By Ellen Campbell-Grizzle - PHARMACY TODAY
HAEMORRHOIDAL ATTACKS are a pile of trouble. They are very common particularly in persons over 50 years old. Patients complain about 'an itch in the private area', 'bleeding from the back passage', 'pain down below', 'blood in the stools', 'a burning sensation on the passing of stools', and even constipation.
While the majority of haemorrhoidal attacks are minor, uncomfortable and embarrassing, they are usually not serious and may last between seven and 10 days. However, blood in the stool can come from any part of the intestine and has to be investigated. As the condition worsens, patients report four to six attacks per year and may need surgery to remove the problem.
Haemorrhoids (piles) are normal structures at the upper end of the anal canal supported by two tissues. Constant pressure on the tissue, such as straining when constipated, tends to destroy the tissue. As a consequence, the haemmorrhoids become swollen like a balloon, tissues may rapture and the haemorrhoids become permanently protruded. External piles are more easily recognised by patients who report a swollen area in the anus. However, both internal and external piles cause similar problems and can produce blood in the anus even without the passing of stools. Patients see bright red blood, not usually mixed in with the stools, on toilet paper.
CHRONIC STRAINING
A major cause are those things that cause us to raise the pressure in the abdomen. These include chronic straining with constipation, after and during pregnancy, overweight and heavy lifting jobs. Irregular bowel movement, frequent changes in lifestyle and excessive travel are contributory factors. Teachers, who stand for a long time or other workers who sit for long periods tend to accumulate blood in the veins and are vulnerable.
Prevention works well. You should avoid becoming overweight; eat a high- fibre diet including bran, whole grain, green vegetables and fruits; avoid alcohol, tea, coffee and spicy foods and never postpone the urge to pass your stools.
Your doctor can help decide the grade of piles you are suffering from and the appropriate treatment. Common remedies are:-
Regularisation of bowel movement including increased fibre in your diet and lots of water (at least 1.5 to 2 liters daily)
Take Sitz bath twice daily fill a tube with warm water (not too hot) and sit in it for about 15 minutes each time.
Use medicated creams or suppositories inserted into the anus, usually at bedtime for seven days.
Regular exercise.
There are several types of medicines for piles that can reduce the size of the swelling, pain and itching. These include the following groups:
Astringents these form a protective coat over sensitive areas.
Local anaesthetics reduce pain at the site.
Heparinoids reduce swelling and leaking from haemorrhoids.
Protectants cover inflamed, irritated tissue.
We know that piles normally ease in a matter of days. It is best to use the least amount of treatment possible. If simple measures do not work or the problem keeps coming back, you must go back to your doctor. Associated danger signs include weight loss, anaemia, change of bowel habit, slime (mucus) in the stools or darker blood mixed in with the stools.
If you want to know more about the various types of medicines used to treat piles, ask your pharmacist, you have the right to know!
Ellen Campbell-Grizzle, president, Caribbean Association of Pharmacists; director, Information & Research, National Council on Drug Abuse.