Haemorrhoids and Anal Fissures

What are haemorrhoids and anal fissures?

Haemorrhoids, also known as piles, are distended or swollen blood vessels (veins) supplying the rectum or the anus (back passage). Haemorrhoids can be internal, situated inside the anal canal, or external, around the opening of the anus. Haemorrhoids can exist for years but may not be detected until they bleed. They usually last for several days and often come back.

Anal fissures are cracks or tears in the delicate lining of the anus. They usually radiate out from the opening of the anus.

Both haemorrhoids and anal fissures can cause itching, bleeding, and can be painful. Bright red blood may be seen on the toilet paper or on stools, or may drip into the toilet bowl following a bowel movement. Itching and pain occurs during and after passing stools. Anal fissures are generally more painful than haemorrhoids, and a throbbing pain may last for several hours after bowel movements.

Can I get treatment for haemorrhoids/anal fissures online?

The Online Clinic can prescribe ointments and suppositories that can help to shrink and heal haemorrhoids and reduce the itching associated with this condition. We can also prescribe a helpful gel to aid the healing of an anal fissure. Please complete a consultation form on the website to get started. Your consultation will be reviewed by a doctor and you can then proceed with a purchase if the doctor agrees to prescribe.

Should you be concerned about haemorrhoids and anal fissures?

In most cases, the bleeding from haemorrhoids and anal fissures is not of a serious nature. However, all anal bleeding should be investigated as it may be indicative of something more serious such as bowel disease.

Who gets haemorrhoids and anal fissures?

Anyone can develop haemorrhoids and anal fissures. They commonly occur in pregnant women.

What causes haemorrhoids and anal fissures?

Haemorrhoids are thought to arise from recurring pressure in the veins of the rectum and anus. Anal fissures are caused by damage to the anal canal, such as from over stretching of the delicate tissues beyond their limits, which usually occurs during bowel movements.

They can occur when the anal sphincter muscles (a ring of muscles surrounding the anal canal) spasm as a stool is passed, resulting in injury to the anal canal.

Consequently, both haemorrhoids and anal fissures are commonly caused by constipation and excessive straining to empty the bowels. Conversely, chronic diarrhoea also causes a stress on the bowels and anus, and can lead to these conditions. Other risk factors include sitting for long periods, obesity, age-associated loss of muscle tone, anal infection, anal intercourse, rectal surgery, and inflammatory bowel disease. Haemorrhoids and anal fissures particularly occur in pregnant women during the third trimester due to pressure from the baby, and one month after giving birth due to giving birth or as a result of episiotomy.

How are haemorrhoids and anal fissures diagnosed?

The doctor will want to distinguish between haemorrhoids and anal fissures, or determine whether you have another condition. Diagnosis is made by examination of the anus and surrounding area. This may involve a tube device called an anoscope to see the anus interior (anoscopy), or a tube-like optical instrument to examine the rectum and lower colon (sigmoidoscopy).

How are haemorrhoids and anal fissures treated?

Small lifestyle adjustments can relieve the symptoms and aid healing of haemorrhoids and anal fissures. To avoid constipation, increase your intake of water to maintain good hydration, and dietary fibre, with plenty of fruit vegetables and wholegrain cereals.

To relieve pressure on the anus, anal canal and rectum, do not strain to pass stools and put your feet on a foot stool when sitting on the toilet. Use soft, unperfumed toilet paper or moist wipes. Keep your anal area clean by washing. A sitz bath is ideal to relieve pain; soak in warm for about 10 minutes regularly throughout the day.

Itching, pain and swelling may be treated with topical creams, ointments or suppositories containing a corticosteroid, which reduces these signs and symptoms of inflammation. Some treatments contain a local anaesthetic for pain relief, but used over a long time these may also cause itching. Creams and ointments containing zinc oxide may be of benefit to the irritated area. Firstly, try an over-the-counter preparation but consult a doctor if your complaint worsens, does not resolve, or recurs.

Stool softeners in the form of fibre supplements are available to prevent hard, dry stools, which are mainly bulking agents. Other laxatives should not be used as they may cause diarrhoea, which exacerbates these conditions.

Most haemorrhoids and anal fissures completely disappear after a couple of weeks if approached as suggested above. However, severe haemorrhoids and deep anal fissures may require injection, cauterisation, or surgery. Haemorrhoids can be surgically treated with injection sclerotherapy, infrared coagulation, or rubber-band ligation, which cause shrinkage and the blood to clot. Rubber-band ligation is most effective, relatively painless, although pain relief may be required for the ache that usually lasts for 2-days after surgery. A common surgical procedure for anal fissures is lateral internal sphincterotomy (closing the fissure). Alternatively, fissurectomy (excision of painful fissures) may be performed. Controversially, chemical sphincterotomy using botulinum toxin injections may be carried out for chronic anal fissures that have not improved with other treatments to stop anal muscle spasms delaying healing.

How can I reduce the risk of haemorrhoids and anal fissures?

You can minimise the risk of haemorrhoids and anal fissures by making the simple changes of increasing fluid and dietary fibre intake, and by using fibre supplements if these adjustments do not keep the stools sufficiently soft. Regular exercise and maintaining a healthy body weight will also help. You should go to the toilet when you need to, neither hurry to evacuate a stool or sit on the toilet for prolonged periods, and avoid forceful wiping with rough paper following a bowel movement. Recurrence of haemorrhoids and anal fissures may be prevented by avoiding constipation and the urge or need to strain to pass a stool.