Haemorrhoids (uncomplicated)
Introduction
Haemorrhoidal tissue is part of the normal anatomy which contributes to anal continence. These mucosal vascular cushions are found in the left lateral, right posterior and right anterior portions of the anal canal (3 o'clock, 7'o'clock and 11 o'clock respectively). Haemorrhoids are said to exist when they become enlarged, congested and symptomatic
Classification
Types of haemorrhoids
External
Internal
Grading of internal haemorrhoids
External
- originate below the dentate line
- prone to thrombosis, may be painful
Internal
- originate above the dentate line
- do not generally cause pain
Grading of internal haemorrhoids
| Grade I | Do not prolapse out of the anal canal |
|---|---|
| Grade II | Prolapse on defecation but reduce spontaneously |
| Grade III | Can be manually reduced |
| Grade IV | Cannot be reduced |
Epidemiology
- Incidence: 1000.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: 1:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Clinical features
- painless rectal bleeding is the most common symptom
- pruritus
- pain: usually not significant unless piles are thrombosed
- soiling may occur with third or forth degree piles
Management
Management
- soften stools: increase dietary fibre and fluid intake
- topical local anaesthetics and steroids may be used to help symptoms
- outpatient treatments: rubber band ligation is superior to injection sclerotherapy
- surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
- newer treatments: Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy
Complications
Complications
- thrombosed haemorrhoid