Haemorrhoids

Question 1

What are haemorrhoids

Answer 1

Haemorrhoidal tissue is part of the normal anatomy which contributes to anal continence. These mucosal vascular cushions are found in the left lateral, right posterior and right anterior portions of the anal canal (3 o’clock, 7’o’clock and 11 o’clock respectively). Haemorrhoids are said to exist when they become enlarged, congested and symptomatic

Question 2

Clinical features

Answer 2

• painless rectal bleeding is the most common symptom
• pruritus
• pain: usually not significant unless piles are thrombosed
• soiling may occur with third or forth degree piles

Question 3

Types of haemorrhoids

Answer 3

External

• originate below the dentate line
• prone to thrombosis, may be painful

Internal

• originate above the dentate line
• do not generally cause pain

Question 4

Grading of internal haemorrhoids

Answer 4

Grade I : do not prolapse out of the anal canal
Grade II : Prolapse on defecation but reduce spontaneously
Grade III : can be manually reduced
Grave IV: cannot be reduced

Question 5

Management?

Answer 5

• soften stools: increase dietary fibre and fluid intake
• topical local anaesthetics and steroids may be used to help symptoms
• outpatient treatments: rubber band ligation is superior to injection sclerotherapy
• surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
• newer treatments: Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy