Haemorrhoids

Haemorrhoids

I have difficulty when passing motion and often need to strain.

I have also noticed blood in my stool...

What are haemorrhoids?

Haemorrhoids, also called piles, are vascular structures in the anal canal. In their normal state, they are cushions that protect the anal skin from the passage of stool. Problems arise when these cushions swell, bleed or prolapse to outside of the anus.

What are factors contributing to haemorrhoids?

• Genetic predisposition to weak blood vessel wall around the rectum • Increased pressure caused by pregnancy, obesity or heavy lifting • Chronic straining during bowel movement How do I know if I have haemorrhoids?

• Fresh bleeding with bowel movement • Itchiness • Soft lump that protrudes out of anus (prolapsed piles) during bowel movement • Pain if blood clot accumulates These symptoms may be similar to more serious conditions like cancer of the large intestine. Therefore, your surgeon may suggest other investigations such as colonoscopy to exclude other more serious conditions before treating the haemorrhoids.

What are the treatment options available?

Non-operative treatment As anal cushions have an important function in maintaining faecal continence, non-operative methods should first be used if haemorrhoids are minimally symptomatic.

Correct toilet habits: Sitting toilets are preferred over squatting ones.

Minimise prolonged sitting on toilet bowl during bowel movement (e.g, do not bring reading materials while waiting for bowel movement in toilet).

Nutrition: High fibre diet may aggravate constipation by producing big and hard stools. Some people with constipation may require reduced dietary fibre to facilitate bowel movement. Adequate fluid intake is essential.

Medication: Your doctor may prescribe medications to reduce bleeding and inflammation of haemorrhoids, as well as to soften hard stools.

Rubber-band ligation: Rubber bands are applied above small haemorrhoids to induce shrinkage.

This method is 60-80% effective.

Operative treatment Surgery may be offered for large and prolapsed haemorrhoids where non-operative treatment is less likely to be effective.

Depending on presentation of the haemorrhoids, surgical options include: • Stapled Haemorrhoidectomy • Open Excision Haemorrhoidectomy • Ligasure Haemorrhoidectomy • Trans-doppler Haemorrhoidal Artery Ligation Your surgeon will discuss treatment plans in detail after assessing the haemorrhoids.

What complications can occur?

Pain – especially during bowel movement. Painkillers should be taken as advised by the doctor during the initial period after surgery.

Difficult urination – usually temporary and resolves the next morning. In some cases, a temporary tube may need to be inserted for release of urine.

Bleeding from operation site – Some slight yellowish-blood stained discharge is expected during the first two to three weeks after surgery.

Prolonged straining during bowel movement after surgery may result in more serious bleeding and should be avoided.

Stricturing – The anus may become tighter than before surgery. This can be avoided if you return for followup after surgery. The doctor can assess and treat before it becomes problematic.

The recurrence rate for haemorrhoids is about 10%.

When to seek medical attention after discharge?

• Excessive bleeding • If any of the above complications do no resolve

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

GS.PE.03.0722