Rectal bleeding: haemorrhoids

ILLUSTRATION | NATION Haemorrhoids usually result from excessive pressure on the veins in the rectal and anal area, or more generally, on the pelvic floor.

What you need to know:

  • Bleeding from the anal canal can be caused by several conditions, such as anal fissures (sort of cracks at the anus), haemorrhoids, severe ulcers with lots of bleeding, or even cancer.
  • Haemorrhoids usually result from excessive pressure on the veins in the rectal and anal area, or more generally, on the pelvic floor.
  • The main symptom is anal/rectal bleeding, which is often painless, though in a few cases, particularly if the blood in the haemorrhoids clots, one may experience a lot of pain.
  • Haemorrhoids are diagnosed from the history as well as from physical examination.

Dear doctor

For several months, I have noticed blood in my stool. Lots of it. I didn’t feel pain initially. Now I have started to.

I am quite embarrassed about it, so I have not seen a doctor as I am afraid of the examinations they may need to carry out.

Lately, I even feel like passing stool, but when I go to the loo, nothing comes out except blood.

What could be the issue?

Bleeding from the anal canal can be caused by several conditions, such as anal fissures (sort of cracks at the anus), haemorrhoids, severe ulcers with lots of bleeding, or even cancer.

In your case, it is likely to be due to haemorrhoids. This is because of the initial absence of pain and the feeling of ‘something coming out’.

So what are haemorrhoids?

Haemorrhoids, also known also as piles, are enlarged veins in the anal canal.

What causes haemorrhoids?

Haemorrhoids usually result from excessive pressure on the veins in the rectal and anal area, or more generally, on the pelvic floor. This may be caused by constipation, straining when passing stool, diarrhoea, late pregnancy, being overweight or obese, sitting for long, and anal infections.

What are the signs and symptoms?

The main symptom is anal/rectal bleeding, which is often painless, though in a few cases, particularly if the blood in the haemorrhoids clots, one may experience a lot of pain.

Other symptoms include itch and sometimes pain on passing stool. One may also find mucous in the stool.

There is also the feeling of something coming out, yet on going to the toilet, nothing comes out. This is usually because the haemorrhoid comes through the anus and then goes back.

In more severe cases, the haemorrhoids will be felt constantly as a mass at the anus or outside it.

What complications can arise?

In case of prolonged blood loss, one may develop anaemia and experience such symptoms as fatigue and awareness of one’s heartbeat. One may also lose lots of blood suddenly and present in shock.

In some cases, the haemorrhoids may get infected and present with fever and pain.

How is a diagnosis made?
Haemorrhoids are diagnosed from the history as well as from physical examination. The doctor will want to inspect the anal area and do a digital (finger) exam. They may also do other tests to rule out cancer, including proctoscopy and colonoscopy.

TREATMENT

Treatment aims at addressing the cause. Various treatments are available:

Diet: The mainstay of treatment is diet modification, with a focus on increasing intake of water and fibre-rich foods.

Warm salty baths: Sit on a basin with warm water to alleviate pain and itchiness. You can do this for 10 to 15 minutes twice a day

Stool softeners that your doctor will prescribe

Creams applied to the area to reduce pain.

Other treatments target removal or cutting off circulation of the haemorrhoids. This is done if they are persistent or if they have a clot. These include:

Injection: To shrink the haemorrhoid

Banding: Prolapsed haemorrhoids (those that have come outside the anus) are ‘tied’ so the blood supply is cut off and they shrivel and break off.

Cautery or coagulation: Electric probes or laser beams are used to burn the haemorrhoids, causing them to break off.

Surgery: The haemorrhoids are removed. While haemorrhoid removal treatments are effective, unless one takes up dietary and lifestyle changes to address the causes, they may recur.

The writer is a doctor and public health specialist. Send your questions to [email protected]