Haemorrhoids

Question 1

What are Haemorrhoids?

Answer 1

• Also known as piles
• Swollen blood vessels in lower rectum and anus = a lot of pain, itching, discomfort

Question 2

Aetiology

Answer 2

• Raised pressure in veins around anus and rectum.
  o Due to long time standing/sitting, obesity, chronic constipations/straining during poo
  o Blood vessels swell in rectal area = haemorrhoids
• Connective tissues and muscles weaken which usually support veins in rectal area (ageing/pregnancy, childbirth could be due to weakening)
• Diet = low fibre diet (strain in rectal area during bowel movements)
• Straining = puts pressure on blood vessels
• Sedentary lifestyle, lack of exercise, sitting/standing long period of time.
• Genetic factors, family history

Question 3

Pathophysiology

Answer 3

• Increased pressure (same reason as in aetiology)
• Weakening of connective tissue = blood vessels prone to distention and swelling
• Impaired blood circulation = high pressure and weak connective tissue cause this:
  o Blood likely to pool in vessels = congestion and formation of haemorrhoids
  o Comprised oxygen delivery and nutrients to tissues = more swelling
• Inflammation and engorgement
  o Common reason
  o Body immune system trigger inflammatory response = blood vessels swollen, red, painful
  o Intensified further by irritation of rectal and anal tissues = friction, extra wiping, harsh chemical exposure
• Thrombosis:
  o Sometimes piles lead to blood clots in swollen veins (thrombosed haemorrhoids)
  o Further disrupt blood flow, further inflammation, symptoms more severe

Question 4

Risk factors

Answer 4

-Sedentary lifestyle:
o Main reason developing piles
o Long hours sitting/standing with no movement = extra pressure on veins in rectal area= swelling and inflammation
-Chronic constipation:
o Continuous episodes of constipation
o Strain during poo = pressure on rectal veins = inflammation and haemorrhoids development
o Lack of fibre, low fluid consumption, lack of physical activity
- Pregnancy:
o Growing uterus = extra pressure on veins in pelvic area = prevent smooth blood flow = swollen haemorrhoidal veins
o Hormonal changes = weaken veins, usually gets sorted after childbirth
- Obesity:
o Excess body weight = pressure on pelvic veins = stretch and enlarge
- Age:
o Get older = tissue supporting veins in rectal area= weaker, likely to be damaged

Question 5

Signs/symptoms

Answer 5

• Rectal bleeding: bright red blood on toilet paper/bowl, stool = swollen blood vessels irritated during bowel movements
• Pain/discomfort, swelling and lumps.
• Mucus discharge: from anus on toilet paper or underwear—itching and irritation.
• Incomplete bowel movements = swollen blood vessels obstruct passage of stools
• Difficulty sitting
• Protrusion of haemorrhoids: severe cases, can protrude outside of anus, proper medical treatment required

Question 6

Diagnosis

Answer 6

• Physical examination: detailed history, physical GI examination, digital rectal examination (assess rectal tone/any linked abnormalities)
• Sigmoidoscopy, colonoscopy: look at rectum and lower GI tract

Question 7

Management

Answer 7

• Lifestyle changes: increase fibre intake, regular exercise, good bowel habits
• Topical treatments
• Surgical procedure: rubber band ligation, sclerotherapy, haemorrhoidectomy (those who keep experience discomfort/complications)