Internal and external haemorrhoids
Haemorrhoids are swollen veins in the lower rectum or anal canal. Everyone has these veins, but it is only when they become enlarged or irritated that they cause symptoms. The most common symptoms of haemorrhoids are rectal bleeding, itching, and pain. You may be able to see or feel haemorrhoids around the outside of the anus, or they may be hidden from view, inside the rectum. Haemorrhoids are classified as internal (arising from inside the rectum) or external (arising from the anal canal or outside).
Haemorrhoids are common, occurring in both men and women. Although haemorrhoids do not usually cause serious health problems, they can be annoying and uncomfortable and the symptoms they produce (particularly bleeding) can mimic those of more serious bowel problems. When conservative therapies have failed, endoscopic injection or banding of haemorrhoids may be appropriate.
Injection of internal haemorrhoids with fibrovein at the time of Sigmoidoscopy or Colonoscopy can be an extremely effective therapy. It causes a local inflammatory reaction which allows the vein to collapse down and retract. I perform the procedure under direct vision using an endoscopic injector rather than using an external needle and proctoscope. This allows more accurate injection and the use of smaller doses of fibrovein meaning there is less post procedure discomfort. If haemorrhoids are large the procedure may need to be repeated.
Rubber band ligation of internal haemorrhoids is also a highly effective therapy that can be performed at the time of Sigmoidoscopy or Colonoscopy. The technique involves suctioning the haemorrhoid into a ligator device and then applying a band around its base. This leads to thrombosis of the haemorrhoid and development of local scarring that allows the haemorrhoid to retract. If haemorrhoids are large the procedure may need to be repeated. I use endoscopic banding with direct vison in severe bleeding cases with good result.