What to do about haemorrhoids

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Bulging blood vessels in the backside can be a pain, but patients have many options for treating them.

Some women have a passing encounter with haemorrhoids during pregnancy. By midlife, many more of us have had one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse (protrusion of haemorrhoids into the anal canal).

Leakage of feces may also occur. Although haemorrhoids are rarely dangerous, they can be a painful recurrent bother. Fortunately, there's a lot we can do about them.

What are haemorrhoids?

In one sense, everyone has haemorrhoids - pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. Trouble develops when these veins become swollen and distended, like varicose veins in the legs.

And like varicose veins, haemorrhoids may be a byproduct of our blood vessels' constant battle against gravity to get blood back to the heart - and part of the price we pay for being upright creatures.

There are two kinds of haemorrhoids: internal ones, which occur in the lower rectum, and external ones, which develop under the skin around the anus. External haemorrhoids are the most uncomfortable, because they irritate and erode the overlying skin.

The pain may be sudden and severe if a blood clot forms inside an external haemorrhoid. The clot usually dissolves but may leave excess skin (a skin tag) that itches or becomes irritated.

Internal haemorrhoids are usually painless, but they often result in bleeding, which may show up bright red on toilet paper or dripping into the toilet bowl. An internal haemorrhoid may also prolapse and extend beyond the anus, causing potential problems.

For one thing, it may collect small amounts of mucus and microscopic stool particles, leading to a condition called pruritus ani (anal itching). The problem worsens if you repeatedly wipe to relieve the itch.

What causes haemorrhoids?

Experts don't fully agree, but several mechanisms are probably at work. Large, prolapsing haemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet - all of which can cause blood to pool and enlarge the vessels. Inadequate fibre intake may also contribute.

People with haemorrhoids tend to have a higher than average resting anal canal tone - that is, the smooth muscle of the anal canal is tighter than average, even when they're not straining.

Constipation adds to the trouble, because straining during a bowel movement increases pressure in the anal canal and pushes the haemorrhoids against the sphincter muscle. Finally, haemorrhoids may bulge and prolapse because the connective tissues that support and hold them in place become weaker with age.

Diagnosing haemorrhoids

Haemorrhoids can usually be diagnosed from a simple medical history and physical exam. External haemorrhoids are generally visible, especially if a blood clot has formed.

Your clinician may perform a digital rectal exam to check for blood in the stool. She or he may also examine the anal canal with an anoscope, a short, lighted plastic tube inserted into the rectum.

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