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Medical Condition:
Haemorrhoids
Useful Links:
Also Known As:

 

Description:

This condition is also known in the UK as Piles, In America it is spelt hemorrhoids common misspellings include heamorrhoids, hemroids, hamorhoids, hemmerhoids hamerroids, hemmoroids

This is one of those conditions which people often feel embarrassed about and don’t really want to discuss. However, searching the internet for information to better understand your condition can offer you the opportunity to make an informed decision to visit your doctor.  Visiting your doctor is the only way you can positively have this condition diagnosed and I would hasten to add that it affects probably 50% of the population of over 50 year olds, it does affect many people who are younger too. Whilst the condition can seem as if it is on-going, for many it is a short lived episode, but for others it can be very debilitating

My aim is to alleviate some of your anxiety, supply information about haemorrhoids but most of all encourage you to visit your doctor.

The aspects I will cover will include:-

Other less common haemorrhoid treatments include

What are Piles- Haemorrhoids?

Inside the anus there is a spongy layer of tissue called mucosal cushions which are soft and very vascular (they have a good blood supply) when areas of these cushions become enlarged and bulge they are called Haemorrhoids.

The main reason the cushions have become enlarged is usually due to trying to pass stools (faeces/poo) which is quite solid. To enable faeces to pass through the bowel and be excreted easily the faeces need to be soft but with form. If you have solid hard faeces it will cause you to strain when opening your bowels. This recurrent straining can cause these sensitive vessels to become engorged, and each time this occurs the walls of the blood vessels become stretched; this leads to them losing their elasticity causing them to become baggy and bulge. If this is occurring on a regular or daily basis the natural ability of the vessels to reshape is reduced in addition the tissue of the walls themselves become more fragile. When the hard stool passes the thinned vessels these can then tear and fresh bright red blood will be on the excreted stool as well as the toilet paper when you wipe your bottom.

Inside the anal canal there is a line which is referred to as the dentate line. This is relevant as below this line nerves and pain receptors exist whereas above the line further up into the bowel there are no pain receptors.  You may have been suffering from internal haemorrhoids for some time although unaware of them. You first indications of having a problem will be that you begin to notice blood on your toilet paper or possibly they begin to protrude out of your anal sphincter.

The blood on the stool and the toilet paper will noticed as bright red the same colour as if you have just cut yourself. If your stools are a dark red or there is black sticky blood present I would suggest you visit your doctor with urgency for further investigations.

Piles - Haemorrhoids symptoms:

The list shows symptoms which you may suffer from - you may not suffer from all of them or all at the same time but will probably suffer from some.
           
Anal itching and discomfort
Anal discharge of liquid/mucous/slime
An anal lump which may be engorged and tender
Fresh blood after evacuating your bowels
Feeling as if your bowels are not empty after passing a stool
Pain when passing your stool (faeces/poo)
Straining to pass a stool
Leaving stool marks in your underwear

Types of Haemorrhoids - Piles:

Doctors have agreed on a grading system which has been used universally since the “80’s’” it is used to define the size of the haemorrhoid.

The haemorrhoids can vary both in size and position you can have internal (inside the rectum) these can develop between 1-2 inches (2-4cm) up inside, or external (outside the anus) these are less common and occur on the rim of the anus or just outside and can become very raw and sore.

Internal Haemorrhoids-Piles:

These use the grading system from 1- 4 or First to Fourth degree

    • Grade 1/ First Degree –These are relatively small remaining inside the anal canal and are bulges in the mucosal layer of the rectum. They can be felt on digital rectal examination by a doctor.
    • Grade 2 / Second Degree – These are larger and will remain inside your rectum, occasionally protruding when a stool is passed but returning inside once you have finished evacuating your bowels.
    • Grade 3 / Third Degree - These begin inside the rectum but actually hang out and you may be able to feel these. They can be gently pushed back inside the anal canal with your fingers.
       
    • Grade 4/ Fourth Degree - These become large protrude outside the anal sphincter. They are not able to be pushed back inside. You will need to see your doctor about these as you will require treatment.

    External Haemorrhoids - Piles:

    These haemorrhoids are not so common and are usually found on the outer rim of the anal sphincter which is the tight band of tissue around your anus.  These external Piles can become irritated and occasionally they can become thrombosed (a clot of blood has formed inside them). These can be very painful and require urgent treatment. If you are extremely unfortunate you may suffer from both external and internal haemorrhoids.

