Haemorrhoids & Anal Problems

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Haemorrhoids & Anal Problems

Haemorrhoids, also known as piles, are enlarged blood vessels in the anal canal, positioned at the end of your large intestine. They form cushions of tissue that can become congested, prolapsed or bleed when you pass stools. They are most common between 45 and 65 years of age but can affect younger people too.

Other anal problems are also common and like haemorrhoids, most can be easily treated following accurate diagnosis as well prevented from returning with the correct medical advice.

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Haemorrhoids

Haemorrhoids (piles) are swollen, enlarged blood vessels in and around you anus. They do not always cause symptoms but you may experience:

  • Bleeding or mucus discharge when you pass stools
  • An itchy, sore or red anus
  • A lump that hangs down from your anus after passing stools.

Haemorrhoids are associated with increased pressure in the blood vessels in and around your anus. This may be due to too much straining caused by constipation. Other factors that can increase your risk include:

  • Pregnancy
  • Being overweight
  • Ageing
  • Lifting heavy objects
  • Persistent cough.

Anyone can be affected but they are more common as we age and the body’s supporting tissues weaken.

Haemorrhoids often clear up by themselves but you can also apply cream to relieve short term symptoms, or take a laxative or fibre supplement to make it easier to pass stools. In severe cases you may need an outpatient  procedure called banding (using a tight band to cut off blood supply to the haemorrhoid) or surgery.

  • Increase the amount of fibre in your diet
  • Drink plenty of fluids
  • Exercise regularly
  • Avoid becoming overweight
  • When you have the urge to go to the toilet, do not ignore it as this can cause stools to become hard and difficult to pass.

Learn more about the causes and types of Haemorrhoids

Anal itching & eczema

  • A powerful urge to scratch the area around the anus, leading to sore, broken skin and tearing
  • Possible excoriated and thickened skin
  • Itching can affect sleep
  • May cause anxiety or depression.

An itchy bottom (pruritus ani) can have a number of possible causes, including:

  • A bacterial infection
  • Atopic eczema, causing the skin to become red, dry and flaky
  • Haemorrhoids (piles) – swollen and enlarged blood vessels in and around the anus
  • In children, threadworms
  • Discharge and leakage from the anal canal or the presence of anal fistula
  • Sometimes there is no identifiable cause.

There is no single group of people who are particularly at risk, although children may be especially prone to threadworms. Symptoms can be exacerbated by heat, moisture, stress or anxiety.

  • Avoid using perfumed creams, soaps, wipes and powder on the affected area
  • Your doctor may prescribe creams or ointments to help relieve the itching and protect the skin
  • Treatment for any underlying causes, such as a bacterial and fungal infection or piles.

Keep a note of when your symptoms worsen – for example, after eating certain foods or at night. Wear loose fitting underwear and avoid repeated vigorous wiping. You can talk to your GP about how to prevent some of the symptoms.

Anal 
Fissure

An anal fissure is a cut, tear or sore in the lining of the anal canal, between the rectum and the anus.

Symptoms include:

  • Pain when you pass a motion, which can be followed by a sharp burning pain that may last several hours
  • Blood in your stools – bright red and fresh looking.
  • Damage to the anal canal or anus, normally caused by constipation and straining resulting in the tear
  • Persistent diarrhoea
  • Inflammatory bowel disease
  • Sexually transmitted infection
  • Pregnancy and childbirth
  • Sometimes there is no obvious cause.

Anal fissures are common – around one in 10 people may be affected at some point in their life. Children and young adults, up to the age of 30, are most likely to suffer from fissures.

  • Most anal fissures heal within a few weeks without needing treatment
  • Over the counter painkillers, such as paracetamol or ibuprofen, can help manage the pain
  • Soaking your backside in a warm bath after you pass stools can also be effective
  • Medications, such as laxatives to make your stool easier to pass, and painkilling ointment
  • Surgery or an injection of botox may be recommended for persistent fissures.
  • Increasing dietary fibre, including fresh fruit and vegetables, wholemeal bread and brown rice, to avoid constipation
  • Drinking plenty of water to stay well hydrated and exercising regularly
  • Don’t ignore the urge to go to the toilet as this can cause stool to dry out and harden, making it difficult to pass.

Read our answers to Frequently Asked Questions by other patients of Windsor Bowel Clinic

Anal Fistula

An anal fistula is a small tunnel under the skin that can develop as a result of an abscess near the anus. When the abscess heals and the pus drains away it can leave a channel that will not heal. The only external sign might be a small hole in the skin near your anus.

Symptoms of an anal fistula include:

  • a constant throbbing pain that worsens when you pass stools, or sit down
  • skin irritation
  • unpleasant smelling discharge, pus or blood
  • swelling and fever if an abscess forms
  • leakage from around the anal canal.

