Treatment for Haemorrhoids General Surgery What are haemorrhoids? There are vascular cushions at the lower end of the rectum. These vascular cushions are normal structures that contribute to faecal continence. Problems arise when these cushions swell up or bleed. Internal anal sphincter External anal sphincter Internal haemorrhoid Dentate line Anoderm Perianal blood vessel
Prolapsing internal haemorrhoid
External haemorrhoid
What are the factors contributing to haemorrhoids? • Genetic predisposition to weak rectal vein walls and/or valves around your rectum • Squatting during bowel movement • Prolonged straining • Inadequate fluid intake • Pregnancy How do I know if I have haemorrhoids? • Fresh bleeding on bowel movement • Itchiness • Prolapse of haemorrhoidal tissue during bowel movement • Pain if blood clot accumulates However, these symptoms can overlap with more serious conditions like cancer of the large intestine.
Therefore, your surgeon may suggest other tests such as colonoscopy to rule out other possible causes of the above symptoms. What are the treatment options available? 1) Non-operative treatment As anal cushions have an important function in maintaining faecal continence, non-operative methods should first be used if haemorrhoids are minimally symptomatic. a) Correct toilet habits Sitting toilets are preferred to squatting toilets. Reading and other habits that prolong the time required for bowel movement must be stopped. b) Nutrition High fibre diet may aggravate constipation by producing bigger, harder and more impacted stools. Some constipated patients require decrease in dietary fibre to ease bowel movement. A more cautious approach to fibre consumption will be recommended by your doctor. Adequate fluid intake is essential. c) Medication Oral medications have been shown to have properties to reduce bleeding and inflammation of haemorrhoids. They can be useful as an initial treatment and also as an adjunct to other forms of treatment.
d) Rubber-band ligation This is simple procedure that causes minimal pain. Rubber bands are applied above the haemorrhoid mass which results in shrinkage of the haemorrhoids. This method is 60-80% effective. 2. Operative treatment Surgery is recommended for severely prolapsing and/or large haemorrhoids that do not respond to non-operative treatment. a) Stapled Haemorrhoidectomy There is no external wound in this technique, and this may result in reduced post- operative pain and faster recovery. However, it may not be suitable for all cases.
a. Stapled Haemorrhoidectomy procedure
b. After procedure
b) Open Excision Haemorrhoidectomy This is the surgical removal of the prolapsed haemorrhoids. Our surgeons have helpful ways to reduce postoperative pain and improve healing. Your doctor will discuss your treatment plans with you.
What complications can occur? • Pain – especially during bowel movement. You should take adequate painkillers as prescribed and drink plenty of water. • Difficult urination – usually temporary and resolves the next morning. • Bleeding from operation site – some slight yellowish-blood stained discharge is expected during the first two to three weeks after surgery. Prolonged straining during bowel movement after surgery may result in more serious bleeding and should be avoided. • Stricturing – the anus may become tighter than before surgery. This can be avoided if you return for followup after surgery. The doctor can assess and treat before it becomes problematic. • The recurrence rate for haemorrhoids is about 10%. When to seek medical attention after discharge? • Excessive bleeding • If any of the above complications do not resolve Please return to our Acute & Emergency Care Department immediately if any of the above occurs.
Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
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