HAEMORRHOIDS: Find out more about these piles of pain and pang.

Updated: Mar 28

Haemorrhoids can mean the anatomical site in the rectum or the symptoms of the condition itself.



Haemorrhoidal plexus is a branching network of nerves, blood vessels (especially the tiniest and smallest blood vessels), tissues and smooth muscles.

Haemorrhoidal plexus is found in the lower rectum and it is a network or a cluster of 

  • Tissues 

  • Small arteries (arterioles)

  • Small veins (venules) 

  • Material-venous anastomosis/connections 

  • Smooth muscles

Haemorrhoidal plexus are cushions that help with stool control. During the passage of stool, there is high pressure in the abdomen. The Haemorrhoidal plexus cushions blood vessels and sphincters of the anus from the pressure during the passage of stool.


The plexus also ensures that the anus is tightly closed at rest. Haemorrhoidal plexus are embedded in loose connective tissues. They have little support from surrounding body tissues, this means they are weak and incapable of resisting abdominal and blood pressure.


There are two types of Haemorrhoidal plexus

1. Internal plexus

2. External plexus

External plexus are supplied by nerves while Internal haemorrhoids are not supplied by nerves. This means external haemorrhoids are PAINFUL while internal Haemorrhoids don't cause pain.



So, what are Haemorrhoids?


The term haemorrhoid is usually related to the symptoms caused by haemorrhoids. 

 When Haemorrhoidal Plexus produce symptoms, they are referred to as haemorrhoids. They cause symptoms when enlarged, inflamed or popping out of the anus. Constant exposure to risk factors leads to abnormal swelling of the Haemorrhoidal Plexus.


This causes dilatation and engorgement of the arteriovenous connections (the smallest veins and arteries) in the haemorrhoidal plexus. Then the stretching of the rectal muscles and popping out of rectal tissue through the anus. The swollen and engorged anal wall becomes traumatized.




Slight friction by the passage of stool leads to bleeding that is bright red. 

Prolapse (Popping out of rectal tissue) leads to mucus discharge which triggers itchiness of the anal area.


The specific offending cause of haemorrhoids is not known, however, there are associated factors which increase pressure in the Haemorrhoidal Plexus in the lower rectum.

This increased pressure can cause the blood vessels in the lower rectum to become swollen, inflamed and painful.


RISK FACTORS

  • Straining when passing stool

  • Sitting on the toilet seat for long especially for people who go to the toilet to browse on the phone or read a book while passing stool.

  • Pregnancy.

  • Anal sex 

  • Obesity

  • Injury of the spinal cord

  • Low fibre diet

  • Weak rectal muscles

  • Family history of haemorrhoids.

Internal haemorrhoids usually do not cause pain and discomfort. However, straining and irritation when passing stool erodes and injures the wall of a haemorrhoid causing it to bleed. 



External haemorrhoids lie under the skin around the anus. They itch and bleed when irritated by a passing stool. Blood can pool inside an external haemorrhoid and form a BLOOD CLOT.

The clot causes severe pain, itchiness, swelling and inflammation.


Signs and symptoms of Haemorrhoids:


  • Pain or discomfort when sitting or passing stool.

  • Itching & irritation at the anal opening.

  • Your toilet paper or toilet bowl has bright red bloodstains.

  • Painful swellings and lumps around the anal opening.


Bleeding when passing stool is the most common sign of haemorrhoids. This bleeding is known as RECTAL BLEEDING.

Rectal bleeding can, however, indicate a more serious condition, such as Colo-rectal Cancer or Cancer of the anus.


Treatment

Haemorrhoids should be considered for treatment if they bother you, are painful or embarrassing. Haemorrhoids can be self-treated at home however they may not be cured. Self-treatment at home relieves mild pain, swelling and inflammation.


Complicated or repeat cases may require aggressive treatment or surgery. If the haemorrhoids have formed a clot, the doctor will incise and remove the clot in a surgical procedure known as haemorrhoid thrombectomy. If there is persistent bleeding or persistent severe painful haemorrhoids,  visit the doctor for further surgical management. The surgeon would consider doing any of the following procedures:

  • Rubber band ligation-  using a rubber band to cut off the blood supply to the haemorrhoid causing it to shrink and die.

  • Sclerotherapy-  an injection into the haemorrhoid to make it harden and shrink.

  • Electrotherapy -  an electric heat treatment that causes the haemorrhoid to harden and shrink.

  • Haemorrhoidectomy and Haemorrhoid stapling - removal of a haemorrhoid with a scalpel or laser

 Haemorrhoids can come back after treatment; hence, they are controlled or prevented rather than cured. 


SELF TREATMENT at HOME

  • You can soak the anal area in warm water for 15 minutes. This will give you mild relief.

  • You can also use suppositories to relieve pain and reduce swelling.

  • You can use stool softeners which help stools to be passed more easily.

  • The anal area should be kept clean by bathing or showering.

  • Taking oral pain medication, such as paracetamol can also help to relieve discomfort.


PREVENTING HAEMORRHOIDS



Keeping your stools soft is the best way to keep haemorrhoids at bay. 


  1. Eat high-fibre foods like complex carbs and vegetable.

  2. Drink plenty of fluids. A lot of water, every day.

  3. Don't strain when on the toilet. Go to the toilet as soon as you feel the urge. If the poop doesn't come, exit the small room.

  4. Exercise regularly. This is very important.

  5. Lose weight if you are overweight.

Haemorrhoids are associated with poor habits and lifestyle. Change this. 


If you are struggling with Haemorrhoids, reach out to me through my email eric@amerix.co.ke or send me a private message in my Twitter Inbox here.


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