Common Lumps & Bumps – Haemorrhoids

What are they?

 Haemorrhoids, otherwise known as piles, are a common lesion experienced by many people. They consist of engorged veins in the anal mucosa (lining). They may arise in the anal cavity itself (internal) or near the opening of the anus(external).

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Depending on the site and size of the hemorrhoid, they may present either as a sensation of something in the anus ( often with the feeling that you need to pass motion) or as a visible lump at the anal verge. Haemorrhoids may or may not be painful and can occasionally bleed, causing the alarming symptoms of blood mixed in the stool or streaks of blood seen on wiping.

Why do I get them?

The veins in the anal region fill with blood to help control bowel movements. Theses veins may become strained and chronically engorged when there is a prolonged increase in the pressure applied. Increased pressure caused by straining at the toilet when passing motion (in constipation for example) may lead to the development of haemorrhoids. Additionally, increased intra-abdominal pressure, caused by increased girth in overweight persons or in pregnancy for example, may also lead to the development of haemorrhoids.

Are they dangerous?

Haemorrhoids are by themselves harmless. Often they may present alarmingly ( the sudden onset of blood in the stool for example). It is important to assess new onset haemorrhoids and rule out other causes of per rectal bleeding such as rectal tumors, or sinister causes of vein engorgement such as chronic liver disease.

What should I do?

Firstly, you should seek medical attention for all new cases of hemorrhoids. They may present as a lump in the anus, with or without discomfort. Often you may also notice bleeding per rectum, particularly when passing motion. Sometimes the only symptom you experience is the passage of blood from the anus. Occasionally the lump may not be visible and you may only notice the sensation of fullness in the anus, with a constant urge to pass motion, even though you have minimal output when you try to empty your bowels.

Your doctor will do a clinical examination to determine the cause of your symptoms. This may include a rectal examination and possibly a proctoscopy to visualize the lesion(s). Based on your history and relative risk factors you may be recommended to see a colorectal specialist to do a baseline assessment and screening for other conditions.

How do I get rid of it?

Most hemorrhoids may be managed easily and effectively in the GP setting. A course of oral medications can reduce the size of the piles, often completely. Topical applications and/or suppositories may be used for relief of symptoms such as discomfort, pain or to reduce the size of the piles itself. You may need dietary supplements such as fibre or laxatives to help ensure good bowel motion to minimize recurrence of piles caused by constipation.

Occasionally some patients may have recurrent piles, or piles that do not respond well to medications. In these circumstances, you may warrant visit to a colorectal surgeon to discuss operative management. Oftentimes these procedures may be done as a day surgery, with you being able to return back to work shortly after.

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