An anal fistula can develop if an anal abscess fails to heal properly once the pus has drained away.

One in every two to four people who have had an anal abscess develop a fistula. They can also be linked to certain conditions including: Crohn’s disease, diverticulitis and hidradenitis supperativa, and can develop as a complication of anal surgery.

Anal fistulae usually require surgery. There are a number of different procedures, including:

    • Fistulotomy – cutting open the fistula so it heals into a flat scar
    • Seton procedure – placing a suture which is a piece of surgical thread in the fistula to help it heal
    • Filling the fistula or blocking the entrance with a flap of tissue.

Follow the advice of your doctor or surgical team if you have had surgery, complete any course of antibiotics and be sure to attend for any follow-up appointments.

Rectal bleeding/irritation/pain

Rectal bleeding is bleeding from your anus. The blood might be bright red, or very dark. Sometimes it might be accompanied by mucus and irritation or pain in and around the anus.

Various conditions can cause rectal bleeding, including:

  • Haemorrhoids – bright red blood, with possible pain, itching and lumps
  • Anal fissure – bright red blood and pain when passing stools
  • Side-effects of medication such as warfarin – bright red blood
  • Anal fistula – bright red blood and pus, irritation, pain
  • Gastroenteritis – bloody diarrhoea, often with vomiting
  • IBD – bloody diarrhoea with cramps and bloating
  • Bowel polyps/early bowel cancer – blood in stools, change in bowel habit, mucus
  • Ulcer or diverticulitis – dark blood, stomach cramps.

Many of us experience rectal bleeding at some point in our lives but older people are particularly at risk as well as those taking medication for heart conditions or strokes.

Treatment will vary depending on what is causing the bleeding.

Eating a healthy diet rich in fibre and drinking plenty of fluids can help prevent rectal bleeding caused by anal fissure or haemorrhoids.

Rectal cancer

Rectal cancer is the development of malignant cells in the tissues of the rectum. Symptoms include:

  • Blood in your stools
  • A change in bowel habit – diarrhoea, constipation, a feeling that the bowel is not emptying properly
  • Abdominal pain
  • Change in appetite
  • Unexplained weight loss
  • Feeling very tired.

Certain factors increase your risk of developing colorectal cancers (cancers of the colon and rectum). These are outlined below.

You are more at risk of developing rectal cancer if:

  • A close family member (parent, sibling or child) has had colorectal cancer
  • You have previously had cancer of the colon, rectum or ovary, or bowel polyps.
  • You have IBD, familial adenomatous polyposis or Lynch syndrome.
  • You smoke or drink more than three alcoholic drinks per day
  • You are obese
  • You have a diet low in fibre or high in processed meat.

The treatment options will depend on:

  • The stage of the cancer and whether it has spread to other parts of the body
  • Where the cancer is in the rectum
  • Your general health
  • Whether this is a new diagnosis or a recurrent cancer.

Diets rich in vegetables, fruits and wholegrains and low in red and processed meats have been linked to a lower risk of colorectal cancer. Other risk factors can also be managed by lifestyle changes, including losing weight, exercise, giving up smoking and reducing alcohol intake. Participating in screening can detect cancer at an earlier stage, therefore making it easier to treat with better outcomes.

To find out more information, read our answers to Frequently Asked Questions by other patients of Windsor Bowel Clinic

Anal Skin tags

Anal skin tags are small bumps or raised areas on the anus. They are common and benign. Symptoms include sensitivity, discomfort and itching.

If a blood vessel around the anus becomes swollen or enlarged, it can cause a skin tag. This is because the extra skin can remain even after the swelling subsides.

Skin tags are common and can be caused by constipation, heavy lifting, strenuous exercise, pregnancy and haemorrhoids. People with IBD are also at risk.

Treatment for skin tags is fast and simple. You will be given a brief anesthetic and the skin tag will be surgically removed as a minor day case procedure.

Avoiding constipation, heavy lifting or strenuous exercise may reduce your risk of developing anal skin tags.

Pilonidal Sinus

Symptoms of Pilonidal Sinus include pain, discharge and infection in the natal cleft (just overlying the coccyx).

Ingrown hairs burrowing into the skin is the cause of Pilonidal disease. Pits or sinuses can then form which discharge and lead to infection. A chronic cavity can occur underlying the pit and this sometimes results in an abscess if the pit becomes infected.

Patients that are most at risk are those in a younger age group (15-40) with prominent hair formation in this area.

Surgery is performed to excise the pit and any associated cavity. The wound is usually closed afterwards and the procedure is done as a day case.

Keeping the area as hair free as possible reduces progression and further pit formation. Taking antibiotics early if there is acute infection is advisable to try and prevent abscess formation.

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