Haemorrhoids

Haemorrhoidal cushions are a normal part of the anal canal and everyone has them. We only speak of haemorrhoids as a problem when these cushions become enlarged, slip downwards or become inflamed. They then show themselves through bleeding, itching, swelling or a feeling that the bowel is not completely empty after a bowel movement.

The most common first sign is bright red blood: on the toilet paper, as a streak on the stool or as drops in the toilet bowl. Internal haemorrhoids are usually not painful, because the lining above them has no pain receptors. When the pain is sharp and constant, it is more often a tear in the lining or a thrombosed lump, which are different conditions with different treatment.

The symptoms often come and go. For a few days all is calm, then after a hard stool or a long spell of sitting it all starts again. It is precisely this coming and going that keeps people at home longer than is sensible.

What triggers the symptoms and makes them worse

Constipation and straining on the toilet are the main strain. Sitting on the toilet for a long time, including with a phone in your hand, has the same effect, because pressure in the area stays raised the whole time.

Other common factors include too little fibre and fluid in the diet, long-lasting diarrhoea, pregnancy and childbirth, regular lifting of heavy loads and mostly sedentary work. In some people there is also a family tendency towards weaker connective tissue.

Haemorrhoids often settle on their own once bowel habits are sorted out. If they keep coming back for months despite regular bowel habits, that is not a reason to put up with them, but a reason for an examination.

When not to book an appointment but to seek help immediately

If you have heavy bleeding from the back passage that does not stop, or if with the bleeding you become dizzy, pale, light-headed and your heart is pounding hard, call 112. The same applies if you take blood-thinning medicines and the bleeding is not minor.

Black, tarry and foul-smelling stool is not a sign of haemorrhoids. It means bleeding higher up in the digestive tract and requires immediate treatment at an emergency medical service, not booking an appointment.

You also need an immediate assessment if you have severe pain around the back passage with swelling, fever and chills. This picture points to an abscess, which needs to be treated quickly.

What the examination involves

The examination begins with a conversation: how often you open your bowels, what the stool is like, how much blood you notice and when, and whether there is also pain, itching or discharge. This is followed by an inspection of the area and, at the doctor's discretion, a rectal examination and anoscopy, that is, a look into the anal canal with a short instrument.

The examination is brief and takes place in the privacy of the consulting room. Most people describe it as unpleasant rather than painful. If the area is very sore, say so at the start, as the doctor will adapt the extent of the examination.

Blood on the stool does not in itself tell you where it is coming from. This is exactly why a proctological examination sometimes leads to a referral for colonoscopy, especially in people over fifty, or where there is a change in bowel habits, anaemia or unintentional weight loss.

Treatment options

For milder symptoms the core of treatment is simple and you carry it out yourself: more fibre and fluid, regular exercise, opening your bowels without delay and without straining, and as little time on the toilet as possible. Local medicines in the form of ointments or suppositories ease the symptoms but do not remove the cause.

When symptoms persist, outpatient procedures are available, including rubber band ligation and sclerotherapy. They are carried out quickly and, as a rule, without general anaesthesia.

For more extensive or prolapsed haemorrhoids, surgical treatment may be considered. Which route is right for you is decided after the examination, according to the degree of change and what bothers you most in everyday life.

Proctological care at Medicinski center Ljubljana is self-pay, while endoscopic examinations of the digestive tract, i.e. gastroscopy and colonoscopy, are carried out both with a referral under the Health Insurance Institute of Slovenia (ZZZS) and on a self-pay basis. Appointments are booked with the clinic that runs the service.