    Haemorrhoid cream Treatments - Also Known as Piles cream:

    If you need to speak to the pharmacist they will usually be able to help you decide which preparation will help you with your specific problem. (OTC) Over the counter preparations can be purchased from your local chemist or from supermarkets and online. Creams and lotions should be applied in moderation as excessive amounts can lead to more irritation of the surrounding tissue. Most of these topical creams will contain some of the following attributes.

    Local anaesthetic – These induce a short term numbing effect and are a good form of topical pain relief. Be aware that It has been known to cause allergic reactions and should not be used for longer than a week at time as it can make the condition worse

    Hydrocortisone 1% -This is an anti-inflammatory product used for reducing the local irritation of swelling, burning, and itching sensations which you experience more with external haemorrhoids

    Vasoconstrictors – Ephedrine is one of the most common vessel constrictors – this act by shrinking the blood vessels thereby reducing pain and bleeding.

    Astringents – these can dry the skin surface and should be used sparingly witch hazel is one of these and it is known to reduce itching and swelling

    Corticosteroids – These should be used with great caution. They reduce the inflamed area around the anus and relieve itching however they should not be used for more than two weeks continuously as they may cause permanent skin damage.

    Barriers / skin protectors –barrier creams act as a barrier to the leakage of faecal mucous and fluid from the anal canal. This fluid if left on the skin can lead to irritation and soreness around the anus, the barrier cream protects the skin.

    There are precautions which you will need to be aware of prior to using any of these products so always read the information supplied with the medication.
     
    Make sure you are not allergic to any of the ingredients.
    Burning stinging and itching are some of the side-effects but these symptoms     should pass.
    These products should not be used for more than 7 days at a time due to further irritation from over use.
    If you continue to suffer from piles after initial treatment you will need to consult your doctor.
    Always ensure you wash your hands after using any of these preparations

    Causes of Piles - Haemorrhoids:

    • People who when they go to the toilet have to strain to push the stool (faeces / poo) out are more likely to suffer.
    • People who suffer from chronic (constant) bowel conditions which cause either diarrhoea or constipation. Diet tablets which cause you to have loose watery stools can exacerbate haemorrhoids.
    • It appears to be one of those conditions which can affect people over 50 years old although it is not unknown in younger people.
    • Piles can be a rather unpleasant side effect of pregnancy due to the pressure which is exerted on the perineum by the additional weight. Fortunately once the pressure is relieved often so is the condition, unfortunately this may be a predisposing factor for reoccurrence later in life.
    • People who are obese can also suffer from haemorrhoids due to the same extra pressure being exerted; to reduce this risk factor it would be worth considering losing weight. 
    • People who have anal sexual intercourse are at a higher risk of developing haemorrhoids due to the friction on the mucosal layers of the bowel causing the vessels to thin and engorge.

    The Internal Rectal Examination or Digital Rectal Examination:

    When you visit your doctor to discuss the problems you are experiencing they will explain that after taking your relevant medical history your will need to have a rectal examination. The doctor will fully explain the procedure to you prior to beginning and ask for your consent to perform it. 

    1. You will be asked to remove your underwear in privacy and lie on your side on the doctor’s couch.
    2. The doctor will ask you to lie on your side with your knees drawn up to your chest with your bottom towards the doctor.
    3. The doctor will gentle part your buttocks and look at your external anus to see if you have external haemorrhoids or a  rash or skin tags.
    4. You may be asked to push gently as if you were going to have a bowel motion.
    5. The doctor will then lubricate the gloved finger which will be gently inserted into your anus. The doctor will be able to feel around inside the rectum to feel how your anal sphincter functions (which is the tight band around your anus which relaxes when you excrete your stool).
    6. The doctor will feel to check if you have internal haemorrhoids.
    7. Occasionally your Doctor may wish to examine your rectum with a proctoscope this is a usually a disposable plastic conical shaped instrument with a rounded end which can be removed so that the doctor can see into the rectum they may have a separate light which they will place in position to help with the visibility.
    8. Once the procedure is complete they will either wipe off the excess lubricant or offer you tissues to do this yourself in privacy with the curtains around you.
    9. You will then be able to get dressed the doctor will then discuss their findings with you. This is not usually done during the procedure as you will have you mind on other thoughts.

     

    If the doctor is completely satisfied that you have haemorrhoids they will offer you advice on how to treat them. If they feel that a surgeon should take a look and /or an endoscopy is appropriate for further investigations this will be arranged and you will be sent an appointment.
     
    Piles - Haemorrhoids Home Treatment

    The bad news is there is no definitive “cure” for haemorrhoids as such despite many internet claims. Symptoms of haemorrhoids can be relieved and the piles treated but that is no guarantee that the condition will not return.

    There are a great many home treatments for piles which you can find on the internet some proven others not. Those claiming a cure are in fact offering a relief or treatment. Before making any purchases from the internet I would urge you to visit your doctor to exclude any other type of bowel condition.

    Often people who have had one incident of haemorrhoids don’t always go on to develop long term problems.  There are positive steps you can take at home to help yourself.

    Non-invasive or Conservative Haemorrhoid treatments include

      • Change of diet
      • Plenty of fluids
      • Creams with either local anaesthetics/ corticosteroids or both
      • Laxatives

    Pain relief for Haemorrhoids

    Piles pain is very sharp and it builds up often in the mind as you are aware that every time you have your bowels open you will experience pain. This may lead to bad eating habits or changes in behaviour such as taking lots of laxatives to make sure that your stools are loose. This is counterproductive as often stimulating laxatives can make the stools loose but the associated irritation to the tissues in the bowels cause as much damage.

    • If you are in discomfort with your haemorrhoids you can take regular pain relief tablets which you can obtain from your local chemist or supermarket. Usually the pain is short lived usually it is experienced just when you are passing stools (faeces /poo), creams with local anaesthetic can help relieve this. You should follow the instructions on the packaging when using creams but instructions usually indicate they should be used after each bowel movement or morning and night.
    • If you have a thrombosed pile you will be in considerable discomfort and will need to seek medical attention urgently.
    • If you have other medical conditions which are causing you pain please be aware that some pain relief medications can contain codeine i.e. co-codamol. This is known to cause constipation and if taken regularly will exacerbate your symptoms. Consult your doctor to look for alternative pain relief.

    Haemorrhoids and diet

    • Eating a well-balanced diet of foods which are rich in fibre such as vegetables, fruit and wholemeal products like bread and pasta, bran, brown rice. In consultation with your doctor you may be advised to take a bulk-forming laxative NOT a bowel stimulating  one like senna but one with ispaghula husk or similar to help with your bowel movements and the affect it has on your haemorrhoids.

    Exercise

    • Always consult your doctor prior to embarking on a regular activity which you have not undertaken before, begin gently and work up to a regular routine.

    20-30 minutes exercise everyday will keep you fit and strong which helps to maintain a healthy digestive system.

    Weight loss

    • It is logical if you think about it, if you are overweight the pressure you will be unnecessarily exerting on the blood supply around you anus will be increased, therefore by lowering you weight that pressure will decrease.
    • Eat what you like but in smaller portions and less often, and drink plenty of water.
    • As you age your pelvic floor muscles can relax, especially more so if you are also overweight therefore practising pelvic floor exercises daily will reduce the strain and pressure.

    Fluids

    • If you change one aspect of your diet to help your whole digestive system it would be to drink more water. Whatever you drink is good if you drink milk or juice or squash just by increasing those fluids will help with your digestive system. Your body needs approximately two litres of fluid a day. If it doesn’t receive enough fluids orally it removes it from the food travelling through your intestines (gut) thus making your stools (faeces /poo) hard and lumpy.  If you drink more your stools will be soft and more easily expelled more like toothpaste consistency.
    • One cautionary word about alcohol and caffeine. These  drinks are counterproductive they act as a diuretic making you urinate(wee) more often this causes your intestines to loose fluid and again the stools become hard and difficult to pass. If you drink lots of tea or coffee during the day try switching to decaffeinated. Interestingly the next time you have a few alcoholic drinks try to think what you’ve drunk and how often you urinated you will find that you have lost more fluids than you digested, and for the good time you had you will have a hangover and lumpy faeces.

