Haemorrhoids

These are prominent veins in the rectum that can bleed. They can be internal or external. They can cause rectal bleeding when passing a bowel motion. Usually the blood is bright red, and can be seen on the toilet paper or in the pan.

Haemorrhoids can be repaired by ligating with a type of rubber band (rubber band ligation), or by surgically removing them (haemorrhoidectomy). Most of the time a colonoscopy will be required beforehand to rule out other causes of rectal bleeding.

Haemorrhoids are a normal anatomical structure in the anal canal. There are internal and external haemorrhoids.

Haemorrhoids

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They may be associated with pregnancy, prolonged sitting, straining, chronic and constipation. They can become troublesome and cause symptoms, which can include:

• Rectal bleeding
• Rectal pain
• Anal itching
• Faecal soiling or discharge

The most common symptom is painless rectal bleeding. The blood is bright red and is usually associated with passing a bowel motion. The blood may be seen on the toilet paper or in the toilet pan. Other conditions can cause similar symptoms and it is important to make a correct diagnosis as their treatments may vary. Frequently, people who experience rectal bleeding need a colonoscopy. This is to rule out another source of bleeding. If internal haemorrhoids are identified during the colonoscopy, they can be rubber band ligated. This involves specialised equipment to place a small rubber band around the base of the haemorrhoid. This can cause a mild to moderate amount of discomfort for a couple of days. After about a week, the banded haemorrhoid will fall off. At this one-week mark, a small amount of bleeding may be experienced. ​

Large or external haemorrhoids are not able to be managed by rubber band ligation. These require surgery (haemorrhoidectomy). This involves a general anaesthetic and the haemorrhoids are surgically removed. Although surgical haemorrhoidectomy involves relatively small incisions, the pain and discomfort for the first few days can be significant. You will need regular pain relief and stool softeners for a few weeks. If the haemorrhoids are circumferential, you may require more than one surgery to remove all the symptomatic haemorrhoids. This is to reduce the risk of complications such as stricture of the anal sphincter.

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