Haemorrhoids are also known as piles. They are enlarged blood vessels placed inside of the anal canal (back passage). They are also called as anal cushions. Entirely normal and physiological to have haemorrhoids. These an integral part of body and contribute significantly to our continence. They prevent us from leaking liquid stools or wind. Haemorrhoids sometimes can swell and cause discomfort. These lumps can cause series of unpleasant symptoms. The symptoms include swelling, bleeding, leakage, itching an inability to keep the back passage clean. Occasionally there can be a blood clot within these causing pain. This is called as thrombosed haemorrhoid.

Bleeding whilst evacuating, itching, mucus discharge, lumps around the back passage, lumps prolapsing in and out, feeling of fullness in the back passage are some of the common symptoms. Pain is usually not a symptom in the vast majority except with those with a blood clot within the haemorrhoid. This is called as thrombosed haemorrhoid. Large bulky haemorrhoids associated with loose lining of the rectum and back passage, can cause evacuatory difficulties.

The changes that happen during pregnancy are responsible for troublesome haemorrhoids. Increasing uterine size in addition to abdominal and pelvic pressure causes dilatation of the haemorrhoidal venous plexus. Increased circulating blood volume, thinning of veins and swelling of the veins all contribute to symptomatic haemorrhoids. Hormones have a role to play. Especially during the last trimester there is increased Progesterone which leads to smooth muscle relaxation thereby increasing the laxity of the Veins. Progesterone also causes constipation as a consequence of relaxation of the small muscles of the Intestine. Constipation adds to straining on defecation and increases the time on the toilet. All these add to increased haemorrhoidal problems. One in three women become constipated during pregnancy and a majority of them develop haemorrhoidal symptoms.

Prevention of symptomatic haemorrhoids is possible. Consumption of a high fibre diet, increased water, mobility and training the urge sensation all help. This means to go to the toilet and open the bowel as soon as the urge to evacuate arises. Gastro colic reflux is when there is an urge to evacuate after a meal. It is important to utilise this reflux. Abandoning the defecation reflux and the gastro colic reflux are less helpful in preventing haemorrhoids. In addition to maintaining regularity in evacuation, it is also important to adapt squatting Posture so as to aid evacuation. This also helps in prevention of haemorrhoids. A light Cardio physical exercise is good and advised.

If you have the symptoms suggested you very likely have troublesome haemorrhoids. If in doubt seek medical attention. General Practitioners can easily arrive at a diagnosis after a thorough history about symptoms and examination. Usually General Practitioners prescribe first line therapy which include lifestyle changes and topical applications. Irrespective, it is advisable to seek a Specialist opinion or if the symptoms persist despite initial therapy.

A detailed history in addition to the symptoms, a diligent examination and appropriate investigations are vital for the right diagnosis. Especially with the knowhow a specialist can arrive at the right diagnosis and exclude the more serious causes of bleeding such as colitis, polyps or cancer. During the examination the specialist relies on an educated finger examination. In addition small devices/cameras (proctoscopy / sigmoidoscopy) that help us arriving at a diagnosis. They are minimally invasive tests. They are normally carried out in the examination room or an endoscopy suite without the need for sedation. There are instances when further examination of the colon if necessary – and a colonoscopy requested. The bulk majority do not need sedation, while a minority do so.

Prevention is better than cure. Despite this, if there are symptomatic haemorrhoids – they are classified based on the complexity and the symptomatology. Treatment strategies would involve dietary and lifestyle changes, consumption of high fibre, consumption of water in the adequacy, change in the toileting habits and adaptation of suitable toileting positions. Pharmacological support is provided with laxatives and local applications. When severe, various therapeutic strategies are adapted. Some of them include electrocoagulation, laser, Doppler guided treatments, LigaSure haemorrhoidectomy, stapled haemorrhoidopexy etc. The Good old Milligan Morgan haemorrhoidectomy and Ferguson haemorrhoidectomy have stood the test of time. It is true to say short term pain provides a long-term gain when it comes to the traditional operations. Every therapeutic strategy has to be weighed based on the patient symptoms, disease grade, patient need, risks / benefits and patient expectations.

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions.