Modern way of living
Modern way of living
Enlarged haemorrhoids and related issues are the result of modern lifestyles and can significantly impact the quality of life. Nevertheless, there are ways to make life easier by solving the issue.
Haemorrhoids are swollen veins, similar to varicose veins, that occur in the lower rectum. These are known as internal haemorrhoids. When they occur under the skin surrounding the anus, they are called external haemorrhoids.
We are all born with haemorrhoids, however, they do not cause concern until they become enlarged and swollen.
People can experience haemorrhoid problems already in their teens. With age, problems become more frequent. Approximately half the people over the age of 50 will occasionally experience haemorrhoid issues. Today's fast pace of life, often accompanied with irregular eating habits, insufficient fluid intake, and stress, significantly contributes to the increase in the incidence of hemorrhoids.
What impacts the onset of haemorrhoids
What impacts the onset of haemorrhoids
There are various factors that result in more frequent haemorrhoid issues:
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Pregnancy
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Chronic constipation or chronic diarrhoea
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Straining during bowel movements
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Sitting on the toilet for longer periods
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Regularly lifting heavy items
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Eating a low-fibre diet
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Family history
There are internal and external haemorrhoids
There are internal and external haemorrhoids
Internal haemorrhoids are not associated with pain. The most usual symptom is bleeding during bowel movements. Blood may appear on paper only as well as in the toilet bowl or stool. Patients can become frightened by the sight of blood because it is often associated with colorectal cancer.
Enlarged external haemorrhoids are usually itchy and painful and will occasionally bleed. They can become thrombosed. They may become swollen and firm. In this case, they will also become painful. Patients will become scared, but the condition is not life-threatening.
Both external and internal hemorrhoids can become prolapsed (i.e. protrude through the anus). In such cases, they are usually painful and bleeding.
However, bleeding is not related to haemorrhoids or colon cancer exclusively. The causes can range from anal canal fissures or ulcers to various inflammatory bowel diseases, e.g., various forms of chronic inflammatory bowel conditions (e.g., Crohn's disease, ulcerative colitis, and others). Therefore, in cases of heavy bleeding, a colonoscopy is recommended in order to rule out the above.
If you notice blood in your stool, visit your doctor, who will make the diagnosis based on the extent and frequency of bleeding as well as the associated issues.
A colorectal exam aimed at confirming enlarged haemorrhoids consists of a digital rectal examination, where the anal canal and the part of the large intestine reachable with fingers are palpated. We then perform a proctoscopy or rectoscopy to visually examine the anal canal and the lower part of the colon. During such examinations, we also perform minor surgeries. When the entire picture of the colon is required, a colonoscopy must be performed. This examination is usually performed if the cause of bleeding (or other issues) cannot be properly explained.
Prevention is important in avoiding problems, however, it cannot be guaranteed that issues will not appear. with chronic bowel movement issues, excretion is often difficult to manage.
Fluid and fibre intake
Fluid and fibre intake
Both are vital for the regular and soft bowel movements. Patients are advised to drink enough fluids. Also important is the sufficient consumption of fibre – at least 20 to 35 grams per day is recommended.
Also important is the intake of probiotics, which have been widely discussed recently. Probiotics play an important role in regulating our digestion. Recently, macrobiotics have been the talk of the town. Macrobiotics are microorganisms, mainly bacteria, present in our intestines which play an extremely important role in regulating our digestion, breaking down food, and even in the immune system function.
Also recommended is the proper hygiene of the anal area. If at all possible, it is recommended to shower follow defaecation. Furthermore, it is often recommended to apply ozonated olive oil to the anal area (using a glove, apply the oil to the anal canal up to approx. the second knuckle). If the skin surrounding the anus is sensitive, it can be treated with a moisturising cream. Avoid aggressive soap during treatment.
How to soothe the condition ourselves
How to soothe the condition ourselves
If the subject has already confirmed the presence of haemorrhoids or has ruled out other causes of bleeding during excretion and pain in the anal area via diagnosis, they can take certain measure to soothe the condition.
First, haemorrhoid ointments or suppositories which are available at virtually every pharmacy can be used They usually contain active ingredients that relieve or soothe pain or itching in combination with oily ingredients that impregnate the mucous membrane, protecting it from the effects of mucus or feces.
To date, in my work with patients, I have found that diosmin tablets, which are available OTC, are also beneficial. It is recommended to following the dosing recommended for the treatment of acute hemorrhoidal syndrome. Maintenance therapy can then be continued as needed. Maintenance therapy encompassing one 500 mg tablet twice daily is often recommended during the hot summer months. Also recommended are warm baths – 10 to 20 minutes daily.
Various treatment options exist. Some of the patients are reluctant to undergo surgical treatment for enlarged hemorrhoids, so the most suitable therapy is arranged based on agreement.
If the problem is merely of a sporadic nature, conservative therapy is usually agreed upon, meaning that, additionally to the above mentioned methods, a therapy involving prescription ointments or suppositories is started. Additionally, the therapy often also includes diosmin tablets. In case of minor hemorrhoids, problems often diminish after the therapy. In more severe cases usually caused by larger hemorrhoids, surgical treatment is recommended.
One of the minor procedures which today are quite common is internal haemorrhoid ligation or sclerotherapy. With this procedure, we attempt to gradually eliminate enlarged haemorrhoids in the course of several sessions. Following these procedures, the patient generally experiences no significant pain. Both procedures can be performed during a routine proctological examination (on an outpatient basis), but they are only suitable for relatively small haemorrhoids.
In the case of enlarged internal hemorrhoids, laser surgery is often recommended where, using a probe, energy is targeted at individual haemorrhoids with the objective of blood vessel coagulation, gradually reducing the hemorrhoids. This relatively new method is performed under local anesthesia. The principle is similar to varicose vein surgery of the legs. The procedure is relatively quick and allows the patient to return home afterwards. It is also suitable for the treatment of enlarged internal hemorrhoids.
The conventional Milligan-Morgan or Ferguson surgery is the method that has been around for a series of years and is the golden standard for the surgical treatment of enlarged external or internal hemorrhoids. The procedure is performed under regional or general anesthesia. Recovery is painful and a slightly longer.