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Enyeribe Ejiogu (enyeribee@yahoo.com)
In common parlance, haemorrhoids refers to piles, which develop when blood vessels in the rectum and anus engorge and become swollen or inflamed. When this happens, they may not be painful, slightly painful or they could cause severe pain. In such situation of severe pain, piles cause discomfort and possibly bleeding.
The incidence of hemorrhoids has been closely associated with constipation, which makes people strain while trying to pass stool. Usually the highly vascularised muscles around the rectum and anus contract to squeeze out faecal matter though the anus. If the feaces is extra hard, the person has to strain, thus making the veins to engorge with blood. The distended part of the vein may then protrude outside the anus or get squeezed into hard little balls of tissue that stay within the lumen of the rectum. Hemorrhoids could also be caused by obesity or pregnancy. Other symptoms include itching and bleeding, which may be brought on by the protruded pile rupturing because of abrasion caused by hard tight-fitting underwear. Occurrence of haemorrhoids or piles is relatively common. The College of Medicine, University of Ibadan, in a study found that about 1.5 cases are recorded per year in Nigeria.
Treatment
Treatment consists of diet modifications and use of laxatives. A high-fibre diet can be effective, along with stool softeners. In some cases, a medical procedure to remove the haemorrhoid may be needed to provide relief. So, consuming foods that have high fibre content as well as raising the level of hydration are both helpful. For instance, you could form a habit of eating cucumber which is high in fibre and water. You should eat more of vegetables such as garden egg, fluted pumpkin, okro, whole grains, legumes like beans and fruits loaded with fibre like chewing the white part of peeled oranges after sucking the juice. You should also increase you intake of water or watermelon as an alternative. Eating more of the aforesaid foods will help avoid constipation and by extension, piles.
In addition to dietary changes, you should take steps to reduce inflammation and the sensation of pain. You could do this by using a cold compress applied directly to the area. Wrap some ice cubes with a clean hand kerchief and press the anus to relieve the swelling for 15 minutes at a time. For large, painful hemorrhoids, this can be an extremely effective treatment. Never apply ice directly to the bare skin.
Zinc oxide ointment is one medication that has been used to treat the itching and pain frequently associated with ano-rectal piles. The role of zinc in the anti-inflammatory response and to create resistance to infection is well known.
Some specialised medical procedures have also been used by doctors to treat haemorrhoids depending on the severity. One of such procedures is cauterization, which involves either burning or freezing a part of the body to remove tissue or stop bleeding. This seals off the wound and prevents blood loss.
Alternatively, rubber band ligation may be used. In this case the dilated blood vessel is tied off with a rubber band to block its blood supply. This causes it to dry up and fall off. Rubber band ligation is only used for internal hemorrhoids. This procedure can only be done is hospital by a doctor, who would first insert an anoscope into the anus, to enable him view the haemorrhoid.
Another treatment is cryotherapy, whereby extreme cold is used during surgical process. Cryotherapy of hemorrhoids is the most effective and has the least side effects when directed at the internal hemorrhoids only, at a high level, and in stages, each application being for a period of one minute only.
In some instances, the doctor may choose to carry out a procedure called sclerotherapy. In this regard,
A salt solution or specialised chemical is injected into the area around the haemorrhoid resulting in a scarring reaction which makes the haemorrhoid gradually shrink or shrivel up over time. It is typically reserved for grades 1 and 2 internal haemorrhoids.
On the hand, another procedure called stapled hemorrhoidopex is a surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position.
In all these is it abundantly clear that go to the hospital have a discussion. Please do not engage in self-medication. It could be fatal.
Medications
Depending on the severity of the condition, the doctor may choose apply a local anaesthetic which will block off pains in the anal area and also ‘knock off’ the nerves in the area.
If your doctor believes it is necessary, he/she could prescribe a steroid. Typical steroids used for haemorrhoids are hydrocortisone, prednisolone, and fluocortolone. They reduce inflammation, and this helps to ease itching and pain. Some preparations also contain a local anaesthetic and/or other soothing agents.
