Haemorrhoids

Abnormally enlarged vascular mucosal cushions in the anal canal

Aetiology

Risk factors

  • Excessive straining (from chronic constipation)
  • Increasing age
  • Raised intra-abdominal pressure (e.g. pregnancy, chronic cough, ascites)

Pathophysiology

  • The classical position of haemorrhoids corresponds to the branches of the superior haemorrhoidal artery - 3, 7 and 11 o’clock
  • Internal haemorrhoids: found above the dentate line, located inside the back passage where the rectum joints the anus
    • Graded 1st to 4th degree
  • External haemorrhoids: form below the dentate line, found at the anal opening and are covered by skin

Clinical presentation

Symptoms

  • Painless bright red rectal bleeding
  • Perianal itchiness
  • No change in bowel habit, no weight loss or other associated symptoms

Signs

  • Examination will usually be normal unless the haemorrhoids have prolapsed

Investigations

  • PR exam
  • Proctoscopy
  • Flexible sigmoidoscopy in patients over 50 or where malignancy is a possibility

Management

Pain and symptom relief

  • Stool softeners
  • High fibre diet
  • Topical creams to relieve acute symptoms

Non-surgical treatments

  • Rubber-band ligation
  • Sclerotherapy

Surgical treatments

  • HALO/THD procedure
  • Haemorrhoidectomy (open, stapled)