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Haemorrhoid

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Haemorrhoids are a common urban disease, a condition in which the arterio-venous plexus and connective tissue in the anus protrude, and symptoms are usually triggered when the haemorrhoids become enlarged or inflamed.


 

Symptoms

Sixty per cent of the symptoms of hemorrhoids are bleeding from the bowel (fresh bloody stools), 55% are anal itching, 20% are anal discomfort or pain, and 10% are fecal leakage. The most common symptom in patients with hemorrhoids is non-painful bleeding in the feces (internal hemorrhoids). In the case of internal hemorrhoids, the bleeding is often seen as red blood at the "end" of the stool, or when wiping the buttocks. When internal hemorrhoids swell to a certain extent, they will sag down towards the anus, so that you can feel the hemorrhoidal mass near the anus. The degree of swelling and prolapse of internal hemorrhoids is classified according to the degree of swelling and prolapse of internal hemorrhoids, and the treatment required is also  different.

The classification of hemorrhoids is as follows:

  • Grade I internal hemorrhoids: the blood vessel clusters and epithelial tissues are bulging without any prolapse.
  • Grade 2 internal hemorrhoids: the hemorrhoid begins to prolapse but can be restored to its original position automatically.
  • Grade III internal hemorrhoids: the hemorrhoids can be pushed back to the top of the dentate line by the fingers after they have prolapsed. This may cause anal itching.
  • Grade IV internal hemorrhoids: the hemorrhoid has prolapsed beyond the anal opening and cannot be pushed back with a finger, and may be accompanied by chronic inflammation and ulceration.
 Internal HemorrhoidExternal hemorrhoid
Location Intra-analExtra-anal vicinity
Symptoms
  • Usually painless
  • Internal hemorrhoids can cause bleeding from the anus, which is usually accompanied by blood in the stool, on toilet paper or in the toilet bowl.
  • Internal hemorrhoids may swell and protrude out of the anus, resulting in prolapsed hemorrhoids and pain near the anus


 

  • Anal itching
  • One or more lumps or bumps near the anus
  • Anal pain, especially when sitting down
  • Bleeding from the anus or blood in the stool


 


 

Causes and risk factors

Varicose veins or abnormal congestion near the anus, usually caused by increased intra-abdominal pressure, which obstructs blood circulation to the anus, i.e. venous reflux. 

  • People with constipation or diarrhea (increased local pressure in the anus)
  • Obese people (increased pressure in the abdomen)
  • Insufficient intake of fibre (constipation easily leads to increased pressure in the abdomen).
  • Occupations with prolonged standing and sitting, e.g. designers, drivers, chefs, hairdressers, etc. (difficult to return blood to the anorectal vein).
  • Patients with portal hypertension (high pressure in the abdominal venous system, affecting the anorectal venous return)

High risk individuals

In addition to the above risk factors, pregnant women (increased pressure in the abdomen affects anorectal venous return) and elderly silver-haired people (loose connective tissue and decreased mobility affects anorectal venous return) are also at high risk.

Diagnosis

Medical HistoryThe doctor will look at your bowel habits, eating habits, toileting habits, use of enemas and laxatives, and your current medical condition.
Physical Examination

The doctor will examine the area around your anus to see if there are any:

  • lumps, swelling
  • Anal fissure

A rectal examination will be performed to check for

  • Tension of the anal contractile muscles
  • Rectum and anal canal for lumps, pressure and tenderness.
AnoscopyDirect examination of the anus or rectum at the outpatient clinic to diagnose internal or external hemorrhoids, and whether there is any tumor or abnormality in the rectum.
ColonoscopyColonoscopy is used to identify colorectal lesions other than bleeding hemorrhoids, such as tumors or ulcers.

Treatment

Treatment of hemorrhoids depends on the symptoms and severity of the symptoms in different patients:

Hemorrhoids with mild symptoms

Lifestyle and symptom relief:

  • High-fibre diet
  • Avoid straining to defecate
  • When hemorrhoids flare-ups occur, patients can use hemorrhoid ointment or suppositories to relieve the pain.
  • Hot water baths to relieve swelling, anal pain, itching and discomfort.
More severe hemorrhoids

Surgery

  • Rubber Band Ligation
  • Injection Sclerotherapy
  • Infrared Coagulation
  • Haemorrhoidectomy (Conventional Haemorrhoidectomy / Circumferential Haemorrhoidectomy)
  • Ultrasound Doppler Guided Haemorrhoidal Artery Ligation

If the hemorrhoids are extremely painful, or if there are suspicious symptoms such as severe anal bleeding, discharge of black feces or blood clots, the patient should consult a doctor immediately for an accurate diagnosis and early treatment. In case of pregnant women, it is recommended to consult a doctor instead of buying medication on their own.

Impact

The most common symptom of haemorrhoids is bloody stools, but bleeding in the stool is not the same as having haemorrhoids. Bleeding in the stool is also a common symptom of other serious digestive diseases, such as colorectal cancer, peptic ulcers or bleeding. Prolonged bleeding haemorrhoids may cause chronic anaemia, which poses a health risk to the patient. If you have a bleeding bowel movement, it is important to seek immediate medical attention to determine the cause of the bleeding.

Prevention

To prevent hemorrhoids, the first thing you need to do is to prevent constipation. Eating more high-fibre foods can help improve bowel movements. Secondly, you should develop a regular bowel habit, do regular exercise, and avoid prolonged standing or sitting, all of which can help reduce the risk of hemorrhoids forming and occurring.

Frequently Asked Questions

General treatments for hemorrhoids are effective, but there is a chance that hemorrhoids may recur. If your hemorrhoids recur frequently, please consult your doctor for further treatment, such as surgery or ligation, as appropriate.
Ointments are often used for external hemorrhoids, while suppositories help with internal hemorrhoids.
Constipation increases the risk of developing hemorrhoids, but taking laxatives for a long period of time can make the body dependent on the medication and interfere with normal bowel movements. When the hemorrhoid problem is serious, doctors will prescribe laxatives to relieve the pain of defecation and help the hemorrhoids to recover. Patients are advised to use laxatives only when prescribed by their doctors.
In the past, the severe pain that occurred during conventional hemorrhoid surgery was mainly due to the tearing or rupture of the sphincter muscle, damaging the nerves and blood vessels in between. However, nowadays, there are advanced analgesic techniques that can ensure that the patient feels no obvious pain during and after the surgery, and facilitate the patient's recovery after the surgery. In addition, the current application of minimally invasive hemorrhoidal techniques has compensated for the disadvantages of traditional surgical excision, such as small trauma, thorough treatment, normal defecation 24 hours after surgery, and the pain of the patient is greatly reduced.

References

  1. Non-communicable Disease Watch January 2011 - Haemorrhoids - No Joke - Centre for Health Protection from https://www.chp.gov.hk/files/pdf/ncd_watch_jan_2011_chi.pdf 
  2. Common Diseases in Men - Haemorrhoids - Health Protection Centre from https://www.chp.gov.hk/tc/static/80041.html
  3. Hemorrhoids - NIDDK from https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids

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