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Haemorrhoids

Haemorrhoids

Definition & Overview
  • Haemorrhoids, commonly known as piles, are swollen blood vessels in or around the anus and rectum.
  • They can be internal (inside the rectum) or external (outside the anus).
Epidemiology
  • Common condition, affecting both men and women.
  • Incidence increases with age, especially in individuals aged 45-65.
Causes & Risk Factors
  • Increased intra-abdominal pressure due to:
    • Constipation.
    • Pregnancy.
    • Heavy lifting.
  • Straining during bowel movements.
  • Low fibre diet.
  • Chronic diarrhoea.
Clinical Presentation
  • Internal Haemorrhoids:
    • Painless rectal bleeding during bowel movements (bright red blood).
    • Protrusion during bowel movement, often self-reducing.
    • May cause mucus discharge, sensation of incomplete evacuation, and rectal itching.
  • External Haemorrhoids:
    • Pain and swelling around the anus.
    • Possible blood clot formation leading to a painful, bluish lump (thrombosed external haemorrhoid).
Investigations
  • Clinical examination: Inspection and digital rectal examination.
  • Proctoscopy: For internal haemorrhoids.
  • Additional investigations if concerned about other colorectal conditions (e.g., sigmoidoscopy or colonoscopy).
Management
  • Conservative:
    • High-fibre diet.
    • Topical treatments: creams, ointments, and suppositories to relieve pain and inflammation.
    • Warm baths.
  • Interventional:
    • Band ligation for internal haemorrhoids.
    • Injection sclerotherapy.
    • Infrared coagulation or electrocoagulation.
    • Surgical haemorrhoidectomy for large or persistently symptomatic haemorrhoids.
Prognosis
  • Many individuals experience relief with conservative measures.
  • Surgical procedures have a high success rate but may be associated with complications like pain, urinary retention, and infection.

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