THE NIG­GLE NO­BODY TALKS ABOUT

Haem­or­rhoids – they’re a pain in the butt, lit­er­ally. Piles, which are swollen veins that pop up near the anus and are of­ten itchy or painful or both, can af­fect any­one at any time, but the in­creased pres­sure of preg­nancy does tend to en­cour­age their occu

Your Pregnancy - - Pregnancy Files - YP

PILES, HAEM­OR­RHOIDS are a com­mon side-ef­fect of preg­nancy. In­ter­nal haem­or­rhoids are lo­cated in­side the rec­tum, while ex­ter­nal haem­or­rhoids de­velop un­der the skin around the anus. “Oc­ca­sion­ally, strain­ing dur­ing a bowel move­ment can push an in­ter­nal haem­or­rhoid through the anal open­ing and cause what’s known as pro­trud­ing or pro­lapsed haem­or­rhoids, which can cause pain and ir­ri­ta­tion,” says Jo­han­nes­burg-based GP Dr Dulcy Raku­makoe. For­tu­nately, piles are usu­ally fairly easy to deal with. It’s im­por­tant to keep the anal area clean by bathing or showering daily, and gen­tly pat­ting rather than rub­bing the area dry. For pain or dis­com­fort, ap­ply ice packs or cold com­presses; soak your anal area in plain warm wa­ter for 10-15 min­utes two or three times a day; and avoid us­ing dry toi­let pa­per – rather use wet wipes. Speak to your doc­tor about a painkiller that’s safe to use – parac­eta­mol is usu­ally con­sid­ered safe dur­ing preg­nancy, but don’t take non-steroid anti-in­flam­ma­tory drugs (NSAIDs) such as ibupro­fen if you have rec­tal bleed­ing, as this can make the bleed­ing worse, and avoid painkillers con­tain­ing codeine, as they can cause con­sti­pa­tion. If your piles are par­tic­u­larly dis­tress­ing or per­sis­tent, your doc­tor may pre­scribe an oint­ment or sup­pos­i­tory that can give relief, but there are a few ba­sic life­style changes that can go a very long way to en­sur­ing that your piles will be short-lived and, hope­fully, never re­turn.

LIFE­STYLE CHANGES

• Drink plenty of wa­ter: six to eight glasses a day will keep you prop­erly hy­drated. • Eat high-fi­bre foods: “Eat more fruits, vegeta­bles and whole grains, which soften the stool and in­creases its bulk, which will help you avoid the strain­ing that can cause haem­or­rhoids,” ad­vises Dr Raku­makoe. • Don’t strain: “Strain­ing and hold­ing your breath when try­ing to pass a stool cre­ates greater pres­sure in the veins in the lower rec­tum,” ex­plains Dr Raku­makoe. • Go to the toi­let as soon as you feel the

urge: “If you wait to pass a bowel move­ment and the urge goes away, your stool could be­come dry and be harder to pass.” • Ex­er­cise: “Stay­ing ac­tive helps to pre­vent con­sti­pa­tion, and ex­er­cise can also help you lose ex­cess weight that may be con­tribut­ing to your haem­or­rhoids.” • Avoid long pe­ri­ods of sit­ting: “Sit­ting for too long, par­tic­u­larly on the toi­let, can in­crease the pres­sure on the veins in the anus.”

WHAT IF THE HAEM­OR­RHOIDS DON’T GO AWAY – OR THEY GET WORSE?

There are a few com­pli­ca­tions that can oc­cur. One is a throm­bosed haem­or­rhoid, which hap­pens when a clot forms in the pile. “This will cause a lump near your anus which isn’t dan­ger­ous but can be ex­tremely painful and some­times needs to be cut and drained,” says Dr Raku­makoe. “If the blood sup­ply to an in­ter­nal haem­or­rhoid is cut off, it can be ‘stran­gu­lated’, an­other cause of ex­treme pain,” she adds. “And, rarely, chronic blood loss from haem­or­rhoids may cause anaemia.” Your doc­tor can treat stub­born haem­or­rhoids in a va­ri­ety of ways. “In a rub­ber-band lig­a­tion, she will place one or two tiny rub­ber bands around the base of an in­ter­nal haem­or­rhoid to cut off its cir­cu­la­tion, and the haem­or­rhoid will wither and fall off within a week,” says Dr Raku­makoe. In scle­rother­apy, your doc­tor in­jects a chem­i­cal so­lu­tion into the haem­or­rhoid tis­sue to shrink it. Coag­u­la­tion tech­niques use laser or in­frared light or heat to cause small, bleed­ing, in­ter­nal haem­or­rhoids to har­den and shrivel. In a haem­or­rhoidec­tomy, your sur­geon will re­move ex­ces­sive tis­sue that causes bleed­ing. “This is the most ef­fec­tive and com­plete way to treat se­vere or re­cur­ring haem­or­rhoids,” says Dr Raku­makoe.

RED-FLAG IS­SUES

Although bleed­ing dur­ing bowel move­ments is a com­mon sign of haem­or­rhoids, don’t just as­sume that the rec­tal bleed­ing is be­ing caused by piles, es­pe­cially if you’re over 40 years old. “Rec­tal bleed­ing can oc­cur with other dis­eases, in­clud­ing col­orec­tal can­cer and anal can­cer, so if you have bleed­ing along with a marked change in bowel habits or if your stools change in colour or con­sis­tency, con­sult your doc­tor,” says Dr Raku­makoe.

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