Haemorrhoids develop in the anal canal when the vascular endo-anal cushions become stretched or swollen, due principally to dilatation of the contained veins.

1. How are Haemorrhoids Classified?

Haemorrhoids are usually classified according to their severity.

	First degree haemorrhoids may bleed, but do not protrude.
	Second degree haemorrhoids protrude, but spontaneously reduce without the need for manual replacement.
	Third degree haemorrhoids protrude but can be reduced by manually pushing them back inside.
	Fourth degree haemorrhoids protrude from the anus all the time, and cannot be pushed back into the anal canal.

All degrees of haemorrhoids can bleed, and painful protruding swellings due to thrombosis are increasingly common with second, third, and fourth degree haemorrhoids.

2. What Causes Haemorrhoids?

Contributing factors include:

	Hereditary
	Low fibre diet
	Chronic constipation
	Prolonged straining of stool
	Sedentary lifestyle
	Pregnancy
	Stressful lifestyle

It is believed that the above factors cause a progressive disruption of the supporting structures in the anal canal.

What are the Symptoms of Haemorrhoids

The most common symptoms include:

	Bright red bleeding with defecation
	External protrusion of anal tissue
	Anal pain

Bleeding is the most common symptom, and if it is recurrent and neglected, a secondary iron deficiency anaemia may result.

Prolapsed thrombosed haemorrhoids may be extremely painful. Patients with any of the above symptoms should see their doctor for professional assessment and diagnosis.

Blood in the stools may be due to other causes including cancer, and adequate investigations should be carried out to verify that the bleeding is due to haemorrhoids only.

3. How to Prevent Haemorrhoids?

The following measures may help:

	Healthy lifestyle with increased physical activity
	High fibre diet
	Drink more water
	Avoid excessive straining at stool

High Fibre Diet
This may be all that is necessary to manage first degree haemorrhoids.

Injection
Injection usually is effective in stopping bleeding associated with first and second degree haemorrhoids.

Banding
Using a special instrument, a rubber band is placed around the base of the haemorrhoid, thus drastically reducing the blood supply to the haemorrhoid, which then “withers” and disappears.

Open Haemorrhoidectomy
Under general anaesthesia, each haemorrhoid is excised after its vascular pedicle is ligated. This traditional operation effectively removes the haemorrhoids, but the resultant open wounds take up to six weeks to completely heal. Patients remain in hospital up to five days, and experience significant local pain and discomfort for up to three weeks.

Stapled Haemorrhoidopexy
A stapling device is used to remove the disrupted and stretched structure of the endo-anal cushions, thus curing the haemorrhoid. The great advantage of this procedure is that, while it is performed under general anaesthesia, post-operative pain is minimal, and patients can usually leave hospital after 24 - 48 hours and return to work in under a week.

Haemorrhoid Artery Ligation Operation (HALO)
A miniature doppler ultrasound device is introduced into the anal canal to locate the arteries that supply the haemorrhoids. The supplying arteries are then ligated, drastically reducing the blood flow to the haemorrhoids, which subsequently shrink and "wither". "HALO" was introduced into Hong Kong in 2006, but has been used extensively in the US and Europe for around 10 years.

Haemorrhoid Artery Ligation Operation (HALO) is a new and ingenious method to treat haemorrhoids.

A miniature doppler ultrasound device is introduced into the anal canal to locate the arteries that supply the haemorrhoids. The supplying arteries are then ligated, drastically reducing the blood flow to the haemorrhoids, which subsequently shrink and "wither".

"HALO" was introduced into Hong Kong in 2006, but has been used extensively in the US and Europe for around 10 years.

Advantages of HALO operation

	No anaesthesia is required.
	Patients have only a minimum of discomfort, which clears within a few days.
	The procedure can be done on an outpatient basis, and the patient can return to work immediately.
	Minimally invasive with a very low risk of complications, such as bleeding and ulceration. The haemorrhoids reduce and 'wither' approximately ten days after the procedure.
	Good for patients who are not suitable for general anaesthesia, or who are unable to take significant time off for their treatment.

This procedure is not suitable for every patient with haemorrhoids. Please discuss with your doctor the best treatment option for your particular situation.

Ground Floor, Hong Kong Adventist Hospital
40 Stubbs Road , Hong Kong