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
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.
• 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.
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.