More than half the population will suffer from haemorrhoids at some stage in their lives. Whilst many cope with mild discomfort sometimes they can force the person who has them to make unwelcome lifestyle changes due to such symptoms as being uncomfortable sitting in the same place over an extended period of time.

What are haemorrhoids?

Haemorrhoids, or piles, are a swelling on the inside of the anal canal which can, in extreme cases, swell and rupture causing bleeding. If left untreated they can become increasingly swollen and painful and may even become infected. Medically they can be classified into four grades:

Grade 1 No prolapse
Grade 2 The haemorrhoids recede by themselves.
Grade 3 The prolapse can be pushed back manually
Grade 4 The haemorrhoids are permanently external

What are the symptoms associated with haemorrhoids?

Any of the following may be indicative of haemorrhoids:

• Anal itching
• Bleeding during bowel movements
• Sensitive lumps around the anus.

What causes haemorrhoids?

The following have been identified as having a possible connection with the development of haemorrhoids:

• Age
• Chronic constipation
• Chronic diarrhoea
• Straining during bowel movements
• Overuse of laxatives

How can the condition be diagnosed?

Because haemorrhoids are similar to other conditions such as an anal fissure it is important to be seen by a consultant and have a proper diagnosis. This will involve an examination of the anal area. This may be momentarily painful if external haemorrhoids are present but is helpful in making a correct diagnosis. In some instances the consultant may need to use an instrument called an anoscope to see internal haemorrhoids.

What is the HALO technique?

A relatively new technique – haemorrhoid artery ligation operation (HALO) – can overcome these problems.

HALO is a laparoscopic technique involving an ultrasound probe to find the blood source as it flows into the piles then tying the vessels off and leaving them to shrivel up. Because no incisions have to be made it is relatively painless and can be done as day surgery. Recovery is measured in days rather than weeks.

After an operation under general anaesthetic lasting about half an hour and some minor discomfort the patient can expect to be home within hours. Sleeping with a pillow between the legs is one way to prevent strain on internal tissues. Consuming more liquid than normal and eating plenty of fibre is usually all that is involved in dietary matters.

What is the HALO RAR technique?

The HALO procedure works well for smaller haemorrhoids were bleeding is the main problem. When haemorrhoids become larger (grades 3 & 4) both the bleeding and the prolapse need to be addressed. A new modification of the HALO technique available since late 2005 called the recto-anal repair or RAR has been introduced to tackle the latter. A modified hand piece allows a plication stich to pull the prolapsed haemorrhoids back into position inside the anal passage after the HALO has been performed. Your doctor can advise as to which procedure is most suitable for you

What other treatments are there?

Most often haemorrhoids are considered to be mild and changes in lifestyle and diet can be sufficient to alleviate the condition. One aim is to ensure that the stool should be soft and easily passed - a high fibre diet will help achieve this.

Keeping the anal area clean is also important for recovery. Sitz baths (sitting in warm water) can help bring relief and over the counter wipes containing witch hazel (a natural astringent) can also help.

For more severe cases where the condition is more painful more invasive forms of treatment will be necessary.

• clot removal. Minor surgery often done with a local anaesthetic. A small incision is made and the clot lifted out
• rubber band litigation. A small rubber band is placed around the haemorrhoid. This will starve it of bloodand both the band and haemorrhoid will be discharged after a few days and the wound will heal.
• injection therapy. Also known as sclerotherapy. A small hardening agent is injected into the haemorrhoid which causes it to shrivel and pass with bowel evacuation.
• infrared coagulation. Infrared light is aimed at the base of the haemorrhoid causing it to clot, shrivel and recede