Haemorrhoids

Haemorrhoids are small, very vascular (full of blood vessels) lumps on the inside of all of our bottoms. Haemorrhoids can become enlarged and cause symptoms such as:

• bleeding
• a feeling of the lumps coming out of your bottom, especially when you open your bowels (called prolapse)
• itchiness and discomfort

Symptomatic haemorrhoids are often referred to as “piles” and the symptoms will often settle naturally although some patients find benefit from GP prescribed, or over-the-counter creams and ointments.

Sometimes haemorrhoids don't resolve, causing persistent, troublesome bleeding and/or prolapse. In these cases, people would normally be referred to a specialist like me for help.

Do you have haemorrhoids?

If somebody has haemorrhoids, they will usually have signs of bleeding, often visible on toilet paper after wiping their bottom. This can be quite unnerving when first seen and some people do start to worry whether it means they something more serious like bowel cancer. Depending upon your age and symptoms I may recommend a colonoscopy to exclude more serious disease before treating haemorrhoids.

Haemorrhoids don't usually cause pain but can cause itching around the anus. If they prolapse they can remain hanging out of the bottom, whilst this often isn’t too painful, it can be uncomfortable and can make it difficult to wipe yourself clean. Rarely, thankfully, the blood in prolapsed piles may clot which does result in inflammation and significant pain.

The good news is that there are some effective treatments available to treat and get rid of haemorrhoids. As I'll explain below, surgery can be of help and, although it can be a fairly painful operation to have, the overwhelming majority of people who have it tell me that it was worthwhile.

How do you treat haemorrhoids?

Haemorrhoids are often seen as a bit of a joke in popular culture and the operations to treat them extremely painful. This is unhelpful as it can put people off coming to get help and, because it involves their bottom, some people are embarrassed about asking for help.

I always say to people that it is definitely worth getting help for their haemorrhoids when their symptoms go on for a long time or become more uncomfortable. As someone who has spent over 20 years treating people with this problem, I have seen the difference the correct treatment can make to people.

The first options I'll advise will always be conservative (non-surgical), including a high fibre diet or even mild laxatives to help improve bowel habit. Sometimes patients are just seeking reassurance that they don’t have something more serious and that their mild symptoms don’t need to be treated.

Often people will have already tried these or over-the-counter creams before they come to see me, in which case surgery may be beneficial. Current government guidelines say that a GP has to have tried all conservative measures for six months before they can refer somebody. I do think that this is a good thing, as it is a quality-of-life operation rather than a life-saving operation. I am always happy if surgery can be avoided by using these conservative treatments.

If surgery is needed, the simplest option is to place special rubber bands over the haemorrhoid in order to cut off their blood supply. This can be done as an outpatient appointment with little discomfort for most patients, although it's important to point out that this is only effective for about a quarter of people in the long term.

There are also suturing techniques, where the haemorrhoids are literally sewn up inside the bottom and the blood vessel feeding it is obliterated. The two commonest are known as HALO (Haemorrhoid Artery Ligation Operation) and THD (Transanal Haemorrhoidal Dearterialisation) and use a laser probe to identify the feeding blood vessels. These operations are associated with less postoperative discomfort than cutting haemorrhoids away. There will still be some discomfort for a few days to a week, but it is milder.

The final operation I can do is a haemorrhoidectomy, which involves cutting the haemorrhoids out. This is obviously a very good way of removing the problem, but it is a painful operation to recover from. I don't give false expectations to my patients, always telling them that it will probably be quite unpleasant going to the toilet the first few times, even the first week. After one or two weeks the pain will settle.

Relief from your symptoms

Although a haemorrhoidectomy is painful, the vast majority of people are pleased they've had it done because of the lack of symptoms. They may have lived with blood soaking into their clothes, never quite knowing when it's going to happen, feeling uncomfortable and wet down there with haemorrhoid prolapse. Being able to have an operation to stop all those life-limiting problems can be such a relief to people.

I believe in patient-led care. When I first meet somebody for a consultation, I will spend time talking with them, explaining exactly what haemorrhoids are, why their haemorrhoids are causing symptoms and what I could offer them. I always balance the potential benefits with any potential pain and am very happy to use any of the above methods guided by the patient.

If you would appreciate help and advice, it is very easy to book a consultation with me. Please contact my private secretary who will be delighted to schedule things for a time that is most convenient for you.