General Surgery Haemorrhoids

We can deal with most anal problems at The London Day Surgery Centre.  Some do not require an operation and some do, under local or general anaesthetic.  Patients are able to go home immediately after their treatment or after an hour or so in the recovery area. 

 

Haemorrhoids are not painful until they develop complications.  There are two painful anal conditions – thrombosed external haemorrhoid and anal fissure.  There are two infective conditions – abscess and fistula-in-ano. Any of these conditions can be confused with haemorrhoids, even by doctors and nurses.

Commonly it is important to exclude other diseases of the intestinal tract by tests, such as a colonoscopy, which we do not do at The London Day Surgery Centre.  This will be explained to you, if necessary, and the arrangements for the tests can be made by us.

 

 

Piles (the other name for haemorrhoids) are very common and are due to dilatation (swelling) of the normal veins lying just below the skin surface of the anal canal.  These veins normally form what are called 'anal cushions' and being soft and malleable help the sphincter muscle to make a gas tight seal.  They distend because humans cause increased pressure within them by straining to pass hard stools, obesity, pregnancy and spending too long sitting on the toilet.

Piles are usually adequately controlled by only an ointment or suppositories.  Sometimes, however, they can become more troublesome and then require (surprisingly non-painful) treatment by injection or banding (using a special instrument to apply a tiny elastic band).  It is unusual these days to have to carry out a haemorrhoid operation.  These local treatments are carried out through a small hollow instrument called a proctoscope which is inserted into the anus and is not painful although some patients find it uncomfortable.

 

Patients with symptoms suggestive of piles (bleeding, itching, soreness) need an examination of the lower end of the bowel with a lighted tubular instrument called a sigmoidoscope.  This requires no anaesthetic or sedation and together with treatment of the piles takes five or ten minutes only.  You will be asked to return after about four weeks for a check and it is quite common to require another set of injections or banding.  Some patients require three or four and a very few piles never seem to respond completely.

 

It is common for piles to recur months or years later but this can be lessened by attention to diet and this advice is also available at the London Day Surgery Centre.  The important thing is to keep your stools soft by eating plenty of dietary fibre and drinking plenty of water or clear fluid.  And you should avoid spending a long time on the toilet.

 

In this condition a blood clot has formed in the dilated vein which is the pile.  This causes a very tender firm lump which is different from the soft swelling, or no noticeable swelling, of an uncomplicated pile.

 

If left alone most settle in about two weeks but the pain can be immediately relieved by a small operation under a drop of local anaesthetic.  A small incision is made over the blood clot and it is squeezed out.  You will then need frequent washing, care to keep your stools soft and probably continuing pain killer tablets for another day or so.  Sometimes the incision does need repeating two or three days later.

 

Complications are very rare but you will be given a 24 hour telephone number in case of need.  Patients are given a follow up appointment for about four weeks later so that a complete ano-rectal examination can be carried out without causing pain.