Haemorrhoids

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

What are Haemorrhoids?

Haemorrhoids are swollen veins located in the lower rectum and anus. They can develop internally (inside the rectum) or externally (under the skin around the anus). Haemorrhoids can cause discomfort, pain, and bleeding, especially during bowel movements. Although they are common and typically not serious, medical intervention may be required if symptoms persist or worsen.

Types of Haemorrhoids

Haemorrhoids vary in their location, severity, and symptoms, which helps determine the appropriate treatment. The main types of haemorrhoids include:

Internal Haemorrhoids

Internal haemorrhoids develop inside the rectum and are usually not visible and painless as this area lacks pain-sensitive nerves. However, you may notice bright red blood in your stool or on toilet paper if they bleed.

External Haemorrhoids

External haemorrhoids form under the skin around the anus and can cause itching, swelling, and pain, particularly during bowel movements or while sitting. These haemorrhoids may also develop blood clots (thrombosis), which can lead to a hard, painful lump.

Prolapsed Haemorrhoids

Prolapsed haemorrhoids are internal haemorrhoids that have pushed through the anal opening. They can vary in severity, from slight protrusion that can be pushed back inside to more severe cases where they remain outside the anus.

Causes and Risk Factors of Haemorrhoids

Several factors can contribute to the development of haemorrhoids:

Straining During Bowel Movements

Frequent straining, often caused by chronic constipation or difficulty passing stool, puts extra pressure on the veins in the rectum. This can cause the veins to swell and lead to haemorrhoids.

Prolonged Sitting

Sitting for long periods, particularly on the toilet, can restrict blood flow in the veins of the rectum, leading to swelling and increasing the risk of haemorrhoids.

Pregnancy

During pregnancy, especially in the later stages, the growing uterus places additional pressure on the pelvic and rectal veins, which can cause them to swell, leading to haemorrhoids. Hormonal changes during pregnancy can slow digestion, contributing to constipation and further increasing the risk.

Age

As people age, the tissues supporting the rectal veins weaken and stretch. This natural weakening of the tissue makes older adults more susceptible to haemorrhoids, particularly after the age of 50.

Obesity

Excess body weight increases pressure in the abdomen and pelvis, placing more strain on the rectal veins. This can contribute to the development of haemorrhoids.

Diagnosis of Haemorrhoids

To diagnose haemorrhoids, a colorectal surgeon uses several methods to identify the presence, type and severity. These diagnostic tools help determine appropriate treatment options:

Physical Examination

The surgeon begins with a visual inspection of the area around the anus to identify external haemorrhoids or prolapsed internal haemorrhoids. This is often the first step in diagnosing haemorrhoids, especially when external symptoms are present.

Digital Rectal Examination

During a digital rectal examination, the surgeon inserts a lubricated, gloved finger into the rectum to feel for any internal haemorrhoids, lumps, or abnormalities, assessing their size and location.

Anoscopy

An anoscope (a small, lighted tube) is gently inserted into the rectum, allowing the surgeon to examine the inside of the rectum and detect internal haemorrhoids that are not visible during a physical examination. This procedure is relatively quick and effective for identifying smaller internal haemorrhoids.

Proctoscopy

Proctoscopy allows for a deeper examination of the rectum than anoscopy. This procedure is used to assess larger or more complex haemorrhoids and ensures that the entire rectal area is thoroughly examined. It is especially useful when haemorrhoids are suspected but not easily detected through other methods.

Treatment Options for Haemorrhoids

Non-surgical Treatment

Non-surgical treatments are often recommended for managing mild to moderate haemorrhoids, aiming to reduce symptoms and, in some cases, eliminate haemorrhoids without surgery:

Topical Treatments

Creams, ointments and suppositories can help relieve inflammation, itching, and pain. They are particularly helpful for mild haemorrhoids and can be applied directly to the affected area to manage symptoms while they heal.

Rubber Band Ligation

This minimally invasive procedure, commonly used for internal haemorrhoids, involves placing a small rubber band around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid gradually shrinks and falls off within a few days.

Medication

Oral medication used to cause vasoconstriction is commonly used to treat smaller haemorrhoids with good results.

Surgical Treatment

Surgical is considered when non-surgical methods fail or when the haemorrhoids are large, prolapsed, or causing significant discomfort and bleeding. Surgery aims to provide long-term relief by removing or shrinking the haemorrhoids.

Haemorrhoidectomy

Haemorrhoidectomy involves the complete removal of the haemorrhoid. It is usually recommended for large or prolapsed haemorrhoids unresponsive to less invasive treatments. Although effective, it may require a longer recovery period with postoperative discomfort, but it offers long-lasting relief for severe cases.

Stapled Haemorrhoidopexy

Stapled haemorrhoidopexy is a procedure primarily used for internal haemorrhoids. The haemorrhoids are stapled back into their normal position inside the rectum, cutting off their blood supply and causing them to shrink. This procedure typically results in less pain and a quicker recovery compared to a traditional haemorrhoidectomy, making it suitable for prolapsed internal haemorrhoids.

Laser Haemorrhoid Surgery

This is a minimally invasive procedure that uses a laser to remove or shrink haemorrhoids. The laser seals the tissue as it cuts, reducing bleeding and post-operative pain. Patients generally experience quicker recovery and less discomfort compared to other surgical methods. This technique can treat both internal and external haemorrhoids.

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How Can Haemorrhoids Be Prevented?

Preventing haemorrhoids involves maintaining a high-fibre diet with plenty of fruits, vegetables, and whole grains to keep stools soft and reduce straining. Staying hydrated also helps ease bowel movements.

Avoid prolonged sitting, especially on the toilet, and respond to bowel urges promptly to prevent unnecessary pressure on the rectum. Regular exercise aids digestion and prevents constipation, reducing the risk of haemorrhoids.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can haemorrhoids go away on their own?

    Yes, mild haemorrhoids can often resolve on their own with lifestyle changes, such as increasing fibre intake and staying hydrated. However, more severe haemorrhoids may require medical treatment.

    How do I know if I need surgery for haemorrhoids?

    Surgery may be necessary if haemorrhoids are large, prolapsed, or cause significant pain, bleeding, or discomfort that does not improve with non-surgical treatments. Consult a doctor to determine the best course of action based on your symptoms and the severity of your condition.

    Are haemorrhoids dangerous?

    Haemorrhoids are generally not dangerous but can cause discomfort and bleeding. Severe or untreated cases may lead to complications such as anaemia (from chronic blood loss) or thrombosis (formation of a blood clot in external haemorrhoids), requiring prompt medical attention.

    Can haemorrhoids come back after treatment?

    Yes, haemorrhoids can recur even after treatment, especially if risk factors such as straining during bowel movements, chronic constipation or prolonged sitting are not addressed. Adopting preventative measures, like maintaining a high-fibre diet and staying active, can help reduce the risk of recurrence.

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