Haemorrhoids are anal cushions that have developed problems thus becoming symptomatic. In the anal anatomy, the lining of the anus is divided into two halves – deep and superficial. These are separated midway in the anal canal by an irregular jagged line referred to as the dentate line. Above this are three anal cushions that consists of specialized blood vessels. These cushions can rapidly fill up or decompress; an attribute that helps avoid leakage of gas and faeces when there is a sudden change in pressure, like when a person sneezes or carry heavy things.
First thing one must know about haemorrhoids is that it is present in everyone. When the anal cushions over-expand – mostly caused by chronic straining from difficult bowel movement – and becomes enlarged, these abnormal swollen and engorged anal cushions are known as haemorrohoids.
There are two types of haemorrhoids – Internal and External. Internal haemorrhoids reside within in the anal canal and can’t be felt. They usually present with bleeding and a sensation of anal discomfort. When the haemorrhoids continue to enlarge and prolapse out of the anal canal, they are known as external haemorrhoids. These usually cause some pain beside bleeding. On the other hand, a thrombosed haemorrhoid occurs when there is a clotting of blood (also called thrombosis) in the vessels below the dentate line. The thrombosed vessel will appear to be a hard-painful lump at the edge of the anus.
Haemorrhoid conditions is divided into four degrees of severity based on its size and the symptoms it shows.
Piles or haemorrhoids can be caused by different factors. But some of the most common causes includes the following:
Usually there are 3 main indications of haemorrhoids: prolapse, bleeding and pain caused by thrombosis. However, one must note that these symptoms can also indicate more serious conditions such as Colon Cancer. This is why it is important to have a full assessment of your current condition to be able to make an accurate diagnosis.
Aside from the three symptoms mentioned above, here are some other common indications you should watch out for:
As what was mentioned earlier, haemorrhoids are classified into four degrees of severity. – Depending on how serious your condition is, the doctor may just recommend simple preventive measures such as an increase in fibre and fluid intake. Otherwise, you may be advised to undergo either an operative or a non-operative treatment.
Conventional Excisional Haemorrhoidectomy
- This operative technique cuts off the prolapsed haemorrhoid while the wound is left open to heal on its own. This method has the most uncomfortable recovery process as well as the longest healing time.
Closed-wound Excisional Haemorrhoidectomy
- This is similar to the method above except the wound is stitched afterwards. The recovery period takes about 2 weeks and there is only minimal pain during bowel movement.
- The prolapsed tissue is pulled back to its ideal position before the haemorrhoid is removed. Afterwards, the cut edges are stapled together. This technique is less painful than the previous methods.
- The haemorrhoids are cut away using an instrument that removes the tissue and stops the bleeding at the same time. This has the least painful recovery but patients that undergo the procedure often complain about a foul-smelling discharge during the first 2 weeks after the surgery.
Transanal Haemorrhoidal Dearterialization
- In this method, an ultrasound probe is used to identify the blood vessels that can be removed. This is the least uncomfortable technique in treating piles but is not suitable for prolapsed haemorrhoids.
Post-operative recovery may differ from every person since this will depend on the type of procedure done. It is normal to experience the loss of control to the passing of gas. Aside from this, bleeding can also be expected especially during the first 5 to 10 days after the surgery. In terms of food intake, there is usually no dietary restrictions. However, it is still advisable for you to consult your doctor so that you will know what specific steps to follow in order to speed up your recovery process.
Still have further questions? Dr. Dennis Koh, Singapore Colorectal Surgeon, is available to assist you in all your Colon and Rectum related concerns. Feel free to contact us at +65 6262 1226.