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Haemorrhoids

Haemorrhoids, also known as piles, are swollen veins in the lower rectum and anus, similar to varicose veins. They can cause significant discomfort, pain, and inconvenience, impacting the quality of life. In Australia, haemorrhoid management surgery is a common procedure, employing advanced surgical techniques to provide effective relief.

Overview

Haemorrhoids are classified into two types: internal and external.

  • Internal Haemorrhoids: These are located inside the rectum and are usually not visible. They may cause painless bleeding during bowel movements but can become painful if they prolapse or protrude through the anus.
  • External Haemorrhoids: These are found under the skin around the anus. They can be painful and cause swelling, itching, and bleeding. Thrombosed external haemorrhoids occur when blood pools and forms a clot, causing severe pain and swelling.

Several factors can contribute to the development of haemorrhoids:

  • Straining During Bowel Movements: Increased pressure in the lower rectum from straining can cause haemorrhoids.
  • Chronic Constipation or Diarrhoea: Both conditions can lead to haemorrhoids due to increased strain and irritation.
  • Prolonged Sitting: Sitting for extended periods, particularly on the toilet, can increase pressure on the rectal veins.
  • Obesity: Excess body weight increases pressure on the veins in the rectal area.
  • Pregnancy: The increased pressure on the pelvic veins during pregnancy can cause haemorrhoids.
  • Low-Fibre Diet: A diet lacking in fibre can lead to constipation and straining, contributing to haemorrhoids.

Haemorrhoids can present a variety of symptoms depending on their type and severity:

  • Painless Bleeding: Bright red blood during bowel movements is a common symptom of internal haemorrhoids.
  • Pain or Discomfort: Especially with external haemorrhoids, which can be painful, particularly when sitting.
    Itching or Irritation: Around the anus.
  • Swelling: Around the anus, which may be sensitive to the touch.
  • Lump Near the Anus: This can be a thrombosed external haemorrhoid, which can be very painful.

Several factors can increase the risk of developing haemorrhoids:

  • Age: Haemorrhoids are more common in older adults due to weakened veins.
  • Family History: Genetics can play a role in susceptibility to haemorrhoids.
  • Pregnancy: Increased pressure on the rectal veins during pregnancy.
  • Diet: Low-fibre diets can contribute to constipation and straining.
  • Lifestyle: Sedentary lifestyles with prolonged sitting or heavy lifting can increase the risk.

While lifestyle changes and non-surgical treatments can manage mild haemorrhoids, persistent or severe cases often require surgical intervention. The main surgical techniques for treating haemorrhoids include rubber band ligation, sclerotherapy, haemorrhoidectomy, and haemorrhoid stapling.

Treatment Options

Rubber Band Ligation

  • Overview: Rubber band ligation is a minimally invasive procedure used to treat internal haemorrhoids. It involves placing a small rubber band around the base of the haemorrhoid, cutting off its blood supply.
  • Procedure:
    • Anaesthesia: Usually, no anaesthesia is required, but a local anaesthetic may be used to numb the area.
    • Band Placement: A specialised instrument called a ligator is used to place a rubber band around the base of the haemorrhoid inside the rectum.
    • Haemorrhoid Shrinks: The haemorrhoid loses its blood supply, shrinks, and falls off within a week, typically during a bowel movement.
    • Post-Procedure: Patients may experience mild discomfort or a sensation of fullness, which usually resolves quickly.

Sclerotherapy

  • Overview: Sclerotherapy involves injecting a chemical solution into the haemorrhoid tissue, causing it to shrink and eventually disappear.
  • Procedure:
    • Anaesthesia: Local anaesthesia may be used to numb the area.
    • Injection: A sclerosing agent is injected into the haemorrhoid tissue, causing it to harden and shrink.
    • Post-Procedure: Minimal discomfort is expected, and patients can typically resume normal activities immediately.

Haemorrhoidectomy

  • Overview: Haemorrhoidectomy is a surgical procedure to remove large external haemorrhoids or prolapsed internal haemorrhoids. It is considered the most effective treatment for severe or recurrent haemorrhoids.
  • Procedure:
    • Anaesthesia: General or spinal anaesthesia is used.
    • Incisions: Small incisions are made around the haemorrhoid.
    • Tissue Removal: The haemorrhoid tissue is removed, and the incisions are closed with sutures.
    • Post-Procedure: Recovery can take several weeks, with pain management and wound care being crucial components of postoperative care. Patients may experience significant discomfort, which can be managed with prescribed medications.

Haemorrhoid Stapling (Stapled Haemorrhoidopexy)

  • Overview: Stapled haemorrhoidopexy is a procedure used to treat prolapsed haemorrhoids by repositioning the haemorrhoid tissue and cutting off its blood supply using a stapling device.
  • Procedure:
    • Anaesthesia: General or spinal anaesthesia is used.
    • Stapling: A circular stapling device is used to reposition the haemorrhoid tissue and remove a ring of excess tissue.
    • Tissue Repositioning: The stapler pulls the haemorrhoid back into its normal position inside the anus.
    • Post-Procedure: Recovery is typically faster than with traditional haemorrhoidectomy, with less postoperative pain. Pat

Postoperative care is crucial for successful recovery and optimal results. It includes:

  • Pain Management: Pain medications are prescribed to manage postoperative discomfort.
  • Wound Care: Instructions on keeping the incision sites clean and dry, and recognising signs of infection.
  • Dietary Changes: A high-fibre diet and increased fluid intake to prevent constipation and straining during bowel movements.
  • Activity Restrictions: Guidelines on limiting physical activity and avoiding heavy lifting to allow proper healing.
  • Follow-Up Appointments: Regular follow-up visits to monitor recovery, remove sutures if necessary, and address any complications.

As with any surgical procedure, haemorrhoid surgery carries potential risks and considerations:

  • Bleeding: Postoperative bleeding can occur, though it is usually minimal and resolves on its own.
  • Infection: Infection at the surgical site, though rare, can occur and may require antibiotics.
  • Pain: Postoperative pain is common, especially with haemorrhoidectomy, but can be managed with medications.
  • Urinary Retention: Difficulty urinating after surgery, particularly with spinal anaesthesia, may occur but is typically temporary.
  • Recurrence: While surgery is highly effective, there is a small risk of haemorrhoid recurrence.

Conclusion

Haemorrhoid surgery provides effective relief for those suffering from the discomfort and complications of haemorrhoids. Advanced surgical techniques available in Australia, such as rubber band ligation, sclerotherapy, haemorrhoidectomy, and stapled haemorrhoidopexy, offer tailored solutions to meet individual patient needs.

Understanding the causes, symptoms, and risk factors of haemorrhoids, along with the surgical options, is crucial for those considering treatment. With comprehensive care and expertise, patients can achieve significant relief and an improved quality of life.

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