Haemorrhoids (Piles)

• Bright red bleeding, usually noticed on the toilet paper, in the toilet bowl or coating the stool
• A lump or swelling around the anus that may be felt or seen
• Itching, irritation or soreness around the back passage
• A feeling of fullness or that the bowel has not completely emptied
• Mucus discharge or soiling of underwear
• Discomfort or pain, particularly if a haemorrhoid becomes swollen or clotted (thrombosed)
• A swelling that comes down on opening the bowels and may need to be pushed back

Haemorrhoids develop when the cushions of blood vessels that line the anal canal become enlarged and engorged. The most common trigger is raised pressure in the area, typically from straining to pass hard stools, long-standing constipation or, less often, persistent diarrhoea. Sitting on the toilet for long periods and a low-fibre diet both contribute.

Pregnancy is a frequent cause because of the pressure of the growing baby and hormonal changes that relax the blood vessels, and symptoms often improve after delivery. Other risk factors include increasing age, being overweight, heavy lifting and a family tendency. Bleeding from the back passage should never be assumed to be due to piles alone, as other conditions can produce similar symptoms, which is why proper assessment is important.

Mr Hussain diagnoses haemorrhoids through a careful history and a gentle examination of the back passage. This usually includes inspection of the outside of the anus and a digital rectal examination, often followed by proctoscopy, in which a short, smooth instrument is used to view the anal canal directly and confirm the presence and grade of internal haemorrhoids. These examinations are quick and carried out as comfortably as possible.

Because rectal bleeding can occasionally be a sign of more serious bowel conditions, Mr Hussain may recommend further investigation such as a flexible sigmoidoscopy or colonoscopy, particularly in older patients, those with a change in bowel habit, anaemia or a family history of bowel cancer. This ensures that nothing important is missed before treatment for haemorrhoids is started.

At your consultation Mr Hussain takes a careful history and gently examines the back passage, usually including a proctoscopy in the clinic so he can see and grade the haemorrhoids directly. The examination is quick and carried out as comfortably and discreetly as possible. He then explains your grade and walks you through every option, from creams and banding to HALO/THD and surgery.

Many haemorrhoids are dealt with there and then — rubber-band ligation, for example, is a brief outpatient treatment that needs no anaesthetic and lets you return straight to your day. If you need a procedure under anaesthetic such as HALO, THD or haemorrhoidectomy, it is usually a day case: you are admitted a couple of hours beforehand, the procedure takes around twenty to thirty minutes, and you go home the same day once you are comfortable.

Recovery depends on the treatment. After outpatient procedures such as banding, most people feel a dull ache or fullness for a day or two and can return to normal activities almost immediately. Some light bleeding when the haemorrhoid separates after a few days is normal and not a cause for concern.

After surgical treatments such as HALO, THD, stapled or conventional haemorrhoidectomy, there is usually more discomfort, particularly on opening the bowels in the first week or two, and Mr Hussain will provide painkillers, laxatives to keep the stool soft and advice on warm baths and hygiene. Most people are back to work within one to two weeks, sooner for the less invasive procedures. Maintaining a high-fibre diet and good fluid intake afterwards helps healing and reduces the chance of recurrence.