What are haemorrhoids?

Haemorrhoidal disease is one of the most common human ailments. Maimonides⁴, an ancient physician from al-Andalus (1135-1204 AD), already pointed out the importance of diet and detailed a series of treatments to relieve the symptoms of haemorrhoids, including food broths, suppositories, creams or enemas to eliminate or prevent symptoms–they all non-surgical treatments.

Haemorrhoids (piles) are clusters of arteriovenous blood vessels forming a protrusion in the anal canal. When vascular tone is out of control and haemorrhoidal tissue degeneration occurs, normal anal cushions are symptomatically and abnormally shifted downward. Sliding anal cushions include abnormal dilation and distortion of the haemorrhoidal cluster, causing very uncomfortable and, in some cases, very severe symptoms.

Haemorrhoids are generally classified depending on the location: internal (located in the rectum and covered by anal mucosa), external (with origin at the anal opening and covered by anoderm) and mixed.

The occurrence of haemorrhoids or piles increases with age and it is estimated that approximately half of individuals suffer from haemorrhoids at 50 years age. The frequency of occurrence worldwide is between 14-40%, especially in women (with higher incidence during pregnancy) and older adults^1,3.

There are different causes that can trigger the occurrence of haemorrhoids, being constipation the most prevalent as there is greater effort during evacuation and therefore more pressure on the anal cushions. However, alcohol, spicy foods, diarrhoea, pregnancy, occupation and sedentary lifestyle, should be considered as predisposing factors. It is more frequently related to Western societies, possibly associated with low fibre consumption.

Due to the different development of haemorrhoids they must be treated with different approaches, individually adapting to each case. The possible treatments are medical, non-surgical therapies and surgical treatments. The classic treatment for this ailment has been surgical, but postoperative pain, hospital costs, time away from work, and the patient's resignation has led to creating procedures avoiding such inconveniences.

Alternative or non-surgical treatments include: diet and changes in lifestyle, adding to diet hydrophilic agents such as Psyllium plantago seeds. Ointments or suppositories to treat haemorrhoidal disease are helpful. However, most of them only provide symptomatic treatment, but not a long-term solution. Other non-surgical options for haemorrhoidal disease comprise rubber band ligation, sclerotherapy, cryotherapy, bipolar coagulation, etc.

References:

1) Conte Vila, O. et al. Diciembre 2003. 2) Hemorrhoids and anal fissures. University of California, Berkeley. Appointments 510/642-2000. 3) Lohsiriwat, V. 2015 August 21. 4) Charúa Guindic, L. 2014.