THE WORD “HEMORRHOUS” CAN BE HEARED OFTEN, but in a figurative sense, as a designation of hassle or life difficulties. The disease itself remains a taboo topic, which is embarrassing to talk about even with loved ones; Many people are embarrassed to go to the doctor at the first concern, so they seek help when it becomes unbearable. At the same time, the disease occurs in a large number of people – almost 40% and even 55% appear in statistics . We understand what hemorrhoids are, how dangerous they are and how they are treated.
What it is
Hemorrhoids occur when the nodes of the hemorrhoidal plexus become inflamed. Previously, these nodes were considered dilated areas of veins, similar to varicose veins, but in the end they were recognized as a normal anatomical feature – they, along with the sphincter muscles, help the rectum to retain its contents. The problem arises when irritation, trauma or thrombosis of these areas occurs – severe pain appears, bleeding may occur.
Scientists have not yet agreed on the causes and mechanisms of the disease, and there are many theories of its occurrence – but, apparently, straining against constipation plays an important role, and the latter is often caused by a lack of fiber and fluid in the diet. They also talk about factors such as age, alcohol consumption, pregnancy (during this period, hemorrhoids are often exacerbated), hereditary features of the structure of connective tissue. A sedentary lifestyle, like in office work, is often the inability to empty the bowels on time, which also increases the risk. In addition to constipation, diarrhea can contribute to the development of hemorrhoids , as well as simply sitting on the toilet for too long – so do not get carried away with reading when the business for which you came to the toilet has already been done.
What does it threaten
The insurance company MAPFRE has dedicated a separate page to hemorrhoids in the road safety section: prolonged driving can worsen the condition if the disease is already present, and constant discomfort or side effects of treatment can make driving risky.
In rare cases, chronic bleeding can lead to anemia. Even less often, the disease can lead to fecal incontinence or the formation of a fistula – a channel between the intestinal lumen and the skin. But the most common complications are severe pain and bleeding with thrombosis of hemorrhoids. They cause discomfort both when sitting in a chair and when going to the toilet; soreness makes quality of life worse, distracting, and can interfere with work or other activities.
Fear of sharing your concerns with loved ones or seeing a doctor only makes things worse. It is not known how many people have been labeled as inattentive or distracted when pain or fear actually interferes with their functioning. We have already told why it is time to remove the taboo from the toilet topic; there are more and more people ready to talk about it – Sasha Kazantseva, the host of the “Washed my hands” channel, collects stories of women with “poop diseases”, and the author of The Cheeky Blog, with witty illustrations, tells, for example, how she tries to solve the problem of constipation.
How to suspect
The most common symptoms of hemorrhoidal disease are red blood on toilet paper, pain during and after bowel movements, itching, discomfort in the anus, a feeling of incomplete bowel movement. The hemorrhoids themselves can be visible or not – they are divided into internal and external. Internal problems can manifest themselves exclusively as bleeding. Sometimes the internal nodes, swelling, protrude out of the anus; external with edema and thrombosis are clearly visible. Internal hemorrhoids are covered with a mucous membrane without pain sensitivity, and when the external ones are irritated, on the contrary, the pain can be very strong.
You can immediately contact a specialist, a proctologist or coloproctologist, if there is such an opportunity, or a local doctor who will send you for the necessary examinations and consultations. What you should definitely not do is be shy and postpone your visit. Intimate areas of the body of any shape, shade and degree of hairiness are routine for a doctor, and no one will laugh at your anatomy; preparation for the examination is not necessary – except for good hygiene. It is also important to seek help because other diseases can have similar symptoms, and only a doctor can make an accurate diagnosis. If additional tests are required, you may be asked to prepare for them – for example, to do an enema and come strictly on an empty stomach.
How to prevent
For the prevention of hemorrhoids, it is important to empty the intestines on time (that is, do not endure when you want to go to the toilet) and eat so that the stool is soft and does not have to push hard – which means that there is a lot of fiber in vegetables and fruits, and drink enough liquid. It is believed that an adult needs 25–40 mg of fiber per day, and most of them get less than they need with food; if so, the doctor may prescribe fiber (dietary fiber) in the form of a food supplement during consultation.