    Personal Hygiene

    • It is important to keep your bottom clean; this will help prevent rashes and irritation. You can carry small packets of baby wipes or moisten toilet paper to use after you have had a bowel motion. This will ensure no stool motion remains on the skin surface to cause irritation if you have external piles.
    • Do not use perfumed soaps to wash with as these are known to irritate the skin.
    • Talcum powder is thought to dry the area or to prevent moisture build up but it does not work and can make any irritation or itching worse.
    • Pat your bottom dry with clean toilet paper.  If you have a constant problem with leakage you will need to visit your doctor for advice but in the meantime you can use a small amount of nappy cream which will protect your skin and sanitary pads can be used effectively to absorb leaking faecal fluid. If you are suffering from fluid leakage it is really important you visit your doctor.

    Toilet Practices

    • Sitting on the toilet and reading while waiting for your bowels to open is both unhygienic and ill advised. This is a habit which should be avoided at all costs as it increases the pressure exerted on the blood vessels supplying the anus causing them to engorge, as well as possibly contaminating the reading material with faeces.
    • You should aim at spending only a couple of minutes evacuating your bowels  and always respond to your body when you feel you need to go, delaying opening your bowels causes the faeces to lose moisture making it more difficult to pass.
    • If you are unable to open your bowels as soon as you sit on the toilet get up and walk around until the urge to go again occurs then try again.
    • Sitting straining on the toilet is counterproductive.

    Constipation

    If you are having problems with constipation you can improve your digestive system by combining the main elements of health.

      • Eat fibre enriched food drink plenty of fluids and become more active. If you are still having problems after you have improved your life style it may be time to speak to your doctor regarding laxatives.
      • It is very important that you have the correct types of laxative as products like senna cause spasmodic contractions in the bowel which may exacerbate the bowel condition.
      • Stools softeners and bulk forming laxatives or lactulose will be a better option as they improve the stool consistency making the passage through the bowel easier.

    Ice and Cold Compresses

    • If you feel you need some cooling soothing relief from you haemorrhoids you can use a cold compress. I am very concerned about the amount of advice that I have read especially on the web that says to use ice packs for this as there doesn’t seem to be any warning or acknowledgement that using ice straight onto the skin surface can itself cause damage.
    • Cold water compresses are just as effective as ice however; if you do use ice it should be wrapped up in a flannel and used for only short periods at a time.  Unfortunately this method whilst giving temporary relief can have a negative effect; once an area of skin is chilled unnaturally the effect is only briefly enjoyed. The body’s defensive mechanism is to dilate the capillaries and warm the skin to return it to skin temperature.

    Questions for your Doctor regarding your Treatment for Piles:

    If you have tried all the conservative treatments available you may be considering the surgical removal of your haemorrhoids these are a variety of questions you might like to ask the doctor/surgeon:

      • Which is the NICE recommended best treatment to have?
      • What are the options?
      • What are the benefits and drawbacks of each of them?
      • Which have the longest term results?
      • If I have to have an operation how long will it take?
      • How long is the waiting list for the operation?
      • What type of anaesthetic is available?
      • Who is doing the operation?
      • How experienced is the surgeon with performing this procedure?
      • What are the post-operative complications of the procedure?
      • How long will it take to recover?
      • How painful will the procedure be?
      • Which pain relief medicine will be used and how effective is it?
      • How long is average for resuming of activities of normal daily living?

      Bleeding Haemorrhoids - Plies treatment:

      It is important to state that if you have blood coming from your rectum it is not necessarily haemorrhoids. Bleeding of unknown origin needs to be investigated by your doctor. If you treat your bleeding haemorrhoids prior to a confirmed diagnosis from your doctor you could be missing a more serious condition.
      The anal veins supply the cushions of the anal canal and it is these cushions which have swollen and become haemorrhoids. Bleeding usually occurs when hard stools (faeces/poo) and straining have caused the thinned walls of the haemorrhoid to bleed. The bleeding can vary from just noticing red blood on the toilet paper after wiping your bottom, to blood dripping into the toilet from perhaps a prolapsed haemorrhoid. It is very alarming the first time this happens and can be the incentive you need to get you along to see the doctor.
      If you have small amounts of blood on the toilet paper after you wipe you bottom this will stop fairly rapidly it may well be internal haemorrhoids which will stop bleeding quite quickly.
      If you are bleeding from haemorrhoids near to the anus and they are itching as well as bleeding it is important to treat this with care, you will need to wash carefully after your bowel motion so your bottom is clean. Do not use perfumed soap as this will aggravate and sting. If you use baby wet wipes these are very gentle as well as cooling. If bleeding persists use a clean piece of toilet paper wet it with cold water and hold it against the bleeding area firmly for a couple of minutes it can take up to five minutes to stop the bleeding. This may seem a long time to put pressure on the pile but if you keep dabbing at the wound it will continue to bleed. If you have been prescribed cream for use after you have had a bowel motion, wait until the bleeding has stopped prior to application.

