Haemorrhoids are enlarged blood vessels covered by lining of the lower rectum just above the anal canal. Main symptoms are bleeding and prolapse. Bleeding occurs as the engorged blood vessels are traumatised during passage of stools. It most commonly manifest as blood on the toilet paper or dripping of bright red blood AFTER passage of stools. Prolapse of haemorrhoids occurs when the blood vessels and overlying mucosa (lining of rectum) protrude beyond the anal sphincter. This often causes pain.

It is often caused by straining or sustained increase in pressure around the perianal region. These includes chronic constipation, pregnancy, straining or other disease that increase straining such as chronic cough.

Treatment of haemorrhoids varies depending on the severity. Most patients with haemorrhoids can be managed conservatively without surgery. These include high fibre diet, increase water intake, improve toilet habit and avoiding excessive straining.

Possible surgical treatment options include:

  • injection of Phenol (in oil)
  • rubber band ligation
  • staple haemorrhoidectomy
  • formal haemorrhoidectomy
  • Haemorrhoids Arterial Ligation (HAL)

Even in thrombosed or prolapsed haemorrhoids, urgent surgery is rare. They often improves with symptomatic treatment and urgent surgery is generally avoided as it has higher risk of complications.