Mayo Clinics remind you that it is important to move because physical activity prevents constipation and distributes blood flow, reducing pressure in the veins. For the same reason, it is best to avoid long-term sitting anywhere – in the office or on an airplane – and get up periodically to warm up. Sitting on the toilet is not a good idea to read or play games on your phone – and in general, ideally, you shouldn’t spend more than two minutes there . Japanese experts also talk about the importance of a balanced diet and healthy toilet habits (avoid straining, do not endure or sit for a long time), and also advise not to freeze and protect yourself from emotional stress.
How to treat
Treatment always begins with the same measures that serve to prevent hemorrhoids: it is important to change your lifestyle, adjust your diet (add vegetables and fruits, remove fatty foods and alcohol), and tidy up the toilet regime. As Badma Bashankayev, medical director of GMS Hospital, head of the International School of Practical Surgery, Moscow State Medical University, says in one of his articles. I. M. Sechenov, even if the planned surgery, it is important to pre-normalize stool – otherwise after the operation every trip to the toilet will cause pain and healing may take several months.
The doctor chooses the tactics of treatment depending on the stage of the disease, the needs of the patient and where the problem nodes are located – inside or outside the anus. To reduce pain and swelling, ointments, creams and suppositories with glucocorticosteroids, analgesic or vasoconstrictor components are used – they help reduce inflammation. NSAIDs are sometimes prescribed for severe pain. We do not welcome self-diagnosis and self-medication, but if hemorrhoids are found where there is no way to see a doctor, first of all, you need to adjust the diet in favor of foods with a lot of fiber, give up alcohol, switch from ordinary toilet paper to wet, or better – to wash water. You can use over-the-counter suppositories or creams from the pharmacy – just read the instructions carefully, and when you have the opportunity, still go to the doctor. It is important to remember that not all drugs from advertising are really effective – and it is easy for a person who is embarrassed to seek help and wants to be treated on his own to sell anything.
Surgical treatment is usually offered if the disease cannot be dealt with otherwise – or if its manifestations (for example, minor episodic bleeding) seriously interfere with the patient’s life. Minimally invasive interventions include, for example, laser coagulation, sclerotherapy of hemorrhoids with a special solution and ligation, in which the knot at the base is tied with a rubber ring; due to the lack of blood flow, the tissue falls off after a few days. In more severe stages of the disease, more serious interventions are also used, removing tissue fragments with hemorrhoids.
As Bashankayev says, after minimally invasive interventions, you can immediately go home, and the recovery period goes without problems – but there is a rather high probability of relapse. For larger interventions, it is necessary to spend in a hospital from one day (if it is a private clinic) to a week (in a public hospital); the postoperative period is painful, and the final recovery takes about a month, but the risk of relapse is minimal. In any case, you need to choose a specific method not on your own, but together with a doctor.
Hemorrhoids and pregnancy
Hemorrhoids during pregnancy or shortly after childbirth, according to some data , occurs in more than half of women, and in the International Classification of Diseases it is even placed in a separate item. True, most often we are not talking about the first appearance of symptoms, but about their worsening. This is facilitated by several factors: the enlarged uterus compresses the intestines, under the influence of hormones, the tone of its smooth muscles changes. In addition, iron prescribed after childbirth to prevent anemia can contribute to constipation.
All this is another reason to strive for a healthy lifestyle during pregnancy. During this period, not all medications can be used, and surgical interventions are performed only in emergency cases – therefore, it is especially important to be physically active, eat a lot of fruits and vegetables, and get enough rest.
Hemorrhoids and sex
Anal sex is not a cause of hemorrhoids, but it can injure hemorrhoids, cause pain or cause bleeding – which means you need to listen to your body, not spare the lubricant, use condoms and discuss any discomfort with your partner. Trouble-free sex is an important part of quality of life, and it may well influence the decision to treat hemorrhoids surgically.
Sometimes hemorrhoids are mistaken for skin outgrowths (skin tags in English) located around the anus that do not hurt or become inflamed. They can be simply a feature of the anatomy or a consequence of hemorrhoids – in this case, the fold remains after the skin is stretched by an inflamed node. They are usually not bothersome, but they can interfere with hygiene, be injured during sex or clothing. Many are simply shy about these folds of skin – although in the discussion on reddit you can find comments and that this is a separate erogenous zone with many sensitive nerve endings. If desired, skin tags can be removed – however, such operations are considered cosmetic, and you will have to pay for them from your pocket.