      Thrombosed Haemorrhoid - Pile Treatment

      An external thrombosed haemorrhoid looks like a bluish, purple lump they can vary in size and can be extremely painful.

      The reason from the thrombosis is because the blood flow through the tissue of the haemorrhoid has become damaged, therefore causing the blood to clot within a very confined space. The pressure increases until the bleeding stops, but you are then left with an excruciatingly painful lump full of clotted blood.

      There are two ways of dealing with this situation

      • You can visit you doctor or A&E department where you will be examined and then given the option of doing nothing or treating. If you have consulted the doctor within the first 72 hours of the onset it is probable they will suggest removing the clot. If you choose to have the clot removed you will be asked to sign a consent form for the procedure
        • You will be positioned either in stirrups or face down on the operating trolley and you will be covered appropriately to maintain your dignity
        • The doctor will then inject local anaesthetic around the thrombosed clot. This will sting momentarily and once the area is numb a small incision (cut) will allow the entire clot to be released.
        • This will give you immediate pain relief as the pressure will have been removed. The wound will be either packed with ribbon gauze, and gauze padding or dressed with an absorbent dressing. You will need to ensure you wash your bottom after you have had a bowel motion to make sure the area is clean and dry to optimise healing conditions.  
        • Complications of this procedure can involve bleeding, infection, and pain
        • Post-operative care will involve the removal of the packing gauze after 48 hours if has not already fallen out.
        • You may experience minor discomfort as the wound heals, but it can be relieved with regular analgesics such as paracetamol/ ibuprofen.
        • Diet should include plenty of fibre rich food
        • Possibly a stool softener
        • Drink plenty of fluids
      • The second option is to do nothing and just take regular pain relief. The pain will continue for probably about 7 days as the body begins to reabsorbs the clot, the whole process can take up to 4 weeks depending on the size of it. If you remain in the same level of pain and is doesn’t reduce to a manageable level after a couple of weeks you will need to visit your doctor.

       Prolapsed Haemorrhoids - Pile Treatment:
      This kind of haemorrhoid is one which has originated from above the dentate line.   Inside the anal canal this area has no nerve supply therefore these are often painless. Below the dentate line there are nerves and these are called external Haemorrhoids.
      It can be a bit of a shock when you feel a piece of tissue outside your body which has originated from inside. This piece of tissue will not feel painful unless it has become strangulated or thrombosed; that the haemorrhoid has become stuck outside the anus and you cannot push it back inside. The tissue can become strangulated by the pressure from the anal sphincter, this leads to either a clot forming within the pile or the tissue becoming starved of a blood supply completely leading to necrosis.

      Treatment for Prolapsed Haemorrhoids:

      Non-surgical Haemorrhoid – Pile Treatment:

      Haemorrhoid Banding:

      Banding / Baron Ligation technique this is a treatment which is very popular as it is 80% effective and the procedure can be performed without a general anaesthetic. It is more effective than any of the other non - surgical haemorrhoid treatments. 

      The haemorrhoid banding procedure 

      1. The doctor who is performing the procedure will explain what they are going to do, and will ask for your consent to perform the procedure.
      2. This procedure is performed on grade2-3  haemorrhoids
      3. If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the consent form.
      4. You will be asked to take your clothes off and put on a gown and placed in the correct position for the procedure.
      5. You will be positioned either on a couch with stirrups for your feet to go in or on your side on a couch with your knees drawn up to your chest it will depend on the location of the haemorrhoid. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
      6. An instrument called a proctoscope or anoscope will be lubricated  and gently placed in your anus so the doctor will be able to have a good view the haemorrhoid.
      7. The doctor may use some local anaesthetic around the base of the haemorrhoid to numb the area.
      8. The haemorrhoid will be grasped gently with a forceps and the haemorrhoid fed through a ringed instrument.
      9. The small elastic band will then be released at the base of the haemorrhoid which will totally cut off its blood supply.
      10. You will usually have only one or two haemorrhoids treated in this way at a time. Further treatment if necessary will be performed at a 4- week  interval to allow for healing.

