Bleeding haemorrhoids, symptoms and treatment

• The symptoms of bleeding haemorrhoids are practically the same as non-bleeding haemorrhoids.
• Bleeding from bleeding haemorrhoids varies depending on the tightness of the anal sphincter, and can be clotted or liquid.
• The only definitive treatment for bleeding haemorrhoids is a haemorrhoid operation.

Before talking about bleeding haemorrhoids, it would be appropriate to define a little more exactly what haemorrhoids, also commonly known as piles, are. By haemorrhoids we mean the dilation in the form of a pouch or varicose vein (such as those that can appear in both legs) of a group of veins and arteries found inside the anus.

These dilatations, bags or varicose veins that form haemorrhoids are nothing more than the product of an accumulation of blood that is produced by multiple circumstances and that at certain times may be able to come out through the anus and produce the symptoms or signs that we will discuss later.

These haemorrhoids, being accumulations of blood, as we have described above, can grow in size when, due to the increased density and hardness of the faeces, we have to make a significant effort when defecating. When they come out with the effort, they become trapped and compressed by the internal sphincter of the anus.

A sphincter is a muscular tissue found in certain areas of the human body and serves, either controlled by people or involuntarily, to exert a certain force in a specific location of the human body. 

In the case of the anus, the sphincter or muscular tissue surrounds the innermost part of the anus and is responsible for preventing the exit of faeces or allowing it, depending on whether the tissue contracts or remains lax.

When the haemorrhoid or piles come out and due to a contraction of the internal sphincter it collapses or becomes trapped, blood accumulates in the haemorrhoid causing it to grow in size and produce the characteristic pain that all patients suffering from this pathology are able to recognise.

If the accumulation of blood when the haemorrhoid becomes trapped on the outside of the anus does not resolve within a few hours, it is possible that the next bowel movement may cause a fissure or irritation of the tissue that forms them with the passage of faeces and produce what we know as bleeding haemorrhoids.

The characteristic bleeding of haemorrhoids when this occurs is a lively, red bleeding, it is not usually mixed with the stool and does not form clots. In most cases, the patient does not notice blood until he or she wipes it off with paper and finds it sticking to the paper.

If the pressure of the internal sphincter of the anus continues over time and the haemorrhoids or piles are not able to be pushed back into the anus, it is possible that the accumulation of blood that we have explained above produces the formation of small clots or thrombi in the interior of the haemorrhoids or piles. In this case we are dealing with thrombosed haemorrhoids.

In the event that bleeding through bleeding haemorrhoids persists over time, even if it is small, it is possible that certain types of people may suffer from transitory periods of anaemia, which is why it is usually necessary to be assessed as quickly as possible in this type of case in order to be able to solve it definitively.

Other symptoms of bleeding haemorrhoids

Bleeding haemorrhoids usually have similar symptoms to non-bleeding haemorrhoids. They both have the same pain during and after each bowel movement. 

The pain is characterised by its intensity and the way in which it appears. 

Sometimes, especially when we are talking about chronic haemorrhoids, the pain that occurs during defecation, which is usually more intense and lancinating (as if they were sticking you with small needles), goes on to leave a sensation of heaviness in the anal area that usually lasts throughout the day and can sometimes be accompanied by pruritus (or anal itching sensation) that interferes even more with the daily life of people suffering from haemorrhoids.

Generally, people who suffer from haemorrhoids or piles suffer from constipation at the same time. 

In most cases, constipation is prior to the presence or detection of haemorrhoids as it is directly involved in their formation. After the onset of the haemorrhoids, the pain that occurs during defecation usually complicates the constipation, which in turn complicates the healing process of the haemorrhoids.

Constipation is defined as a more compact and harder formation of waste material that occurs after the absorption of food and bioactive substances during their passage through the small and large intestine and is caused by a decrease in the usual motility of the intestines. In other words, it is the formation of harder, smaller, wider and more compact faeces.

This type of stool means that patients suffering from this type of symptom need to exert more force to pass it. The size and hardness of the faeces together with the increased force of defecation causes the venous blood in this part of the human body to accumulate in the lower part of the anus. In this case, the lower part of the anus are the vascular plexuses explained above, from which haemorrhoids are produced.

The treatment of bleeding haemorrhoids is very similar to that of normal haemorrhoids. To begin with, it is very important to follow some advice and hygienic-dietary measures that will help the haemorrhoids to stop bleeding and even allow them to reintroduce themselves into the anus of patients suffering from haemorrhoids.

These hygiene and dietary measures are:

• Abundant but controlled intake of water: the aim of this measure is to properly lubricate the faeces generated by eating so that they are as soft as possible.
• Avoid constipation: in this case and as we have explained in the previous paragraph, constipation is both a cause and a symptom of haemorrhoids. To improve this aspect it is necessary to maintain a healthy diet rich in fibre and to do sport every day. Sport or physical activity, whatever it may be, favours the motility or movement of the human body's intestine, thereby reducing the possibility of constipation.
• Sitz baths: this long-standing measure, which has been used for generations, has been shown to be effective in eliminating the pain caused by defecation and to reduce the swelling of piles that are accumulating venous blood inside them. At the same time, it has a relaxing effect on the internal sphincter, reducing the pressure it exerts on the haemorrhoid or piles.
• Cleaning after each defecation: it is very important that all patients suffering from haemorrhoids take extreme care in cleaning the anal area as this will keep the area as aseptic as possible, reducing the inflammation of the haemorrhoid.

Another fundamental aspect for the treatment of bleeding haemorrhoids is usually to initiate adequate analgesia of the area by means of drugs or substances that relieve pain when defecating. The less pain the patient suffers, the less constipation secondary to the pain will occur and the less involuntary contraction of the internal sphincter will occur, thus achieving partial relief of the pain.

The administration of ointments or ointments that are prescribed or bought in pharmacies and which contain a combination of local anaesthetics and corticoids is not usually recommended as the side effects of the repeated administration of substances as powerful as corticoids are more harmful than the possible benefits they may have. 

In any case, they should not be administered for more than 5 or 7 days and always as an analgesic at specific times of severe pain from haemorrhoids or piles.

The only definitive treatment with good long-term results to treat bleeding haemorrhoids is surgery to solve the problem of haemorrhoids or piles (haemorrhoidectomy). 

The haemorrhoid operation is performed in the operating theatre under local anaesthesia and sedation. 

In some cases, a deeper locoregional anaesthesia may be required, but in the vast majority of cases this allows the patient to return to sleep at home. This type of intervention makes it possible to eradicate them at their source, which is why it is considered to be the only procedure that provides a long-term solution.