The most common symptoms of both internal and external haemorrhoids include the following:
• Bleeding while moving bowels. Blood can be seen either on the toilet paper or on the stools.
Most of all, it is generally classified by the severity of the swelling of the haemorrhoids.
Grade 1 haemorrhoids are common where small swellings form on the inside lining on the anal canal.
Grade 2 haemorrhoids are bigger swellings which may be pushed out from the anus after moving stools but would most likely return back inside again.
Grade 3 haemorrhoids most likely to require a surgery are marked by prolapse that protrudes from the anus. However, they can also still be pushed back inside the anus with the finger.
Grade 4 haemorrhoids are large prolapse permanently outside the anus which can’t be pushed back into the anus. There’s also a high risk of complications with Grade 4 haemorrhoids such as blood clots (thrombosis) forming within the haemorrhoids.
The following are recommended:
• Increased fibre intake (through fruits & vegetables or fibre supplements): helps to soften the stools for easier bowel movements
• Drink enough (8-10 cups) water daily and avoid alcoholic or caffeinated (dehydrating) drinks. This will help in softening of the stools as well.
• Avoid spending a long time sitting in the toilet. Skip reading the newspapers and magazines during toilet time.
For the different stages different treatments are best recommended by the doctors.
Stage 1 & 2:
• Rubber Banding treatment
• Oral medication
• Ointments, cream and suppositories. These helps to reduce pain, swelling and itching.
• Sclerotherapy – injection of chemical into the blood vessel to shrink the haemorrhoids.
• Laser therapy – using laser to scar and harden the haemorrhoids.
• Infrared coagulation – using heat to shrink the haemorrhoidal tissue.
• Doppler Ligation – using ultrasound Doppler to identify individual artery that supplies blood to the haemorrhoid and ligating (tie off) it, causing it to shrink off.
Stage 3 & 4 (typically done under General Anaesthesia or Spinal block):
• Conventional Haemorrhoidectomy Surgical removal of haemorrhoids (haemorrhoidectomy) usually is reserved for patients with third- or fourth-degree hemorrhoids. During haemorrhoidectomy, the internal hemorrhoids and external hemorrhoids are cut out using an electric current (also known as diathermy). The wounds left by the removal may be sutured (stitched). However, there are also a number of doctors using the Harmonic scalpel (ultrasound technology) which cuts out the haemorrhoidal tissues and seals using protein denaturisation instead of heat. This procedure can be done as a day case but is often associated with intense pain after operation due to the excision of tissues.
• Stapled Haemorrhoidectomy is also known as Procedure for Prolapse and Haemorrhoids (PPH). PPH is a minimally invasive procedure using a stapler-like device to remove the haemorrhoidal tissues, reposition the haemorrhoids and cutting off their blood supply. Without blood, the haemorrhoids eventually shrivel and die. Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and one can usually be able to return to work about a week afterwards. It also tends to be a less painful procedure. However, this method carries a small number of serious complications including deaths.
• Haemorrhoidal artery ligation (HALO), also known as transanal haemorrhoidal dearterialisation (THD), is an operation to reduce the blood flow to the haemorrhoids. It uses a small ultrasound device called a Doppler probe to identify the terminating branches of the arteries that supply blood to haemorrhoids. A stitch is then placed to “tie-off” the arterial blood flow, blocking the blood supply to the haemorrhoids. This causes the haemorrhoids to shrink without making any excisions. The National Institute for Health and Clinical Excellence (NICE) of UK recommends haemorrhoidal artery ligation as an effective alternative to conventional haemorrhoidectomy or stapled haemorrhoidectomy as this procedure causes less pain and, comparable in terms of results.
Risks of surgery
Complications can occasionally occur after surgery. These may include:
• haemorrhage (bleeding) around six days after surgery or banding. It is a small risk. If it occurs, go to the nearest accident and emergency (A&E) department immediately.
• faecal incontinence, where you involuntarily pass stools (faeces); it is a small risk and can sometimes be corrected with another operation.
• infection is rare and occurs in less than 3 out of every 100 people who have a haemorrhoidectomy.
• anal fistula is where a small channel develops between the anal canal and the surface of the skin, near the anus.