      Post procedure pain

      • You may feel faint or sick after the procedure
      • You will usually experience pain for anything between 24- 48 hours after the procedure
      • You may feel as if you want to have your bowels open

      Special precautions

      • Ensure you have adequate pain relief available to you.
      • Make sure you have someone available to help you should you need it for at least the next twelve hours
      • Make sure you are able to urinate easily after the procedure(go for a wee)
      • Do not use aspirin for pain relief post procedure as it may encourage bleeding
      • Drink plenty of fluids
      • Try and do some gentle exercise
      • Eat plenty of fibre rich foods so you do not become constipated
      • Do not do any heavy lifting for at least two weeks

      Healing / recovery time

      In one to two weeks the haemorrhoid withers and falls off and is expelled when you have a bowel movement. The band will fall off as well as the piece of tissue as the haemorrhoid has been strangled as there is no blood supply to it. A scar will be left in the bowel inside this should prevent a further haemorrhoid occurring in the same place. It cannot be guaranteed that another pile will not reoccur in a similar area if bad bowel practices are continued.

      Complications and risks

      • You may experience problems passing urine (going for a wee) immediately after the procedure, but this usually resolves itself.
      • You may experience pain during the procedure due to the pulling and placement of the band
      • There is a risk of infection
      • Your haemorrhoid may return
      • You may have  a severe bleed

      Sclerotherapy:

      This is now considered an old treatment of piles and rarely used due to it not being as effective as banding. People tend not to want to have the practice of having repeated injections to ensure the pile has been effectively treated.

      It is a quick treatment involving the injection of Oily Phenol Injection BP 5%w/v into the base of the haemorrhoid causing the soft tissues to harden and scar, the haemorrhoid will then starved of a blood supply will wither and fall off.

      The Sclerotherapy Treatment Procedure 

      1. The doctor who is performing the procedure will explain what they are going to do, and will ask for your consent  to perform the procedure.
      2. This procedure is performed on grade1-2  haemorrhoids
      3. If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the consent form.
      4. You will be asked to take your clothes off and put on a gown and placed in the correct position for the procedure/ or just to remove your lower garments
      5. You will be positioned either on a couch with stirrups for your feet to go in or on your side on a couch with your knees drawn up to your chest it will depend on the location of the haemorrhoid. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
      6. An instrument called a proctoscope or anoscope will be lubricated and gently placed in your anus so the doctor will be able to have a good view the haemorrhoid.
      7. The doctor will then inject the base of the haemorrhoid with the oily phenol.

      Post procedure pain
      The procedure itself is usually not too uncomfortable but you may experience pain for the next 24 – 48 hours. Regular paracetamol should keep you comfortable.
                 

      Special precautions

      • Inform the doctor if you are allergic to nuts as this may mean this from of treatment is not suitable for you.
      • Ensure you inform you doctor prior to the procedure if you think you may be pregnant or are breast feeding
      • Ensure you have adequate pain relief available to you.
      • Make sure you have someone available to help you should you need it for at least the next twelve hours
      • Make sure you are able to urinate easily after the procedure(go for a wee)
      • Do not use aspirin for pain relief post procedure as it may encourage bleeding
      • Drink plenty of fluids
      • Try and do some gentle exercise
      • Eat plenty of fibre rich foods so you do not become constipated
      • Do not do any heavy lifting for at least two weeks

      Healing / recovery time
      In two weeks the scar will have blocked off the blood supply to the haemorrhoid and it will have withered and been passed with your stools. You will not usually notice this happening.

      Complications and risks

      • Your Doctor can inject 2-3mls of oily phenol at one time and it can be injected at the base of different haemorrhoids around the anal canal but the total used must not exceed 10mls or else you may suffer from a toxic reaction.
      • Dizziness
      • You may have an allergic reaction to the almond carrier oil if you have nut allergies
      • Discomfort – the phenol is supposed to cause numbing of the nerves but it may not be totally effective causing pain.
      • The area treated may form an ulcer or abscess possibly leading to Necrotising fasciitis
      • Urinary incontinence
      • The phenol may be injected incorrectly and enter the blood stream causing Hepatitis
      • Prostatitis (a painful inflammation of the prostate in men) or Impotency due to the phenol
      • Bleeding after the procedure

      Treatments which are currently advertised but require further research

      The following treatments have been popular in past years but do not appear to date to have been thoroughly researched therefore the effectiveness of the treatments require further research

      Sitz baths Treatment for Haemorrhoids This seems to be advised for many people but without any supporting research.

