"It would be worth remembering, that not all bleeding during defaecation is due to hemorrhoids."

HAEMORRHOIDS (PILES)

Haemorrhoids, also known as piles, is a common ano-rectal condition typically developing between the ages of 20 and 50. Up to 50% of people above the age of 50 suffer from hemorrhoids to some degree or other.  It is basically a condition in which the veins around the anus and lower rectum become swollen and inflammed.

Haemorrhoids are classified either as being:

1. Internal – where the hemorrhoids occur inside the rectum. These are generally painless as there are no pain receptors in this region, and most people are unaware of their presence. They occasionally bleed when the veins rupture due to excessive straining or the passage of hard stools.

2. External – where they occur below the anal verge (where pain receptors are present). These tend to be visible and a lump may be felt. External haemorrhoids are prone to thrombosis (blot clot forms inside the pile). When this happens, sudden pain is experienced.

Haemorrhoids are also classified according to their degree of prolapse:

• Grade I – internal haemorrhoids, not prolapsed.

• Grade II – piles are pushed out (prolapsed) on straining, but spontaneously reduce.

• Grade III – piles prolapse on straining, and have to be pushed back manually.

• Grade IV – piles are prolapsed and cannot be manually reduced.

HAEMORRHOIDS - SYMPTOMS

Bleeding is the earliest symptom. At first, it is minimal fresh bleeding, occurring during defaecation as a “splash in the pan”, or seen on the toilet paper after wiping.

Prolapse is a much later symptom, progressing from Grade II to IV if the underlying cause is not managed. Prolapsed piles can become trapped outside the anal opening if the anal sphincter muscle goes into spasm. Should this happen, blood supply to the haemorrhoid, gets cut off and the pile becomes strangulated.

External haemorrhoids can cause irritation to the skin resulting in itching. As mentioned earlier, external piles can become thrombosed causing significant pain.

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