Thunder it is said does not strike twice on the same spot. Some one sent me a text from Gregory University Uturu, after service on November 10, he said and I quote “ Doc, your article on ‘Low back pain’,in Sunday Sun Newspaper of November 3, was very educative. Thanks. Sure readers will appreciate a write up on haemorrhoids, may be next week, if you can. Regards “. Un quote.
Shortly after, a reader from Lagos asked whether piles and rectal prolapse are the same. Also he wanted me to discuss piles.
Wait a second. “Is it possible that most of my responders have been confusing piles with rectal prolapse?” Or have they been using my prescribed treatment for piles to treat rectal prolapse?
Now everybody pay attention, let me give some simple definitions to differentiate pile with rectal prolapse. Lest I forget, please note that piles and haemorrhoids are one and the same thing. So we can either say piles or haemorrhoids.
Haemorrhoids(piles) – These come about through the enlargement of veins in the walls of the rectum or anus. This may be due to acute constipation, or over straining during excretion. It can also result from tumours.
• The swellings cause the mucous membrane to press against passing faeces, causing discomfort, pain and sometimes bleeding.
Rectal prolapse – while rectal prolapse is the collapse of the rectal wall. It occurs mostly in young babies and the elderly. It is also caused by excessive straining during passage of faeces, and in the old by weak rectal and anal muscles.
• In severe cases an entire area of the rectal wall prolapses through the anal sphincter. Extreme pain from strangulation could result.
I hope we have noted the difference. I shall only discuss pile(haemorroids) today.
• Haemorrhoids(piles) are not simply dilated veins, they are cushions of vascular tissue like lips, occurring in the rectal mucosa. Haemorrhoids are swellings that develop inside and around the back passage – anal canal. There is a network of small veins(blood vessels) within the lining of the anus.
What are the causes of haemorrhoids.
1) Constipation – through low fibre diet, smaller caliber stool causes a person to strain, when passing stool, increasing the pressure within the blood vessels.
2) Pregnancy – due to increased pressure of the enlarged uterus on the rectum and anus.
3) Prolonged sitting – or squatting on the toilet seat with associated straining may increase pressure within the haemorrhoids’ blood vessels.
4) Obesity – increases pressure on rectum and anus.
5) Diarrhoea – both acute and chronic increase pressure on rectum and anus hence pile may become exacerbated.
6) Colon cancer – also contributes to development of pile.
7) Spinal cord injury – leads to loss of sphincter control and pile development.
What are the signs and symptoms of pile?
a) Painless bleeding – usually bright red.
c) Anal itching.
d) Mucus discharge and a feeling that the rectum isn’t completely emptied.
e) Pain at the cite of the prolapse and swelling.
Classification of pile.
Haemorrhoids are classified into three.
1) 1st Degree – haemorrhoids are contained in the rectum and only bleed occasionally.
2) 2nd Degree – haemorrhoids prolapse through the anus during defaecation, but returns thereafter.
3) 3rd Degree – haemorrhoids remain persistently prolapsed, and do not return after defaecation.
How do we treat haemorrhoids?
1. Regardless of the size of the swelling of a haemorrhoid, no treatment is required if symptoms do not exist.
2. Prevention is perhaps the most effective treatment.
3. Diet – and adequate hydration are very important to maintain normal bowel movements.
4. High fibre diet for patients with constipation.
5. Antibiotics to treat those with diarrhoea, and diet adjustments may be required.
6. Warm sitz baths for 1st degree – sitting in warm water tub with antiseptic for 20 minutes, two or three times a day.
7. Medications like docusite sodium, paraffin oil, solace, surfak or correctal to soften the stool.
8. Inflammation could be controlled with creams suppositories eg anusol, witch hazel or hydrocortisone to decrease inflammation.
9. 2nd & 3rd Degrees haemorrhoids are initially treated the same way – using techniques to destroy the haemorrhoid.
10. Patients who failed conservative therapy, or those with 3rd degree will face surgery. Remain medically guided.
11. Avoid over straining when using the toilet, try not to strain. This creates pressure in the veins in the lower rectum.
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