      What is a Sitz bath?

      Sitz baths are purportedly for the relief of piles with unsubstantiated statements of sitting in water either hot or cold using a variety of salts to ease your discomfort for a varying amount of time periods, anything up to  20 minutes  at a time  and for as many as up to 8 times a day!

      I am not sure of anyone at work who has the either the facilities to do this or the time off work allowed to attend to this course of treatment. It seems most impractical and there does not seem to be any guidance on

      1. The temperature of the water – if it is too warm it has the potential of burning the skin or increasing the blood flow to the haemorrhoids therefore increasing the pain.
      2. For women if the anus and vagina are submerged in warm sitz baths there is the potential for faecal fluid to contaminate the water and possibly cause vaginal problems.
      3. The question of the sanitation of these toilet baths as a form of contamination is not considered
      4. The lack of research regarding the herbal potions/salts which are added to these baths and the effects on the haemorrhoids
      5. The length of time you are expected to sit in the sitz bath – there does not appear to be any researched specified length of time or frequency with any measurable benefits
      6. This form of treatment needs to be clinically trailed to confirm the benefits for people.

       Flavonoid Treatment for Haemorrhoids

      Flavonoids have been used recently to treat haemorrhoids as they are purported to have anti – inflammatory and cell enhancing properties.
      The benefits of these are in the process of being researched in clinical trials but as page on line on Hospital Help in UK the licensed use of this medication is not yet recommended.

       Glyceryl Trinitrate Ointment Treatment for Haemorrhoids

      This cream is not currently licensed in the UK for use with Haemorrhoids it is used for the relief of pain and treatment of anal fissure. One of the side effects of this treatment is headaches and low blood pressure. Research has been undertaken in Australia and further research is expected.

      Information resources:

      Banov L, Knoepp LF, Erdman LH, Alia RT (1985). "Management of hemorrhoidal disease". J S C Med Assoc 81 (7): 398–401

      Kaidar-Person et al, 2007
      Nienhuijs SW, de Hingh IHJT. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database of Systematic

      Reviews
      2009, Issue 1. Art. No.: CD006761. DOI: 10.1002/14651858.CD006761.pub2.
      J. J. Tjandra*, J. J. Y. Tan*, J. F. Lim*, C. Murray-Green*, M. L. Kennedy† and D. Z. Lubowski†

      *Department of Colorectal Surgery, Epworth Colorectal Center and The Royal Melbourne Hospital, Melbourne and

      †Colorectal Unit, St George Hospital, Sydney, Australia - Rectogesic® (glyceryl trinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures

      Guidelines are recommended by NICE the National Institute for Health and Clinical Excellence (NICE)
      Hiromi Iwagaki, Yasuhiko Higuchi, Sadanori Fuchimoto and Kunzo Orita First Department of Surgery, Okayama University Medical School, Okayama, Japan  - laser treatment of hemorrhoids
      Information sheet - Summary of Product Characteristics last updated on the eMC: 12/12/2008

      Oily Phenol Injection BP (UCB Pharma Ltd)

      Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation.
      Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Golder S, Jayne D, Drummond M, Woolacott N.
      Centre for Reviews and Dissemination, University of York, UK.

      Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan–Morgan cold scalpel technique

      L. C. Pandini*, S. C. Nahas†, C. S. R. Nahas*, C. F. S. Marques†, C. W. Sobrado† and D. R. Kiss†
      Departments of *Digestive Surgery and †Coloproctology, University of Sao Paulo, Sao Paulo, Brazil

      Novel Technique: Radiofrequency Coagulation -- A Treatment Alternative for Early-Stage Hemorrhoids

      Pravin J. Gupta, MS [Gen. Surgery] Posted: 07/31/2002

      Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy
      George Felice1, Antonio Privitera1 , Ernest Ellul1 and Maria Klaumann1 Department of General Surgery, St. Luke’s Hospital, Gwardamangia, Malta

      Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction

      : Wilkerson, P. M.; Strbac, M.; Reece-Smith, H.; Middleton, S. B.
      : Colorectal Disease Volume 11, Number 4, May 2009 , pp. 394-400(7)


 

 

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