Haemorrhoids are often described as “varicose veins” of the anal canal. In fact they consist of various engorged blood vessels covered by lining of the anal canal. As the haemorrhoid enlarges it bulges into the anal canal and eventually may protrude at the edge of the anus (prolapse). This may be associated with an anal tag.  External anal skin tags usually represent the remnant of stretched skin arising from prolapsed internal haemorrhoids at the anal verge or a previous peri-anal thrombosis.

A perianal thrombosis (clot) is a painful exquisitely sensitive lump on the edge of the anus, often mistaken for a prolapsed internal haemorrhoid.

Internal haemorrhoids are due to a weakening of the supportive connective tissues within the anal canal allowing the lower rectal lining to bulge.  Contributing factors cause veins within the haemorrhoids to enlarge. Contributing factors might include:

• ageing

• chronic constipation or diarrhoea

• pregnancy

• faulty bowel habit

• straining at bowel action

• long periods on the toilet

Bleeding this is the most common symptom of haemorrhoids, usually seen on the toilet paper.  Often the blood may drip or spray into the toilet bowl. It is unwise to assume that bleeding is always due to haemorrhoids without appropriate investigation.

Lumps. Prolapse may only occur during a bowel action or at other times. Usually this is reducible. Acute prolapse is less common, painful and requires a surgical opinion.

Discomfort - Pain. Moderate discomfort is common but severe pain may indicate a complication of the haemorrhoids (e.g. Perianal thrombosis, acute prolapse) or the presence of an anal fissure (split).

Itch (pruritus ani) this common symptom is due to mucous discharge.

There is no relationship known between haemorrhoids and cancer. However the symptoms of haemorrhoids may be very similar to those of bowel cancer.

It is important that all symptoms, especially bleeding, are investigated by a surgeon specially trained in treating diseases of the colon and rectum.

You should not rely on self medication. A consultation with your general practitioner and subsequent referral to a colorectal surgeon will ensure that your symptoms are properly evaluated and effective treatment is prescribed.  Elimination of rectal bleeding is important.  Mild symptoms can frequently be relieved by increasing fibre and fluids in the diet and avoiding excessive straining. Local ointments are of limited value but may give some relief. A perianal thrombosis may necessitate excision of the small blood clots under local anaesthetic.  This procedure should provide rapid relief. After appropriate investigation the majority of haemorrhoids causing symptoms can be treated by simple office procedures.

Injection. Injection with a chemical - phenol (in oil) can stop bleeding if the haemorrhoids are small.

Haemorrhoidectomy. Surgical excision is sometimes necessary to treat large or complicated haemorrhoids. The procedure is performed under anaesthesia. The operation may be conducted in hospital or in a day care centre. Other methods such as infra-red (heat) coagulation, doppler ultrasound-ligation and laser removal have not demonstrated superior results to the above methods.