Published in Panorama
Haemorrhoids, commonly known as piles, it is estimated has affected roughly 30% of the adult population in the UAE in the last two years alone, thanks to the prevailing diet and lifestyle in the region. “This is a very high figure considering the absolute number of people affected”, says Dr. Walid Achi, Consultant General and Laparoscopic Surgery, Belhoul International Hospital Centre, Dubai.
Haemorrhoids are dilated veins in the anus. “In terms of pathology”, explains Dr.Achi, “we can speak of haemorrhoids as if we are speaking of dilated veins in the legs, the varicose veins. Each time you are examining a patient who complains of haemorrhoids, you have to examine his legs to see if he has a congenital problem in his veins which manifests itself in the leg and the anal region.”
Pain, is an overwhelming initial symptom of the problem which first appears during defecation and immediately after. Itching in the region and bleeding are other signs, depending on the stage of the haemorrhoid, according to Dr.Achi..
Haemorrhoids progress through four stages, being internal in the first two stages, the lumps being bigger in the second, huge and external in the third stage, becoming thrombotic or clotted with blood in the fourth stage. External haemorrhoids protrude from the anus unlike the internal ones which remain within the anus.
“Certain categories of people are predisposed to the problem”, says Dr.Achi. “First of all, people who have a problem with their veins on a congenital basis; they are born with a defect in their veins. When they grow, the veins become longer but do not have enough muscles, causing dilation and diseases of the veins, including the anal veins, and consequent haemorrhoids.”
Those prone to constipation or with chronic constipation, face the risk of developing haemorrhoids. The situation is further aggravated by consuming spice food. Clarifying this aspect, Dr.Achi emphasizes, “Some people wrongly believe that substituting pepper for chilli causes no harm. This is absolutely wrong. Pepper is not absorbed through the intestine; it is kept in the rectum for a long time until stools comes out with a wait of 4 hours or sometimes more. During all this time, it is irritating the region. This goes for all hot, spicy foodstuffs that are going to stay in the rectum for a long time, leading to bulging of the veins and finally haemorrhoids.”
One of the commonest risk factors is spending a long time in the WC, according to Dr.Achi. “I emphasize that it is a very bad habit to stay a long time in the WC because while you are sitting you are kinking yourself and kinking and pushing is causing the anal sphincter to pump the blood and to make it congested in the area. With time, you are breaking the muscles of the vein, causing weakening. I would put constipation, eating spicy food and spending long time in the WC, as the major causes for haemorroids.”
Over-weight or obese people, those employed in strenuous weight lifting jobs involving more than 10 minutes of lifting weights at a stretch, heavy alcohol drinkers, are other classes of people predisposed to haemorrhoids, according to the doctor.
“Haemorrhoids are also common in pregnant women because of hormonal changes and pressure from the growing foetus,” explains, Dr. Achi. “In fact, women are more predisposed than men to haemorrhoids since the female hormone makes them more prone to constipation. Again, with the onset of puberty, youngsters are likely to suffer from this problem.”
Haemorrhoids are rarely dangerous or life threatening, except when there is a severe loss of blood and consequent anaemia, according to Dr.Achi. In most cases symptoms will disappear within a few days but in some cases treatment may be needed to get rid of them and quite often there may not be complete cure, although it is possible to prevent their recurrence by adhering to sound lifestyle and balanced diet.
Herbal and other creams and topical applications can work for grades 1 and 2 haemorrhoids, says Dr.Achi, components with local anesthetics, topical treatments with hormones. Topical treatments can work for grade 1 And 2 but not for 3 and 4. Pain, swelling and itchiness of haemorrhoids may be relieved by creams.
The first aspect of treatment involves relieving the contributory factors, according to Dr. Achi. “Relieving these factors will give an improvement which precipitates the treatment and would prevent recurrence. If we cannot negate these factors, we can be sure that even if with treatment even after treatment, haemorrhoids will recur. Treatment includes oral and topical applications to induce improvement in the muscular function of the veins. Second aspect in treatment would be to reduce the pain and inflammation. The third aim of treatment is to restore a normal bowel movement which will lead to improvement in the sphincter which is the muscle controlling the anus which in itself can lead to relieving the symptoms. Once this is done, we can say that we have achieved more than half of the cure.”
Dr.Achi is emphatic, “Once we shift to grade 3 and 4, unfortunately, most of the times, these patients either require surgery, sclerotherapy, cryosurgery, laser, ultraviolet treatment or rubber band ligation.
Rubber band ligation involves rubber bands being placed around the base of the haemorrhoid to cut off its blood supply, causing it to drop off painlessly. It is a successful operation and can be performed quickly and easily.
Alternately, Sclerotherapy, which involves injecting a chemical into the haemorrhoid to make it shrink, may be undertaken.
Cryosurgery involves freezing the haemorrhoid by spraying it with a very cold liquid to shrink it.
Laser may be used to burn the haemorrhoid.
Haemorrhoidectomy, a minor surgical procedure to clamp and remove the haemorrhoid may be used with a good cure rate of 90-95%. With the other techniques, says Dr.Achi, we are approximately close to 50% -60% cure with 40% recurrence. And the public should understand that surgery is more radical.”
Risks of the surgery include bleeding, burning around the haemorrhoids and pain in the region. One of the major but rare a complication from surgery is dysfunction of the muscle of the anal sphincter. The most important thing in the treatment of haemorrhoids is to keep the muscular function of the sphincter working well. This is the only major post operative complication that can happen to anybody with haemorrhoids, opines Dr.Achi. “This is a major social catastrophe causing embarrassment for a patient when he cannot move about without adequate protection with pampers et al. The sphincter problem too can be treated by surgery but it is a highly specialized and difficult treatment; hence surgeons are very careful in the first instance itself when operating to remove the haemorrhoids.”
Prevention of Haemorrhoids
1. There should to sufficient intake of high fiber diet. This implies eating fruits are the preferred choice to drinking their juices.
2. Plenty of water should be taken to moisten the food and make the motion soft and easy to expel.
3. People should go in for brown and wholemeal breads instead of the highly refined white bread.
4. Physical exercise is just as important as a good diet since it influences the movement of the bowel. Avoid sedentary living.
5. Most important, avoid making a reading room of the toilet by sitting there long.