Haemorrhoids & piles
What causes haemorrhoids and should you be worried if you find blood in your stool? Find out this and more.
BY: Dr I Swaminathan
So what causes haemorrhoids?
The true answer is no one really knows. Current opinion is that they are prolapsing anal cushions, which are three columns of anal tissue that are rich in arterioles or blood vessels. When they lose their elasticity, they stretch and start to bleed or prolapse (a term meaning “falling out”).
However, there are certain factors that predispose a person to developing haemorrhoids, such as pregnancy, chronic constipation and straining in the toilet. A family history of haemorrhoids is also a risk factor. But is age also a factor? It is not as many army boys in their National Service days have piles.
Lastly, haemorrhoids can in some cases indicate a more serious underlying condition such as colon cancer. This is why anyone with symptoms of so-called piles must be investigated so to exclude cancer.
The signs & symptoms
Haemorrhoids in their early stages can be without symptoms. The earliest indicator is bleeding on defecation, with bright red arteriolar (one of the small terminal branches of an artery) blood reported, rather than dark red blood from the veins. This is considered first stage of piles.
If not treated, they tend to come out during defecation and then go back, which is then considered second stage. And, if this still not treated, they reach a stage where they remain permanently outside the anus, which is considered the third stage.
In extreme cases, they not only remain outside but become thrombosed (develop blood clots) and become very swollen and painful. This is the fourth stage of piles and requires immediate operation.
For all sufferers, I would advise them to increase their fluid and fibre intake.
Treatment is generally according to stage. First stage can be treated with suppositories and fibre products like Fybogel, Mucillin and so on. Second stage requires one of the minor procedures like injection, rubber band ligation, cryotherapy or infra-red coagulation.
Third and fourth stage are best treated surgically. Nowadays stapled haemorrhoidectomy is popular, as it is seen as less painful and less invasive. Hospital stay and time to return to work are shorter, but it is more costly with the cost being about S$2,000 to S$3,000.
The traditional haemorrhoidectomy is the gold standard operation and requires at least two days’ stay in hospital. The patient has to take care of the wound and do salt baths daily. Painkillers are usually indicated for the first one or two weeks, and the results are very good. Usually it is a one-time procedure for most patients.
Colonoscopy is advisable for all patients over the age of 50 and with bleeding in the rectum and/or blood in the stools. Please consult your doctor if you have rectal bleeding. Early diagnosis and timely treatment can save lives!
So what are some preventive tips?
- Eat as much substantial-soluble fibre meals as possible as this will help soften your stool and help prevent haemorrhoids from creating. Most fresh fruits, like grapes, watermelon and papaya, have a lot of fibre in it. You can also consider soluble fibre tablets to aid in the process.
- Don’t hold out to visit the restroom. This can make your stools dry up up, resulting in it being harder to successfully pass. When this happens, you are then going to tension the blood vessels all around your anus, and thus trigger haemorrhoids. To avoid this, just listen when nature calls.
- Too much consumption of alcohol can worsen one’s hemorrhoids. Also haemorrhoid suffers should try to refrain from excessive consumption of caffeine-rich products like soft drinks, coffee, chocolate and energy drinks. Like alcohol, caffeine can also show a diuretic effect and can lead to constipation.
Dr I Swaminathan is a consultant general surgeon at Parkway East Hospital.
** Agelessonline had to ask Dr Swaminathan about those doughnut-moulded cushions and whether they help to protect one against piles. His answer: “No, they do not really help. I think using them is more psychological.”
(* PHOTO CREDIT: Toilet, benedeki, stock.xchng)