Yes, children can get haemorrhoids.
It’s rare, which is why reviewing the issue with a GP, then seeing a paediatric surgeon is advised.
Haemorrhoids / piles typically start of as a small lump that appears at the anus during stooling. When small, but visible (Grade II), they pop back in promptly after stooling.
As they get bigger (Grade III), they may stay out longer, and sometimes need a helpful hand popping back in. Your child may have some symptoms and signs at this stage e.g. bleeding / blood spotting from the haemorrhoid, itchiness, a feeling of sitting on a hard pea.
Large haemorrhoids are always out, and cannot be pushed back. They can get painful or clotted.
What causes haemorrhoids in children?
It’s not clear why children get haemorrhoids. However, we do tend to see them more in children and adolescents with constipation, who are spending time straining on the toilet. Once the constipation and straining , is resolved, there’s every chance the haemorrhoid improves without surgery.
Rarely, the haemorrhoid may be a sign of congestion arising from pressure from abdominal organs e.g. liver congestion, pelvic mass. Therefore, history and examination by a specialist is helpful. If in doubt, an ultrasound of the abdominal organs and domain can settle any outstanding worries, and allow confident watchful waiting.
What treatments are available?
For chronic, high-grade haemorrhoids , medical options are numbing creams and shrinking creams e.g. Anusol and Scheriproct.
Surgical options include:
- Sclerotherapy
- Haemorrhoidal artery ligation (HALO) procedure
- Haemorrhoidectomy / excised haemorrhoidectomy
- Sutured mucopexy
All these options involve looking inside the bottom with stretching instruments e.g. proctoscope, ultrasound probe etc. In children, due to their much smaller structures, there is a risk to damaging the anal spincter muscle. This is the muscle that helps us keep stools in and be continent. Therefore, you will find paediatric surgeons will want to try all non-operative options first, before offering surgery.
Sclerotherapy involves injecting the engorged blood vessels with an agent that causes inflammation and scarring. Various agents are used e.g. phenol, polidocanol, etc. This option can work, but may need more than one treatment, and may risk ulceration if the agent leaks into surrounding tissues.
HALO involves finding the feeding vessel and blocking it off with a stitch or clip. In adults, this can be done handily with ultrasound guidance. In children, a general anaesthetic would be needed and the child would need to be old / big enough to accept the ultrasound probe to the anus without injury. It can also be done under the surgeon’s direct vision, with careful stretch of the anus.
Sutured mucopexy is a similar procedure, where the artery feeding the haemorrhoid is pinched by a line of sutures running through the bowel wall.
Typical recurrence rates are 10-20% for these surgical procedures.
Excision haemorrhoidectomy removes the haemorrhoid all together, and recurrence after this procedure is less common. However, the child needs to be big enough to accept the stretching instruments required to get a really good view of the haemorrhoid.
Laser treatment is a good option for adults, but we don’t have enough experience in children to be make recommendations as yet. Its best to ask your surgeon about their experience with this method.
Consulting a paediatric surgeon and finding out which procedure they would recommend for your child and setting is key.
