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If you have any other questions or need advice, please contact: Colorectal/Stomacare Nurse Between 8.30am - 5.00pm 01935 384352 Day Surgery Unit Between 8am and 7pm 01935 384339 Haemorrhoids After 7pm, the Senior Sister on duty (Clinical Site Manager) 01935 384525 Day Surgery Unit If you need this leaflet in another format, e.g. large print please telephone: 01935 384256 Leaflet No: 82111013 02/13 Review date: 02/15 www.yeovilhospital.nhs.uk Haemorrhoids (sometimes called piles) are swellings of the lining of the anus and lower rectum (back passage). There is a network of small veins (blood vessels) in the lining of the back passage and it is thought that these veins become wider and swell with blood if the pressure in and around them is increased. The veins and the overlying tissue may then form into one or more small swellings which are referred to as haemorrhoids. Consequences and complications of haemorrhoidectomy, excision or stapling What causes haemorrhoids? Infection - often causes bleeding and worsening pain. May need antibiotics to treat this (relatively common). An exact cause is unknown; however the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include: Ageing Chronic constipation or diarrhoea Pain - often severe for 2-3 weeks and can last for several weeks. We will give you painkillers and laxatives to reduce this (very common after surgery). Bleeding - initially and 5-7 after surgery (relatively common). Recurrence - with surgery, over 5 years , at least 10% will get recurrence of piles (relatively common). Anal stenosis (narrowing of the anus) - caused by excess scarring, problems with emptying bowels (infrequent). Incontinence - leakage of faeces (infrequent complication). Pregnancy Heredity Obesity Faulty bowel function due to overuse of laxatives or enemas Straining during bowel movements Spending long periods of time on the toilet (e.g. reading) Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate - their walls become thin and can bleed. If the stretching and pressure continue, the weakened veins will start to protrude. 1 6 Haemorrhoidectomy - surgical removal of the haemorrhoids There are two types of haemorrhoids: Is a permanent way to remove haemorrhoids. It may become necessary if: External (outside) haemorrhoids - develop near the anus and are covered by very sensitive skin. If a blood clot develops in one of them, a painful swelling may occur. The external haemorrhoid feels like a hard sensitive lump. It bleeds only if it ruptures. Clots repeatedly form in external haemorrhoids Ligation fails to treat internal haemorrhoids The protruding haemorrhoid cannot be reduced There is persistent bleeding A haemorrhoidectomy removes excess tissue that causes the bleeding and protrusion. It is done under anaesthesia and may, depending on circumstances, require a stay in hospital and a period of inactivity. Laser haemorrhoidectomies do not offer any advantage over standard operative techniques. They are also expensive and contrary to popular belief, no less painful. Doctors are studying a new procedure that uses a stapling technique to remove haemorrhoidal tissue and close the wound. No incision is made. More studies are needed before the long term effects of this technique are known. Internal (inside) haemorrhoids - develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal haemorrhoid can cause severe pain if completely ‘prolapsed’ - which means it is protruding from the anal opening and cannot be pushed back inside. Internal External 5 2 Do haemorrhoids lead to cancer? Treatment for haemorrhoids No. There is no relationship between haemorrhoids and cancer. However, the symptoms of haemorrhoids , particularly bleeding are similar to colorectal cancer and other diseases of the digestive system. Therefore, it is important that all symptoms are thoroughly investigated by a specialist in diseases of the colon and rectum. Ligation - rubber band treatment Do not rely on over the counter medications or other self-treatments. See your doctor first so your symptoms can be properly evaluated and effective treatment prescribed. How are haemorrhoids treated? Works effectively on internal haemorrhoids that protrude with bowel movements (image A). A small rubber band is placed over the haemorrhoid, cutting off its blood supply (image B). The haemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes causes mild discomfort and bleeding. Mild symptoms can be often be relieved by increasing the amount of fibre (e.g. fruit, vegetables, pulses and cereals) and fluids in your diet Eliminating excessive straining reduces the pressure on Ligator haemorrhoids and helps prevent them from protruding Forceps Sitting in a bath of plain warm water for about 10 minutes after using the toilet may provide some relief Rubber bands Appropriately prescribed medication, e.g. ‘Anusol’ to reduce discomfort and swelling Rectum With these measures, the pain and swelling of most symptomatic haemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks. If these measures do not relieve symptoms and you are still in severe, persistent pain, your doctor may refer you to a Colorectal Surgeon and you can receive treatment as a day case patient. The surgeon may decide to remove the haemorrhoid containing the clot with a small incision, performed under local anaesthesia as an outpatient, this procedure generally provides relief. 3 Haemorrhoid Often there is anal pain in the 24-48 hours following the banding. Occasionally there can be bleeding when the band separates. Injection We do not offer this at Yeovil District Hospital, but the doctor you see will be able to discuss this with you. 4