Haemorrhoids/Piles

What arr hemorrhoids/piles?

Hemorrhoids or Piles are conditions that occur when the veins or blood vessels in and around the anus and lower rectum become swollen and irritated often as a result of extra pressure on these veins.
Engorgement of the vascular complex or thrombus often leads to the symptoms of disease.
Haemorrhoids or Piles may be external or internal.

Symptoms or Clinical features of Haemorrhoids / Piles

Internal haemorrhoids:

  • these are typically painless but present with bright red rectal bleeding.
  • It may however become thrombosed and protrude into the anal canal.

External haemorrhoids:

  • when thrombosed, external hemorrhoids cause acute perineal pain with or without necrosis and bleeding.
  • Fibrosed external haemorrhoids present as anal tags.

Differential diagnoses of Haemorrhoids / Piles

  • Colorectal cancer.
  • Adenomatous polyps.
  • Inflammatory bowel disease

Complications of Haemorrhoids / Piles

  • Bleeding
  • Necrosis
  • Perineal sepsis
  • Mucus discharge

Risk factors for hemorrhoids/piles

  1. Pregnancy
  2. Obesity
  3. Age of 45 to 65 years old
  4. Family history
  5. Sitting on the toilet for too long
  6. Frequent straining
  7. Chronic constipation or diarrhoea

Investigations

  1. Anoscopy
  2. Full blood count including blood film

Treatment for hemorrhoids/piles

Treatment objectives

The treatment objectives of this condition are to:

  1. Relieve pain and
  2. prevent complications

Non-drug treatment of Haemorrhoids / Piles

  1. Increase fibre in foods.
  2. Increase fluid intake
  3. Avoid foods that cause constipation
  4. Stool softeners
  5. Regular exercise

Drug treatment of Haemorrhoids/ Piles

General

Suppositories/ointments of preparations containing hydrocortisone acetate with or without lidocaine hydrochloride plus astringent(s).

A. When associated with constipation

Evidence Rating: [C]
Liquid paraffin, oral,
Adults 10-30 ml at night

Or

Senna granules, oral,
Adults 1 sachet with water after supper

B. When associated with local itching or discomfort

Soothing agent (with or without steroids), applied or inserted rectally
Adults: One suppository 12 hourly for 7-10 days

C. For infected hemorrhoids

1st Line treatment
Evidence Rating: [B]
Gentamicin, IV,
Adults: 40-80 mg 8 hourly for 5 to 7 days

And

Metronidazole, oral,
Adults: 400 mg 8 hourly for 5 to 7 days
2nd Line treatment
Evidence Rating: [B]
Ciprofloxacin, oral,
Adults 500 mg 12 hourly

And

Metronidazole, oral,
Adults 400 mg 8 hourly for 5-7 days
3rd Line treatment
Evidence Rating: [B]
Amoxicillin, oral,
Adults: 500 mg 8 hourly

And

Metronidazole, oral,
Adults: 400 mg 8 hourly for 5 to 7 days

D. When associated with anaemia

Iron preparation
(ferrous sulphate/fumarate) (See section on Anaemia)

Or

Blood transfusion as indicated

Surgery

  • Elastic band ligation
  • Sclerosis
  • Photocoagulaton
  • Cryosurgery
  • Excisional haemorrhoidectomy

Referral Criteria

The patient should be referred to a facility with resources for rubber band ligation or operative treatment if indicated.

References

  1. John Hopkins Medicine: Haemorrhoids
  2. NCBI: Haemorrhoids
  3. American Family Physician: Haemorrhoids