Haemorrhoids

What are haemorrhoids?

Haemorrhoids are gastrointestinal tract problems that produce symptoms of itchiness, pain, swelling and soreness. They are due normally due to low fluid intake and inadequate dietary fibre.

Haemorrhoids are common to everyone and can be treated through healthy lifestyle and some medication which can be bought at over-the-counter.

The symptoms occur when the anal canal (last part of the rectum before stools are passed out) clumped with masses which can be masses of blood or stools.

Haemorrhoids can be differentiated into two types, internal and external haemorrhoids. Internal haemorrhoid occur at the upper part of the anal canal while external haemorrhoid at lower part of the anal canal.

During haemorrhoids, sufferers may find blood flashed over the toilet pan. The blood could appear as bright red and is due to mixing of the blood with the stools. If the blood appears as dark red, it is comes from the upper part of the GI tract.

It is believed that during bowel movement, the shearing force of the stools downward causes the enlargement of the anal canal and damage the muscle.

Haemorrhoid can be confirmed by the patients themselves by detection of any blood present that may flash over the toilet pan after defecation. It can also be diagnosed when there is a blood at the toilet paper after wiping.

Symptoms
(1) Itchy and irritated at the perianal area.
(2) Swelling of the anus or sometimes associated with pain.
(3) Bleeding on bowel movement.


Who tends to get haemorrhoids?
Haemorrhoids are equally common in men and women but more prevalence in older people around aged 45 to 65 years old.
Pregnant women are also believed to have a higher incidence of haemorrhoids than non-pregnant women. This is because the progesterone levels are increased during pregnancy and subsequently relaxes the gut muscles, hence causing constipation. Constipation can exacerbate the symptoms of haemorrhoids.

When to refer to doctor for further investigation?
(1) A severe, sharp pain on defecation. This is because it may indicate anal fissure which could be due to constipation.
(2) Persistent irritation or pain which does not improved with medication. Approximately 1 week.
(3) Bleeding occurs.
(4) Symptoms present for more than 3 weeks.
(5) Others symptoms such as abdominal pain and vomiting occur.
(6) The desire to defecate when there is no stools present in the rectum. This may suggests tumour present in the rectum.

Treatments
If the patient is constipated, the use of bulk laxatives may be of beneficial.
Local anaesthetics such as lidocaine and benzocaine can be used to treat haemorrhoids. They can help by reducing itchiness and pain felt from the symptoms of haemorrhoids. However, their uses should be limited to 2 weeks from which referral are sought after that.
Topical steroid, e.g. hydrocortisone can be purchased OTC in ointment and suppositories forms to reduce the inflammation and swelling due to haemorrhoids. It is best used in the morning, night and after a bowel movement. Hydrocortisone is licensed to those over 18 years and should not be used for longer than 7 days.
Menthol and phenol have cooling effects that can be used to give a sensation of cooling and tingling.
Skin protectors such as zinc oxide and kaolin have emollient and protective properties that can help to protect the skin from losing moisture.

Practical points
(1) Wash perianal area with warm water after each bowel movement.
(2) Use moist of soft toilet paper with better quality to prevent damaging the skin around the anus which will cause soreness.
(3) Patting rather than rubbing the anus with toilet paper.
(4) Insertion of suppositories form of treatment is easier with the patient crouching or lying down.