ano

This is where the patient develops a tear in the lining of the anal canal. It can be an acute or chronic condition and is often associated with a history of constipation. In this condition the history consists of severe anal pain during defecation. This can be associated with blood particularly after leaving the bathroom. The condition can lead to major problems if it becomes chronic and can be difficult to treat.

Fistula in Ano

Sometimes a track (fistula) exists between the inside of the bowel and the skin around the anus. This is called a "fistula in ano". This means that bowel content can be extruded down the track and lead to leakage onto the skin. Patients present with smelly discharge from a small hole somewhere around the anus. If the condition is left and the track becomes blocked the bowel content can fester in the tissues around the anus and form an abscess which would need urgent surgical drainage. 

Anal Polyps or Tumours

Polyps are fleshy growths which develop from the bowel lining. If these are near the anal canal they can prolapse outside the body and may mimic haemorrhoids. Some polyps may be pre malignant and therefore these need to be removed and tested.

It is also possible to develop tumours of the anus. This is a completely different disease to bowel cancer and can present in a number of different ways. If you have any concern you should seek medical advice.

 

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