The recognition of haemorrhoids (also called piles) dates back to ancient times long before Hippocrates (460 – 370 BC), the Father of Modern Medicine, and Galen (130 – 201 AD) prescribed the standard surgical therapy as documented in their treatises.
Haemorrhoids occur when varicose veins form around the anus. When these veins are formed outside the anal sphincter, they are called external haemorrhoids. When they are formed inside the anal sphincter, they are called internal haemorrhoids.
There is geographical variation in the incidence of haemorrhoids. In any locality, its true incidence cannot be ascertained. This is because haemorrhoids can either be symptomless or when they produce symptoms, many patients are prepared to bear their burden rather than face the prospects of surgery.
Of all non-cancerous diseases of the anus and rectum (the back passage) seen in the tropics, haemorrhoids are the most common. Other non-cancerous diseases of the anus and rectum include anal tear and infections.Haemorrhoids are more common in western societies than in the tropics. In the tropics, on the other hand, a higher incidence could be discerned in urban dwellers when compared with their rural compatriots. Where it is established that the population has had longer contact with western civilization, the incidence of haemorrhoids seems to be rising. This is attributed to the increasing consumption of refined foods which are often low in fibres leading to constipation. On the other hand, the diet of the rural dwellers is bulky and facilitates regular opening of the bowel.
Haemorrhoids is a disease of young and middle aged adults although older patients are not exempted. It is rare in childhood. Both sexes are susceptible and most reports indicate a male preponderance but no causal association has been demonstrated. Although a groin hernia, diseases of the prostate, pregnancy,and cancer of the rectum are occasionally associated with haemorrhoids, most cases have no overt causation.
The standard surgical treatment is still attended by severe after-surgery pain, long hospital stay and in Nigeria an unfounded fear of impotence. Over the years, doctors have devised other effective methods of treating patients with haemorrhoids.
A haemorrhoid is a progressive disorder,and a scale of the severity of its symptoms is recognised in order to have a basis of comparing various treatment regimens.Mild haemorrhoids are present if the patient complains of painless, bright red rectal bleeding on defecation. Examination reveals engorged rectal blood vessels only.
Moderate haemorrhoids occur when there is an anal protrusion on straining at defecation but spontaneously reduces or requires manual push after defecation.
Severe haemorrhoids are present when the haemorrhoids are permanently prolapsed or prolapse readily on standing up. The above classification presupposes that the first symptom of haemorrhoids is bleeding. However, sixty per cent of patients with prolapsing piles claimed that prolapse, and not bleeding, was their first overt symptom. In addition to the symptoms of bleeding and prolapse, some patients complain of anal discomfort or pain (from associated anal tear or clotting of the haemorrhoids) and itching provoked by mucous discharge from the prolapsed anus.
There is always considerable confusion and much difference of opinion in the treatment of any disease whose causation is unclear. The range of patent medicine, suppositories, conservative and operative measures for controlling the symptoms of haemorrhoids bears testimony to this confusion.
The works of Hippocrates and Galen prescribed cutting, tying and burning (or recently, freezing) for the treatment of haemorrhoids. Till today, most operative procedures are still based on this principle with one modification or another to eliminate the disadvantages of cutting and tying.
Modern treatment of haemorrhoidal disease can be operative or non-operative. There are two non-operative methods:
•The use of sitting in warm saline for 30 minutes twice daily, special diets, usually bulk-forming, and local medications in the form of suppositories,etc.
•The injection of chemicals into the piles which dry them off. This will cure mild forms of haemorrhoids only.
Operative forms of treatment include:
• The cutting, tying and burning/freezing method and
• Manual anal dilatation.
Most patients with symptomatic haemorrhoids can be successfully treated by manual anal dilatation. The cost of in-patient management, even in advanced countries, indicates the clear advantages of manual anal dilatation.
The complications of the procedure are not common and include an initial increase in the size of the haemorrhoids in the first few days after surgery and occasional soiling of the pant when the faeces are fluid. These abate within two weeks of operation when the patient is able to return to work.
When treating piles with natural remedies, diet is important. Avoid refined and sugary foods such as biscuits, ice cream,and soft drinks. Drink up to four cups of water on an empty stomach every morning. An effective natural remedy for piles is to eat two half-boiled Irish potatoes, peels inclusive, every night for five days.
If you experience anal bleeding or protrusion, apply coconut oil with cotton wool to the anus. Another remedy is to blend 500 gram or one handful of Neem leaves, also called dogoyaro, in half litter of water and drink once daily.
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