Haemorrhoids
Background
Haemorrhoids also known as piles can be classified into two groups: Internal (inside the anus) and External (sitting outside the anus). The symptoms can be different but all have in common fresh bleeding after a bowel motion. The blood is usually separate from the stool.
Internal piles can prolapse out of the rectum and when returning spontaneously back into the rectum they are called 2nd degree piles. Internal piles that have to be pushed back manually are called 3rd degree piles. Internal piles that prolapse out and cannot be pushed back in are classified as 4th degree piles. They are often thrombosed (blood in the haemorrhoid is clotted) and can result in intense pain and discomfort.
External piles are always sitting outside the anus around the anal margin. They can sometimes cause itching, difficulty in anal hygiene and clot resulting in a thrombosed pile. The latter can also be very uncomfortable and painful.
Treatment
In brief treatments range from suction band ligation, haemorrhoidal arterial ligation, radiofrequency ablation, stapled haemorrhoidopexy and haemorrhoidectomy.
Anal Fissure
Symptoms
The main symptom is pain when opening your bowels with fresh bleeding. This may be in the pan but often is streaking or soaking the tissue paper. The pain feels like ‘shards of glass’ and may continue for 30 minutes to a few hours after bowel action. There may also be itching known as pruritus ani. Sometimes the body tries to protect the fissure by forming a small anal skin tag. This is known as a sentinel pile.
Treatment
There are several treatments available that range from ointments, BOTOX, division of the internal anal sphincter and anal flap.
Bowel/Rectal Prolapse
Background
The most common type is full-thickness rectal prolapse. This can vary in length from a couple of centimetres to over 10 centimetres.
Symptoms
These can be several and include bleeding, and discomfort like a dragging sensation particularly when walking and standing. Being seated can be uncomfortable. A large moist lump or mass can be felt. Stool incontinence and continual mucous leakage may occur.
Treatment
Treatment is with surgical correction. There are two approaches – from the abdomen or the bottom (known as perineal approach). Each has its advantages and disadvantages and it is best to discuss these with your surgeon. The risk of recurrence is around 20 to 30 %.
