When the rectum bleeds

Presenting commonly as bleeding through the rectum, haemorrhoids, is one of the commonest surgical problems among people: it is also a condition where patients are least likely to go to doctors. But with simple measures it can be treated early and the symptoms alleviated with a healthy lifestyle. Despite the distress hemorrhoids or piles is not a disease to be alarmed about. It will not grow into a cancer or cause life threatening problems.

Although the commonest cause for painless per rectal bleeding is haemorrhoids, when a patient develops this for the first time, it is necessary to exclude sinister causes of rectal bleeding. This is essential in those above 45 years and people with risk factors for cancer, who get the problem for the first time. Cancers in the rectum too cause rectal bleeding and this could be the earliest warning sign.

However, cancer is far less common than piles so the chances of those with rectal bleeding having a cancer is not common. But, missing out a cancer at early stage can have serious consequences. Even if the diagnosis is simply haemorrhoids, it needs attention. Piles per se are not cancerous. But the chances are that the cause of the piles could be due to a growth higher up in the bowel, piles being the manifestation, especially in newly occurring piles after the age of 45 years.

Painless bleeding when passing stools will usually be the earliest symptom of haemorrhoids. You will also get discomfort in the anal area when the disease progresses. Discharge of mucus, feeling a lump at the anal opening, sometimes coming out at straining and going back spontaneously are also symptoms. Irritation and itching of the skin around the anus could result from long term mucus discharge. When the disease is well advanced, the lump will stay out and you may suddenly feel severe pain.

Piles are not new growths or tumours. The blood vessels in the delicate skin within the anal canal get engorged with blood, forming soft lumps covered with the soft skin in the anal canal. Later, the blood inside the vessels can clot; the vessels can get damaged causing bleeding, irritation and a feeling of fullness.

Risk factors for the development of piles include constipation, prolonged straining, increased pressure in the abdomen due to any masses or pregnancy, childbirth, heavy lifting, chronic cough or anal intercourse. If your parents or siblings have piles or varicose veins, you are more at risk.

Seeking medical advice is important. Especially if you are above 40 years you may need to undergo certain investigations, to find out the cause for piles. Your doctor will get the necessary details from you, and examine the rectum for presence of piles or any abnormal growths. After weighing the risks, you may need to undergo some investigations, where the lower part of your bowels and the rectum is examined by sending a tube with an inbuilt tiny camera. The procedures are called colonoscopy and sigmoidoscopy. These will be done free of charge in government hospitals. If those are normal, haemorrhoids will be managed accordingly.

In the very early stages, called 'first degree' by the doctors, the management is mostly in the patient's hands. It's all about preventing constipation and avoiding straining. Sometimes you will be prescribed medication too.

Apart from avoiding straining, good peri-anal hygiene may be helpful in providing symptomatic relief and preventing irritation. Try sitting in warm water baths. Avoid tight undergarments. You may also be prescribed medication to be applied to the anal area. If the disease is advanced the doctors may decide to inject chemicals into the engorged vessels or to band them, to prevent bulging. These can be done as out-patient procedures and there is hardly any pain.

In the very advanced stage you may have to undergo surgery. Even when the disease is not very advanced you can discuss the option of surgical removal of piles with your doctor. It is not major surgery, lasting about one hour, depending on the extent of the disease. You will only need to stay about 1 or 2 days in hospital after it. Treatment does not remove the possibility of you getting piles again. Avoid constipation as much as possible even after.