As part of his weekly health column, Dr. Roger Brown, Private GP at Kingsbridge Private Hospital, shares his insight into one of the common causes of rectal bleeding.
To follow up on the theme of my previous blog, one of the common causes of rectal bleeding is piles or, more properly, haemorrhoids.
Haemorrhoids are small varicose veins occurring inside or outside the back passage which, although they sometimes bleed, itch or are painful, causing alarm and distress, are not serious.
Bleeding from a haemorrhoid can be significant and occasionally may necessitate a visit to hospital, but this is rare.
Most people who have haemorrhoids experience a small bulge – perhaps as many as three - at the back passage (anus). Haemorrhoids may prolapse right out of the back passage, or may remain internal and simply bleed. Doctors grade them as internal or external, and from grade 1-4 depending on severity.
Haemorrhoids often resolve spontaneously in many cases e.g. if pregnancy or constipation is the underlying reason. Although no-one has found the exact cause of haemorrhoids, clearly pressure and congestion in the circulation at the back passage increases the likelihood.
If you are unsure about the cause of some rectal bleeding you may be experiencing, or whether you have haemorrhoids, it is sensible to seek the advice of your family GP.
This will involve an inspection of the back passage and a simple one finger examination of the back passage internally if there is no obvious external haemorrhoid. It may also involve the use of a small tube (procotoscope) to inspect the back passage if your GP is not sure.
Correcting constipation is sensible and your Pharmacist or GP can advise you on this. If you have pain or discomfort there are many proprietary creams and suppositories available over the counter without prescription.
If the haemorrhoids do not resolve with this or the bleeding is a daily occurrence and becoming a serious issue, surgery is an option, but not mandatory.
Traditionally, surgery involved excising and stitching the base of the removed haemorrhoid. Then came ‘banding’, a technique in which a band is applied to the root of a haemorrhoid and tightens around the base causing it to die and drop off.
Newer techniques involving electro-cautery, injection of the haemorrhoid with something to cause it to clot or, most recently, a newer technique called Trans Haemorrhoidal De-arterialisation (THD).
THD is as close to the ‘painless haemorrhoidectomy’ as can be achieved at present. It is a less traumatic, minimally invasive approach to haemorrhoids. No tissue is excised, avoiding any wounds and thus minimising post-operative pain and the risk of wound infections. Surgery can be carried out as a Day Case with minimal disruption to activities of daily living. Patients can reportedly get back to work 24 – 48 hours after the procedure. This technique is not available everywhere, but is offered at Kingsbridge Private Hospital on the Lisburn Road.
No treatment is 100% guaranteed and people may have a recurrence, especially older people who have poor tone in their muscles around the back passage.
Haemorrhoids can be a pain in the posterior in every sense, but they are a troublesome problem with a solution. Please seek medical advice if you think you might have haemorrhoids as there is always something that can be done to help.
Dr. Brown is a Private GP at Kingsbridge Private Hospital Belfast, available from 9-8pm Monday to Friday and 9-5pm Saturday.
Find out more about the 5-star Kingsbridge Private Hospital.