An ESCP Guide for Patients
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What are haemorrhoids?
Haemorrhoids (also called piles) are small blood vessels located in and around the anus. They act as cushions to help control continence and bowel movements. When these vessels become swollen or inflamed, they can cause discomfort and other symptoms. This condition is called haemorrhoidal disease.
Causes and risk factors of haemorrhoids
While the exact cause isn’t always known, several factors can increase the risk of developing haemorrhoids:
- Constipation and straining during bowel movements
- Chronic diarrhoea
- Sitting on the toilet for long periods
- Pregnancy and childbirth
- Prolonged standing
Symptoms of haemorrhoidal disease
You may experience:
- Bleeding: small streaks of blood on toilet paper or dripping in the toilet bowl
- Moisture or discharge: due to incomplete closure of the anus
- Itching or irritation: often caused by leakage or skin irritation
- Pain or swelling: especially during or after bowel movements
Important: Anal bleeding can also be caused by other conditions like inflammation, polyps, or even cancer. Always see a doctor for a proper diagnosis. You may need further tests.
Treatment options for haemorrhoids
Non-surgical treatment
The foundation of treatment is dietary and lifestyle changes. Most mild cases improve with adjustments to daily life.
- Increase your fibre intake (fruit, vegetables, whole grains, or supplements)
- Drink plenty of water
- Stay physically active
- Avoid prolonged straining during bowel movements
- Adjust your position on the toilet by using a small step or bench
These steps help create soft, regular stools and reduce the pressure on haemorrhoids. By elevating your feet with a step or bench, it relaxes the puborectalis muscle, allowing for a more natural and complete elimination.
You may also benefit from:
- Over-the-counter ointments, suppositories or creams
- Mild laxatives if you're constipated
- Pain relief medications if needed
Minimally invasive procedures
If symptoms persist, your doctor may recommend one of the following treatments:
- Rubber band ligation: a small band is placed around the haemorrhoid to cut off its blood supply. It falls off within a few days. Healing usually takes 1–2 weeks.
- Infrared coagulation (IRC): a heat-based treatment that shrinks haemorrhoids by clotting their blood vessels.
- Sclerotherapy: a special chemical is injected into the haemorrhoid to shrink it. Common agents include zinc chloride, quinine, or polidocanol.
Surgical procedures
For larger or more severe haemorrhoids, surgery may be necessary:
- Laser haemorrhoidoplasty: uses a laser to shrink and seal haemorrhoids. Best suited for smaller, bleeding haemorrhoids (Grade 2). Recovery time is around 1–2 weeks.
- Haemorrhoidopexy (Longo procedure/PPH): a stapling technique that removes a ring of tissue and repositions the haemorrhoids. Usually less painful than traditional surgery.
- Milligan-Morgan haemorrhoidectomy: the complete removal of haemorrhoidal tissue. It’s the most definitive treatment but involves a longer and initially painful recovery period (2–3 weeks).
Recovery and risks
| Procedure | Recovery time | Possible Risks |
|---|---|---|
| Laser Haemorrhoidoplasty | 1–2 weeks | Mild bleeding, discomfort |
| Longo procedure | 1–2 weeks | Bruising, urinary retention, rare infections, pain |
| Milligan-Morgan surgery | 2–3 weeks | Pain, post-op bleeding, rare infections, (mild) incontinence |
Lifestyle tips for prevention
When to see a doctor
See your doctor or colorectal surgeon if you experience:
- Anal bleeding
- Anal itching
- Pain
If you have any questions, speak with your doctor or colorectal surgeon for personalized advice.
Disclaimer
The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.
The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.