Are your haemorrhoids an issue?

Haemorrhoids, which are very common and are also called piles, are swollen veins in your anus and lower rectum, like varicose veins and nearly three out of four adults will have them from time to time.

Sometimes they don’t cause symptoms but at other times they cause itching, discomfort and bleeding. Mostly the cause is unknown but they may result from straining during bowel movements or from the increased pressure on these veins during pregnancy.

Haemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external haemorrhoids).

Occasionally, a clot may form in a haemorrhoid (thrombosed haemorrhoid). These are not dangerous but can be extremely painful and sometimes need to be cut and drained.

Fortunately, many effective options are available to treat haemorrhoids. Many people can get relief from symptoms with home treatments and lifestyle changes.

Bleeding during bowel movements is the most common sign of haemorrhoids. Your doctor can do a physical examination and perform other tests to confirm it.

Do not self-diagnose and assume rectal bleeding is due to haemorrhoids, especially if you are over 40. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

If you have bleeding along with a marked change in bowel habits or if your stools change in colour or consistency, consult your doctor.

These types of stools can signal extensive bleeding in your digestive tract. Seek emergency care.

SYMPTOMS

Signs and symptoms of haemorrhoids include:

• Painless bleeding during bowel movements – you might notice small amounts of bright red blood on your toilet paper or in the toilet.
• Itching or irritation in your anal region.
• Pain or discomfort.
• Swelling around your anus
• A lump near your anus, which may be sensitive or painful (possible a thrombosed haemorrhoid).

Haemorrhoid symptoms usually depend on the location.

• Internal haemorrhoids: these are inside the rectum. You usually can’t see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can damage a haemorrhoid’s surface and cause it to bleed. Occasionally, straining can push an internal haemorrhoids through the anal opening. This is known as a protruding or prolapsed haemorrhoids and can cause pain and irritation.
• External haemorrhoids: these are under the skin around your anus. When irritated, external haemorrhoids can itch or bleed.
• Thrombosed haemorrhoids: sometimes blood pools in an external hemorrhoid and forms a clot (thrombus) that can cause severe pain, swelling, inflammation and a hard lump near your anus.

CAUSES

The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins (haemorrhoids) can develop from increased pressure in the lower rectum due to:

• Straining during bowel movements.
• Sitting for long periods of time on the toilet.
• Chronic diarrhea or constipation.
• Obesity.
• Pregnancy.
• Anal intercourse.
• Low-fibre diet.

COMPLICATIONS

Complications of haemorrhoids are very rare but include:

• Anaemia: rarely chronic blood loss from heemorrhoids may cause anemia – which is when you don’t have enough healthy red blood cells to carry oxygen to your cells.
• Strangulated haemorrhoid: if the blood supply to an internal hemorrhoid is cut off, it can be “strangulated,” another cause of extreme pain.

PREVENTION

The best way to prevent haemorrhoids is to keep your stools soft so they pass easily. To prevent haemorrhoids and reduce the symptoms of haemorrhoids, follow these tips:

• Eat high-fibre foods: eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause haemorrhoids. Add fibre to your diet slowly to avoid problems with gas.
• Drink plenty of water: drink six to eight glasses of water each day to help keep stools soft. v Don’t strain: straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum. v Go as soon as you feel the urge: if you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
• Exercise: stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your haemorrhoids.
• Avoid long periods of sitting: sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

DIAGNOSIS

Your doctor may be able to see if you have external haemorrhoids simply by looking. Tests and procedures to diagnose internal haemorrhoids include examination of your anal canal and rectum:

• Digital examination: during a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. The exam can suggest to your doctor whether further testing is needed.
• Visual inspection: because internal haemorrhoids are often too soft to be felt during a rectal exam, your doctor may examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope.
• Colonoscopy: this is an option if your signs and symptoms suggest you might have another digestive system disease. You have risk factors for colorectal cancer or you’re over 40 years old and haven’t had a recent colonoscopy

TREATMENT

You can often relieve the mild pain, swelling and inflammation of haemorrhoids with home treatments. Often these are the only treatments needed.

• Eat high-fibre foods: Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can worsen symptoms from existing haemorrhoids. Add fibre to your diet slowly to avoid problems with gas.
• Use topical treatments: apply an over-the-counter haemorrhoid cream or suppository containing hydrocortisone.
• Soak regularly in a warm bath or sitz bath: soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet.
• Keep the anal area clean: bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Avoid alcohol-based or perfumed wipes. Gently pat the area dry or use a hair dryer.
• Don’t use dry toilet paper: to help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol.
• Apply ice: put ice packs or cold compresses on your anus to relieve swelling.
• Take oral pain relievers: painamol or ibuprofen will temporarily to help relieve your discomfort. With these treatments, haemorrhoidssymptoms often go away within a week. See your doctor if you don’t get relief, or sooner if you have severe pain or bleeding. If your haemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These contain ingredients that relieve pain and itching, at least temporarily. Do not use over-the-counter treatments for more than a week unless directed by your doctor as they may cause your skin to thin.
• External haemorrhoid thrombectomy: if a painful blood clot (thrombosis) has formed within an external haemorrhoid, your doctor can remove the clot with a simple incision and drainage, which may provide prompt relief. This procedure is most effective if done within 72 hours of developing a clot.
• Rubber band ligation: your doctor places one or two tiny rubber bands around the base of an internal haemorrhoid to cut off its circulation. The haemorrhoid withers and falls off within a week. This procedure is effective for many people. haemorrhoid banding can be uncomfortable and may cause bleeding that begins two to four days after the procedure but is rarely severe. Occasionally, more-serious complications can occur.
• Injection (sclerotherapy): in this procedure, your doctor injects a chemical solution into the haemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
• Coagulation (infrared, laser or bipolar): coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal haemorrhoids to harden and shrivel. Coagulation has few side-effects and may cause little immediate discomfort, it’s associated with a higher rate of haemorrhoids coming back than the rubber band treatment.
• Haemorrhoid removal: in this procedure, called haemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal or general anesthetic.

Haemorrhoidectomy is the most effective and complete way to treat severe or recurring haemorrhoids. Complications may include temporary difficulty emptying your bladder and resulting urinary tract infections.

Ask the doctor

Dear Doctor

I have constant stomach cramps. It doesn’t make a difference if I’ve eaten or not. Sometimes they happen in the morning when I wake up. What does this mean?

Good day, Constant stomach cramps can be a sign of irritable bowel syndrome, often accompanied by constipation, diarrhoea or even bloating.

These may be related to stress or a diet low in fibre, especially in vegetables and fruit or just not drinking enough water. Please do take up exercising and a healthy diet to see if the symptoms improve. If not, see a doctor for a full history and physical examination.

Dear Doctor My child has a constant rash and I was given steroid cream to treat it. The rash hasn’t gone away and the cream has run out. Will he be forced to use this cream all his life? How do we solve this ?

Hi Madam

Chronically using steroid creams is not good and may lead to complications. Please ask the doctor to refer you to a dermatologist for proper diagnosis of the skin condition.

Dear Doctor

I have a migraine at least once a day and now live on painkillers. How do I put a stop to this? I feel like I’ll be popping pills forever just to cope. I’ve tried different types of remedies but nothing seems to work. Please help.

Hi

Migraine once a day every day? That does not sound possible or nice to live with. Have all other headache conditions been excluded, such as hypertension or neurological conditions?

Has a brain scan been done recently? I really think you should get a full examination and imaging to make sure what you have is migraine. Ask to be referred to a neurologist.

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

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