What are Haemorrhoids/Piles?

Haemorrhoids are enlarged tissue cushions in the anus due to enlarged/congested blood vessels. It is important to note that it is normal to have these tissue cushions. It only becomes problematic when they are enlarged.

Haemorrhoids are often confused with skin tags as both can often be felt at the edge of the anus. Unlike haemorrhoids that arise from within the anus, skin tags arise from the skin around the anus. Treatment for skin tags is much less complex than that for haemorrhoids.

Alpine Surgical is committed to practicing safe and reliable surgery to treat all types of Haemorrhoids / Piles.

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Causes & Symptoms of Haemorrhoids

The most often attributable cause is prolonged straining/squeezing during the passing of motion. The straining causes the blood vessels and overlying mucosa of the haemorrhoids to stretch out and expand with time.

As the haemorrhoids expand, the patient will then experience the common symptoms of anal bleeding, the sensation of a lump at the anus and sometimes a painful lump due to a strangulated/trapped haemorrhoid.

When should I see a doctor?

One of the commonest symptoms of haemorrhoid is bleeding during passing of motion. Early medical consultation with consideration for a colonoscopy is essential, particularly for individuals over 40 years of age, to achieve an accurate diagnosis. Colon/Rectal tumour bleeding can resemble haemorrhoidal bleeding and the differentiation between the two is essential.

A consultation with a General surgeon or Colorectal surgeon can be sought if the haemorrhoids are uncomfortable and the individual wants some form of treatment.

The different grades of Haemorrhoids and its treatment options

First-degree haemorrhoids are the smallest in size and do not prolapse. These are usually residing within the anus and is best treated with medications. No form of surgical intervention is helpful due to the small size.

Second-degree haemorrhoids may prolapse/’drop out’ during the passing of motion but they tend to reduce/’go back’ into the anus after passing motion.

The treatment options include:
1. Medications for the smaller second-degree haemorrhoids.
2. Ligation (tying up with rubber bands) for small to medium-sized second-degree haemorrhoids)
3. Stapled haemorrhoidectomy or the THD/HALO procedure for large second-degree haemorrhoids

Third-degree haemorrhoids are larger than second-degree ones and hence ‘drop out’ during the passing of motion but will require the patient to push them back manually. Third-degree haemorrhoids do not reduce/’go back’ by themselves.

Third-degree haemorrhoids also certainly require some form of surgery as they are too large to shrink sufficiently with either medications or rubber band ligation.

The surgical options include stapled haemorrhoidectomy (for smaller third-degree haemorrhoids), or more commonly a conventional haemorrhoidectomy (Milligan-Morgan or Ferguson method).

Fourth-degree haemorrhoids are the largest haemorrhoids and are permanently ‘out’ of the anus. They can cause a lot of discomfort during sitting down or walking as they rub against each other or the buttocks.

The only treatment is a conventional haemorrhoidectomy (Milligan-Morgan or Ferguson method).

Treatment Options

The rubber band ligation is a clinic procedure that takes about 2 min and involves very little discomfort to the patient. The rubber bands usually dislodge after a few days or up to 2 weeks without the patient being aware. The rubber bands cut off the blood supply and hence shrinks the haemorrhoids.

A stapled haemorrhoidectomy involves using a circular surgical stapler that is placed within the upper anus. The stapler will then excise/remove a 1cm ring of the anal lining that contains the blood vessels supplying the haemorrhoids, followed by a row of staples to re-unite the edges of the cut anal lining. The two common systems available on the market is the PROXIMATE® PPH system by Ethicon and EEA™ system by Medtronic.

Both procedures utilise the same surgical principle of locating the feeding hemorrhoidal vessels with a specially designed ultrasound probe followed by surgical stitching in the anus to close off the vessels without any wounds.

The THD® Doppler Surgery system and the HALO™ system are the commonest systems on the market. It is important to note that this form of surgery is more suitable for patients with predominantly bleeding symptoms with minimal prolapse of haemorrhoids.

 

The Conventional haemorrhoidectomy is the gold standard by which all new hemorrhoidal surgery procedures are compared against. The conventional haemorrhoidectomy method has been in use for over fifty years and is the only treatment option available for large third-degree and fourth-degree haemorrhoids.

The conventional haemorrhoidectomy involves a surgical excision/’cutting out’ of the haemorrhoids with diathermy. The wound can then be left open to heal on its own (Milligan-Morgan method) or stitched up (Ferguson method). Each method has its advantages and disadvantages.

These are variants of the conventional haemorrhoidectomy method, with the LigaSure™ surgical sealer or Harmonic® ultrasonic scalpel used in place of the electrical diathermy. The main advantage is that of a lower post-op bleeding risk.

It is important to discuss with your surgeon in detail the best treatment option for your condition.

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