Haemorrhoids or Piles, as they are commonly known, are one of the most common problems to have afflicted people since time immemorial. They are responsible for much discomfort and suffering, while seldom being serious or life threatening. What are Haemorrhoids? Haemorrhoids are engorged blood vessels, occurring as swellings in the anal canal. They have a rich blood supply and often swell up in response to a bowel movement. When they bleed, it is often seen as fresh, bright red blood. The exact cause of Haemorrhoids is unknown but significant predisposing or contributory factors have been identified. The biggest factor seems to be related to straining during bowel movements. Another is pregnancy and child bearing, commonly cited as the originating event in women with Haemorrhoids. But, it is also common to see people with no known contributory factors having Haemorrhoids. Two types of Haemorrhoids are commonly described – Internal and External Haemorrhoids. Internal Haemorrhoids seem to be related to the main blood vessels supplying the anal region. They originate above a line called the “dentate line” and are covered by rectal mucosa. External Haemorrhoids are situated below this dentate line and are usually covered with skin. Problems with Haemorrhoids Many people have Haemorrhoids, which do not cause them any symptoms or problems and these do not require treatment. The commonest problem from Haemorrhoids is bleeding. The bleeding from Haemorrhoids is typically fresh and accompanies a bowel movement or some straining. Another common symptom is prolapse. When this occurs, a person feels a swelling protruding from the anus. This may or may not reduce in size (return inside) by itself. It may be necessary for one to push it back inside if it remains prolapsed. Pain is not a usual symptom of Haemorrhoids. Pain occurs only when there is thrombosis or hardening of the blood vessels. It also occurs when a prolapsed Haemorrhoid cannot be reduced. If pain is the primary symptom, other causes of anal or rectal pain must be looked for. Some present with itch and a wet anus. These two problems may be more difficult to deal with and are usually related to prolapse. Haemorrhoids DO NOT cause nor lead to cancer. What is important is that the diagnosis of Haemorrhoid bleed or pain is confirmed. Further investigations like a colonoscopy may be necessary in some patients to rule out other causes. Treatment of Haemorrhoids The avoidance of constipation and straining during bowel movements is most important. The ideal is to have bulky soft stools, or well-formed stools without the need to strain to evacuate. Minor degrees of Haemorrhoids will respond to an increased fluid and fibre intake alone. Laxatives causing diarrhea actually worsen Haemorrhoids. Medication There are many sorts of medication available for Haemorrhoids. A wide array of anal ointments and suppositories can be obtained. These medications help by reducing the inflammation, swelling and discomfort. Some contain a low dose of steroids. These are recommended for short periods of treatment and for mild degrees of Haemorrhoids. Oral medications are also available, which have been shown to be efficacious in reducing the severity, and symptoms of an acute Haemorrhoid attack. Minor Office Procedures Many Haemorrhoids can be treated by painless, minor procedures. Essentially, these procedures are aimed at causing some shrinkage or fibrosis of the Haemorrhoids. Injection Sclerotherapy is painless and takes about 2 – 3 minutes to perform. A sclerosant (chemical that will harden the pile) is injected into the Haemorrhoid causing it to shrink. Rubber Band Ligation is another easily performed procedure, which is also painless. A rubber band is used to strangulate the Haemorrhoid. After a few days, the rubber band drops off leaving a pile that has shrunken. There are other methods like Infra-Red Coagulation and Freezing Techniques to achieve the same desired effect. All of these methods can be used with fairly good result for milder degrees of Haemorrhoids. Surgical Procedures A more permanent solution for large Haemorrhoids is surgery. Surgery for Haemorrhoids has, over the years, earned a bad reputation. Post-operative pain is the main culprit. However, many modifications of Haemorrhoid surgery have been made over the years in an attempt to reduce the pain and discomfort. Traditional Haemorrhoid surgery involves an Excisional Haemorrhoidectomy. This entails excising (removing) the Haemorrhoids. Countless modifications of this method have been devised. They range from using different cutting devices (from scissors to laser) to suturing the wounds or leaving them open. None of these modifications have stood out from the rest as being clearly better. However, countless patients have gone through these procures with excellent results. Presently, the latest procedure that has shown superior and excellent results, especially with respect to pain, is Stapled Haemorrhoidectomy. Stapled Haemorrhoidectomy (Longo Haemorrhoidectomy) is a technique where a Titanium Stapling Gun is used to perform surgery. The Haemorrhoids are excised in the upper part and the anal cushions are drawn back in to the anal canal. Because there is no skin wound, there is hardly any post-operative pain, except for an uncomfortable feeling, which usually subsides after a few days. This procedure has been performed throughout the world with excellent reviews. It is likely to be the procedure of choice for Haemorrhoid surgery. Conclusion Haemorrhoids are an extremely common disease that afflicts many. Increasing fluid and fibre intake to ensure good bowel movements is most important measure to avoid Haemorrhoids, and for the treatment of Haemorrhoids. Many Haemorrhoids can be treated easily and painlessly with minor procedures like injection or rubber banding. For the larger Haemorrhoids, the new Stapled Haemorrhoidectomy can be performed safely and with much less pain and discomfort compared to previous surgical methods.