Dr Suchi Bhau
Haemorrhoids, commonly known as Piles, refers to the anal cushions that swell, bleed, thrombose and/or prolapse, hence causing clinical symptoms.
In India approximately 40,723,2838 people are represented to have haemorrhoids. Over a million new cases are reported annually, 47 per 1000 which increases with age. For the age group of 45-65 years it is estimated that 50- 85% of people around world have haemorrhoid and indeed75% of population is estimated.
The typical symptoms include pain, itching, bleeding around the anal area, pain and discomfort while sitting ,itching around anus, pain and discomfort while bowel movements, irritation around anus ,bright red blood in your stools and toilet paper, increase in pressure in lower rectum, swelling around anus and sometimes one or more lumps around anus.
It is important to understand the causes of Haemorrhoids as it makes it easy to prevent it.
Its common causes include:
* Sitting for long periods of especially on toilet.
* Chronic constipation or diarrhoea.
* Obesity
* Pregnancy
* Anal intercourse
* Low fibre diet
* Spinal cord injury
* Poor posture
* Straining during bowel movements
The diagnosis of the haemorrhoid is solitary done through evaluating the history and examination of the patient which might include anoscopic evaluation. One can easily mistakenly attribute rectal bleeding to the haemorrhoids hence it is important to completely evaluate the remainder colon. So for final diagnosis one should undergo following steps of examination:
* Visual examination
* Digital rectal examination
* Visual inspection using proctocsope or sigmoidoscope
* Colonoscopy (for entire bowel)
Haemorrhoids is classified to be internal or external. This classification is based on the position whether it is proximal or distal to the dentate line.
External haemorrhoids are covered with anoderm and are sensate. Internal haemorrhoids are covered with insensate anorectal mucosa hence not causing any discomfort but straining and irritation can damage the surface of haemorrhoidcausing bleeding. Some time straining can push haemorrhoids through the anal opening leading to pain in case of internal haemorrhoids.
External haemorrhoids lie under skin around anus which can itch and bleed on irritation. External pile can be thrombosed(pooling and swelling of pile) leading to pain and swelling of pile. However, bleeding stools can be related to other conditions and one should consult a doctor if he/she is frequently bleeding, having change in bowel habits, black & maroon coloured stools, any perianal pusdischarge or any lesion.
Most of cases can be self-treated and managed conservatively ,without surgical treatment. Only the severe cases require the medication or surgical treatment. Surgery can be both open and endoscopic.
It is possible to prevent Haemorrhoids. Following are the ways:
* Keeping constipation away is the best way to prevent haemorrhoids
* Eat high fibre food
* Drink plenty of fluids
* Eat fibre supplements
*Avoid straining while defecation
* Don’t miss the urge to defecate
* Avoid sittings for long hours
* Routine exercise
It is everyone’s right to stay healthy and it is up to us to make it our responsibility.
(The author is Consultant, GMC Jammu Deptt. of Surgery)
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