By Dr Uwakwe-mangse Hanna (MBBS, MRCS)
I remember growing up those days in Nigeria, sometimes when travelling on a luxury bus to Lagos, you get to hear many merchants come on board and advertise their goods. The ones that I still can’t get my head round is the people selling traditional medicine or concoction.
I have heard many selling drugs that can cure hemorrhoids when taken orally, and I have heard many say Maggi cubes causes hemorrhoids. To be honest the level of ignorance in our land is so alarming and I know these predators thrive on this fact.
Hemorrhoids are swollen veins (enlarged blood vessels) located around the anus or in the lower rectum. About 50 percent of adults experienced the symptoms of hemorrhoids by the age of 50. Hemorrhoids are also known as piles.
Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside of the anus.
External hemorrhoids are the most common and most troublesome. Haemorrhoids cause pain, severe itching, and difficulty sitting. Fortunately, they are treatable.
CAUSES OF HEMORRHOIDS
The exact cause of hemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed.
Many cases are thought to be caused by too much straining on the toilet as a result of prolonged constipation. This is often caused by a lack of fibre in a person’s diet.
Chronic (long-term) diarrhoea can also make you more vulnerable to getting hemorrhoids.
Other factors that might increase your risk of developing hemorrhoids include:
- being overweight or obese
- age – as you get older, your body’s supporting tissues get weaker, increasing your risk of hemorrhoids
- being pregnant – this can place increased pressure on your pelvic blood vessels, causing them to enlarge
- having a family history of hemorrhoids
- regularly lifting heavy objects
- a persistent cough or repeated vomiting
- sitting down for long periods of time especially in the toilet
SYMPTOMS OF PILES
I wrote a few lines on hemorrhoids two weeks ago when I discussed anal pain. You know you may have hemorrhoids if you have the following:
- Extreme itching around the anus
- Irritation and pain around the anus
- Itching or swelling or painful lump around the anus
- Faecal incontinence or leakage
- Painful bowel movement or defecating
- Blood on tissue after pooing
Although hemorrhoids are painful, they are not life threatening and can resolve spontaneously or on their own without any treatment.
DIAGNOSING HEMORRHOIDS (PILES)
If you suspect that you may be having pile or have the symptoms of piles as described above you need to see a doctor and preferably a surgeon. The doctor can diagnose hemorrhoids (piles) by examining your back passage to check for swollen blood vessels.
Some people with hemorrhoids are reluctant to see their doctor because they feel embarrassed. But there’s no need to be embarrassed – most if not all doctors are used to seeing very sensitive parts of their patients and also in diagnosing and treating piles.
It’s important to tell your doctor about all of your symptoms – for example, tell them if you’ve recently lost a lot of weight, if your bowel movements have changed, or if your stools have become dark or sticky- these may be signs of more dangerous illness.
Your doctor may examine the outside of your anus to see if you have visible hemorrhoids, and they may also carry out an internal examination called a digital (finger) rectal examination (DRE).
During a DRE, your doctor will wear gloves and use lubricant like KY Jelly. Using their finger, they’ll feel for any abnormalities in your back passage. A DRE shouldn’t be painful, but you may feel some slight discomfort.
In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin, hollow tube with a light on the end that’s inserted into your anus.
This allows your doctor to see your entire anal canal, the last section of the large intestine.
Doctors are sometimes able to carry out a proctoscopy but in some cases however, not all doctors have the correct training or access to the right equipment, so you may need to go to be referred to a surgeon for this.
TREATING A HEMORRHOID
Hemorrhoid’s symptoms often settle down after a few days without needing treatment. Hemorrhoids that occur during pregnancy often get better after giving birth.
Making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended, this I will discuss later.
Treatment for hemorrhoids can occur at home or at a doctor’s office.
To minimize pain, soak in a warm tub of water for at least 10 minutes every day. You can also sit on a warm water bottle to relieve the pain of external hemorrhoids. If the pain is unbearable, use an over-the-counter medicated suppository, ointment, or cream to relieve the burning and itching. Example of such ointment is Anusol.
If you’re constipated, you can also use an over-the-counter fiber supplement to help soften your stool like Fybogel.
Over-the-counter topical treatments, such as hydrocortisone or hemorrhoid cream, can ease your discomfort from hemorrhoids. Soaking your anus in a sitz bath for 10 to 15 minutes per day can also help.
Practice good hygiene by cleaning your anus with warm water during a shower or bath every day. But don’t use soap, as soap can aggravate hemorrhoids. Also avoid using dry or rough toilet paper when you wipe after a bowel movement. Use baby wipes or wet wipes.
Using a cold compress on your anus can help reduce hemorrhoid swelling, this you can do by using and ice block wrap on a cloth or towel- please don’t put ice directly on a skin to avoid thermal injury. Pain relievers, such as paracetamol, ibuprofen, or aspirin can also alleviate the pain or discomfort.
If home treatments aren’t helping with your hemorrhoids, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off the circulation or blood supply of the hemorrhoid by placing a rubber band around it. This causes loss of circulation to the hemorrhoid, forcing it to shrink. This procedure should only be performed by a medical professional. Do not try this at home, chemist.
If rubber band ligation isn’t an option in your case, your doctor may perform injection therapy, or sclerotherapy. In this procedure, your doctor injects a chemical into the blood vessel directly. This causes the hemorrhoid to reduce in size.
A surgical removal of the hemorrhoids called Hemorrhoidectomy is performed when all the above fail and the symptoms persist very badly. This involves a general anaesthesia whereby you are asleep and the surgeon removes the pile by cutting it off.
The healing time and process of this procedure takes a long time and is literally a pain in the back side and many surgeons are reluctant to go down this route.
To prevent or avoid worsening hemorrhoids, avoid straining during a bowel movement (pooing). Also, try to increase your water intake. Drinking enough water can keep your stool from hardening.
Use the restroom as soon as you feel a bowel movement coming on to prevent hemorrhoids from developing.
Exercise regularly to prevent becoming constipated, and don’t sit for long periods, especially on hard surfaces like concrete or tile.
In a nutshell you need to have many lifestyle changes which include:
- gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats. Dietary fiber helps create bulk in the intestines, which softens the stool, making it easier to pass.
- drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
- not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
- avoiding medication that causes constipation – such as painkillers that contain codeine, tramadol
- losing weight if you’re overweight
- exercising regularly – this can help prevent constipation, reduce your blood pressure, and help you lose weight
COMPLICATIONS OF HEMORRHOIDS
Complications from hemorrhoids are rare, but can include:
- blood clots in the swollen vein which causes severe pain
- iron deficiency anemia caused by blood loss.
In conclusion, hemorrhoids or pile is one of those conditions that is very common and easily treated either conservatively or medically. Don’t patronise the traditionalist out there and if concern seek medical help.
See you next week