Wirral Surgeon - Haemorrhoids are venous cushions (blood vessels) of the ano-rectum and are universally present unless a previous intervention has taken place. Although haemorrhoids are a common condition, many patients are too embarrassed to ever seek treatment.

Condition treated

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Graphic representation of the anal passage, highlighting two Haemorrhoid

About Haemorrhoids

Haemorrhoids are venous cushions (blood vessels) of the ano-rectum and are universally present unless a previous intervention has taken place. Although haemorrhoids are a common condition, many patients are too embarrassed to ever seek treatment. Worldwide, the prevalence of symptomatic haemorrhoids is estimated at 4.4% in the general population. The prevalence of haemorrhoids increases with age, with a peak in persons aged 45-65 years.

Clinical presentation

The most common symptoms of haemorrhoids are rectal bleeding, pain, itching (pruritus), or prolapse. Rectal bleeding is the most common problem. The blood is usually bright red and may drip, squirt into the toilet bowl, or appear as streaks on the toilet paper. Pain truly caused by haemorrhoids usually arises only with acute thrombus (clot) formation. This pain peaks at 48-72 hours and begins to decline by the fourth day.

The presence/absence of prolapse allows grading of haemorrhoids:

Grade I haemorrhoids project into the anal canal and often bleed but do not prolapse

Grade II haemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases

Grade III haemorrhoids protrude spontaneously or with straining and require manual reduction

Grade IV haemorrhoids chronically prolapse and cannot be reduced

Differential diagnosis

Other conditions that should be considered when evaluating a patient with suspected haemorrhoids include:

anal cancer

anal fissures

anal fistulae

pedunculated polyps

rectal prolapse

perianal abscess

colorectal tumors

Management

Haemorrhoids should only be treated when causing significant symptoms; no matter how bad the haemorrhoids look to the practitioner, they should not be treated unless they bother the patient. The following is a quick summary of treatment for internal haemorrhoids by grade:

Grade I haemorrhoids are treated with dietary measures, laxatives, creams, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) and spicy or fatty foods

Grade II or III haemorrhoids are initially treated with non-surgical procedures

Very symptomatic grade III and grade IV haemorrhoids are best treated with surgical hemorrhoidectomy

Treatment of grade IV internal haemorrhoids or any incarcerated or gangrenous tissue requires prompt surgical intervention

Thrombosed external haemorrhoids are treated surgically by removal of the clot if the patient presents early (typically within 72 hours from the onset of pain); conservative measures are recommended for late presentations.