WHAT ARE HAEMORRHOIDS?

Haemorrhoids are special normal anatomical structures found in the anus of everbody. They are composed of a tuft of special blood vessels referred to as Sinusoids.

Haemorrhoids are disposed at two levels, those that are deep in the anal canal are the internal haemorrhoids and those that are found at the anal verge are the external haemorrhoids. The clinical importance of external haemorrhoids is in clot formation to cause severe acute pain.

Many of the complications in haemorrhoids (Haemorrhoidal disease) occur in the internal haemorrhoids.

 

HOW MANY INTERNAL HAEMORRHOIDS ARE THERE?

There are typically three primary haemorrhoids in every anus and these are roughly disposed at the 3, 7 and 11 o’clock positions with the patient lying on the back and the anus viewed as the face of the clock.

There are occasionally smaller heamorrhoids located in-between these primary haemorrhoids. They are called secondary haemorrhoids

 

WHAT ARE THE FUNCTIONS OF HAEMORRHOIDS?

Haemorrhoids have two main functions; these are effected when they are emptied of blood and also when filled with blood:

1. They contribute to the involuntary continence of the anus. They help seal off the anus when the sinusoids are empty in-between stool passage.
2. They cushion the anal canal from injury from the sabulous faeces passed during passage of stool, when the sinusoids are filled with blood and engorged.

 

WHAT IS HAEMORRHOIDAL DISEASE?

Haemorrhoidal disease is when the tuft of blood vessels in haemorrhoidal (Sinusoids) lose their tone, become filled with blood perpetually and are congested. There is weakness in the supporting structures of the vessels and the whole haemorrhoidal tissue so the heamorhoids descend through the anus. It is a progressive disease when it starts, but the rate of progression vary in individuals.

 

CAN DISEASED HAEMORRHOIDS COMPLICATE?

Diseased haemorrhoids can complicate and become painful. Uncomplicated diseased haemorrhoids are painless.

Complications of haemorrhoids are:

1. Permanently prolapsed
2. Thrombosis
3. Infection
4. Strangulation
5. Ulceration
6. Gangrene
7. Anaemia from chronic bleeding

 

HOW COMMON IS HAEMORRHOIDAL DISEASE?

There is sufficient weakness in the connective tissues of haemorrhoids in many people by age 30 years and the symptoms of haemorrhoids prevail from this age and over. It is the commonest disease affecting the anus in humans.

 

WHO DOES HAEMORRHOIDAL DISEASE AFFECT?

Haemorrhoidal disease is not common before age 30 years; thereafter the symptoms of haemorrhoids prevail affecting males and females in equal proportions. Pregnancy increases the risk of haemorrhoidal disease but many such cases resolve spontaneously after delivery and need no treatment.

The other risk factors found in people who develop haemorrhoidal disease are:

1. Chronic constipation and diarrhoea
2. Habitually sitting on the toilet bowl for long periods when not constipated
3. Pelvic tumours, including rectal cancer
4. Obesity
5. Penetrative anal sex
6. Regular lifting of heavy objects
7. Connective tissue disease
8. Familial

 

HOW DOES HAEMORRHOIDAL DISEASE MANIFEST IN THE AFFECTED?

1. Bleeding. This is the commonest way diseased haemorrhoids announces itself. The bleeding occurs when passing stools and the blood is bright red and splashed the toilet bowl. The bleeding typically occurs during passage of stools because of the pressure exerted on the vessels which rupture.
2. The congestion in haemorrhoidal diseases leads to proctitis and anal discharge. Itching of the anus also occurs
3. Anal discharge. Proctitis leads to fluid discharge from the anus
4. Feeling of heat or burning sensation in the anus. The engorged vessels contain blood all the time and the heat in blood worms the anus to give rise to a feeling of heat or burning sensation in the anus.
5. Descent of the haemorrhoids. When diseased internal heamorrhoids descend down the anus with time. The degree of descent of the haemorrhoids is directly related to the extent of weakness of the connective tissue supporting them.

 

WHAT WILL THE DOCTOR DO WHEN YOU REPORT TO THE HOSPITAL WITH HAEMORRHOIDAL DISEASE?

The doctor will talk to you to get more information about the disease to be sure what you are complaining about is haemorrhoidal disease.

You will then be made to lie on a couch. The doctor will insert his/her gloved finger into your anus.

A metallic or plastic instrument will be inserted into your anus and the inner lining of your anus viewed to see if your haemorrhoids are diseased.

The doctor may then request that you do an endoscopy of the large intestine even if it is ascertained that you have haemorrhoidal disease.

 

HOW IS HAEMORRHOIDAL DISEASE TREATED?

Many approaches to treating haemorrhoidal disease are available. They could be employed singly or in combination. These treatment approaches are:

1. Dietary modification to soften stools
2. Flavonoids
3. Topical soothing and anaesthetic agents
4. Injection of sclerosant
5. Cryotherapy
6. Banding
7. Surgery

 

 Prof Jonathan CB Dakubo