Haemorrhoids Case study
Madam NK is a 40 year old mother of two and an international business woman who had a history of something coming out of her anus. Prior to this she had complained of being unable to pass stool for almost 5 days while in Dubai – she is not comfortable using strange toilets. Back home, she had to strain hard in order to move her bowel. A few nights later she noticed the swelling in her butt. Two days later, the swelling became more painful with no signs of regressing and like the typical Nigerian, she decided to self-treat, she applied ‘aboniki’ on it! You can imagine the pain and peppery feeling from the hot menthol in ‘aboniki’! She said she fanned her butt till morning then rushed to see a doctor at day break. The doctor asked questions, examined her and made a diagnosis of haemorrhoids and treated her.
What are haemorrhoids?
Haemorrhoids also known as pile, are swollen blood vessels in the anal region that stretch under pressure. Haemorrhoids may go back in on their or can be pushed back inside the anus by hand.
The earliest records of haemorrhoids date back to before the biblical era, with ancient Egyptian hieroglyphics depicting ‘healers’ taking care of patients with blood or swelling around anal regions. It was remedied with acacia leaves that were ground together and applied around the anal region.
It is often difficult to determine the exact cause of haemorrhoids however there are 2 main causes:
- An inherited weakness in the wall of the veins and/or
- Excessive pressure in those veins
The pressure is usually caused by long standing constipation or diarrhoea, straining during bowel movement, increased intra-abdominal pressure due to excessive physical exertion or an abnormal growth; pregnancy, obesity or liver disorder. The commonest cause of constipation is:
- lack of, or low fibre in food
- inadequate water intake or dehydration
- side effects of some medications (pain killers that contain codeine, morphine or opium; some blood pressure and heart medications; antidepressants, or tranquillizers)
- lack of exercise
- life changes – aging, spinal cord injury
- pregnancy and vaginal deliveries
- excessive use of laxatives or enemas – this damages nerve cells in the bowel interfering with its ability to contract
- ignoring the urge to stool/ making it a habit of postponing it
- extreme stress or depression
- magnesium deficiency
Constipation, diarrhoea and pregnancy can lead to excessive straining. The causes of diarrhoea are many and varied and could stem from intestinal irritation or motility. Examples:
- incomplete food digestion
- drugs – some antibiotics or pain killers
- food poisoning, or ingestion contaminated water
- food allergies, sensitivities or intolerance
- excessive consumption of alcohol
- laxative use or abuse
- overuse of sugar
- emotional stress
- bowel disease
- diabetic neuropathy
Haemorrhoids may be internal or external; the internal one is in the rectum, cannot be felt, not painful and usually presents as blood in stool, but over time, can protrude through the anus. The external haemorrhoids are found under the skin surrounding the anus, they can be felt when they swell, and they may cause itching, pain or bleeding with bowel movement. Haemorrhoids are the commonest cause of finding blood in stool.
Prolonged hours of sitting and extreme cases of cough also seem to be in alignment with the onset of the disease. Reading and using mobile phones are known to prolong time on the toilet and it is often recommended that people desist from this.
Prevention and treatment haemorrhoids
Tackle the root cause – fibre, water, physical activity, treat diarrhoea, a warm Sitz bath is very helpful in soothing the swelling.
Sitting in a few inches of warm water three times a day for 15 to 20 minutes may help decrease the inflammation of the haemorrhoids. It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.
Individuals with haemorrhoids should not sit for long periods of time and may benefit from sitting on an air or rubber donut.
Have a bowel movement as soon as possible after the urge arises. Once that urge passes, stools can become constipated and straining with a bowel movement may occur
Use moist toilet paper to dab the area after a bowel movement to lessen friction from wiping, and rinse off in the shower, use non perfumed soap. After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
Apply ice packs or cold compresses to relieve swelling.
Many creams, ointments, and suppositories are available for symptom relief and may be used for comfort. However, they do not “cure” haemorrhoids. Often they contain a numbing medication or a corticosteroid to decrease inflammation and swelling. If in severe pain, pain killers may be used.
Witch hazel – is one of the oldest known natural remedies for haemorrhoids. Just soak a pad or cotton ball with witch hazel and apply it to the area. Beeswax, apple cider vinegar, aloe vera, garlic oil, tea tree oil, chamomile can also be applied to the area.
Aloe Vera drinks are also very helpful, they are said to be adaptogenic that is manage diarrhoea or constipation depending on the situation.
Probiotics supplements and Probiotic-rich foods such as fermented cheese, yogurt, fermented cabbage (saukraut) are essential for balancing the bacteria in your gut. This in turn prevent constipation and promote overall health.
Fruits such as oranges, grapefruit, lemon, cranberries, and asparagus (to name a few), are often taken to heal haemorrhoids.
Haemorrhoids can be diagnosed by physical examinations from a doctor. A doctor often provides a rectal exam to detect the possibility of tumours in the rectal area or an enlarged prostate. Often times, this examination is done with an amount of sedation because of the severe pain associated with haemorrhoids.
Surgery can be performed if all conservative and simple procedures fail.
Haemorrhoids can be quite uncomfortable and painful in most cases. However, they can be avoided with basic self-care and proper hygiene.