DEFINITION : Haemorrhoids (piles) are dilated, enlarged and twisted veins i.e. they are varicose veins. They are located under the lining of the lower part of the rectal and anal canals.
Piles are a common condition which affects up to half of the population at some point in the life course. Many ordinary and normal people have piles which causes no symptoms or discomfort. Also, they are discovered by the physician or surgeon during scope examination of the anus and rectal canals for something else. This type of Haemorrhoids does not require treatment except for adjustment of diet.
SURGICAL ANATOMY : Haemorrhoid swellings around the controversial discussion topics anus are called External Haemorrhoids and they are covered with anoderm (the delicate skin of the anal canal and anal verge).
Haemorrhoid swellings within the rectum are called Internal Haemorrhoids and they are covered with the delicate mucous membrane of the rectum (a mucous membrane is a membrane that lines cavities or passages and secretes mucus which is a protective slimy secretion).
Haemorrhoids may protrude through the anal verge after a bowel movement and may retract or may be pushed back with a finger. This type is called Prolapsing Haemorrhoids which is covered with a mucous membrane.
Haemorrhoids may protrude through the anal verge and recur after reduction, is also a type of Prolapsing Haemorrhoid but the inside of the mass is covered with a mucous membrane and the outside is covered with skin. This type is called Muco-Cutaneous Prolapsing Haemorrhoids.
SYMPTOMS AND SIGNS : The CARDINAL and the earliest symptom of Haemorrhoid presentation is Painless fresh blood bleeding, typically after a bowel movement and is seen either on the paper upon wiping or as a fresh splash in the toilet bowl. Occasionally, bleeding can cause anaemia. If there is pain with the bleeding, it must raise the possibility of another diagnosis e.g. Chronic Anal Fissure. Haemorhoids NEVER cause pain.
The symptom of bleeding of a pile is usually intermittent, and the condition is not in itself serious. Contributing factors in the development of haemorrhoids are constipation which is due to a low fibre diet, excess weight and during pregnancy when the growing fetus exerts pressure on blood vessels and thus increases the risk of developing haemorrhoids.
Strangulated Haemorrhoids NEVER cause intense and excruciating pain. Yes, they cause discomfort and/or moderate pain.
In my surgical experience, I have seen several young adult males, some are referred to me by Dermatologists and Vinereologists, complaining of piles and the clinical presentation in those patients are painful defaecation with altered blood and muco-purulent discharge of a few days duration. Scope examination reveals Gonoccocal infection.
Peri-Anal skin tags (tags at the anal verge) are common in females especially after delivery and occasionally in males. These tags are not Haemorrhoids. They do not require surgical excision unless they are large or they are a nuisance to the patient.
TREATMENT : There is no singular treatment for all types of haemorrhoids. By and large, it depends on the amount of bleeding, a person’s age, gender, profession and the type i.e. internal, external, strangulated, prolapsed, inflamed or not inflamed, infected or not infected, excoriation or ulceration, acute good topics for cause and effect essays or chronic, pregnant, prostatic obstruction e.g. frequency of urination, hesitancy, urgency, dribbling, tenesmus, etc. Also, it depends on the experience of the surgeon.
In my practice, the vast majority of haemorrhoids are treated conservatively i.e. non-surgically and the outcome is very satisfactory and long lasting. Only the minority are treated by surgical operation.
SYMPTOMS : Peri-Anal Haematoma develops rapidly or suddenly as a result of rupture of one of the small delicate veins under the very thin skin of the anal verge (anoderm). These causes a swelling (clot), sometimes quite large, at the anal verge which could be very tender and painful. The vast majority of patients are healthy young adult males.
1) Expectant Treatment If the haemotoma is small with little pain, the condition will proceed to spontaneous cure after about seven to ten days.
2) Surgical Treatment Sometimes the haematoma is large or enlarging and causing tenderness and especially if the pain is exceptionally severe, surgical operation and evacuation of the haematoma can be advised. I perform the surgical operation satisfactorily under local anaesthesia in the operation theatre of my private surgical clinic in Dubai with almost nil discomfort as a day care surgery. There are no contraindications for the surgery and the patient can resume their ordinary daily activities, but strenuous activity is avoided for one or two days.