What to do before hemorrhoids become a painful problem

By Maria Endah Hulupi

JAKARTA (JP): It's a lifestyle choice: keep to that bad diet, heavy on the junk food and low on fiber, and chances are that hemorrhoids will be in your future.

An internist at Cipto Mangunkusumo General Hospital, Dharmika Djoyoningrat, said many people were not aware that their lifestyle played a big part in the development of hemorrhoids, which are a mass of dilated veins in swollen tissue around the anus or near the rectum.

"People go to the doctor after they notice fresh bleeding when defecating and suffer discomfort and pain in the area. However, although there may be no symptoms, many people with bad bowel habits, who need to strain to discharge hard stool, may have already developed the early phase of hemorrhoids," he said.

Straining leads to vascular dilation and stretching of the supporting connective tissue. Sometimes this condition causes bleeding when the hard stool forcefully brushes against the swollen vein.

Hemorrhoids function as protective "pillows" that engorge with blood during the act of defecation, protecting the anal canal from direct trauma due to the passage of stool.

However, Dharmika said the problem can be prevented by good bowel habits, which is routine smooth, nonpainful defecation, ideally once every day or every two days.

The food we eat is ingested in the small intestine where the nutrients are absorbed. The undigested mass passes into the large intestine, where most of the remaining water is absorbed by the blood stream. Solid waste collects in the rectum and is expelled through the anus.

"The longer the stool remains in the rectum the harder it will become," Dharmika said.

Fiber from fruits, vegetables and grains ease the process of defecation.

"Unlike tender but solid stool, hard stool is not easily and smoothly discharged by the intestinal peristaltic movement. This is the reason why people, especially those with poor bowel habits, need to strain," he said.

Hemorrhoids are differentiated into two types, depending on location: the external hemorrhoid is a swollen vein outside the sphincter, while the internal hemorrhoid is located in the inner part of the sphincter.

People at risk of developing hemorrhoids are those who lead a sedentary lifestyle, those that perform activities that create extra intra-abdominal pressure, such as weight lifting, people with bad bowel habits, including putting off going to the toilet, those with a low-fiber diet and those who drink too little water.

Pregnant women and the obese are also at high risk because of the increased intra-abdominal pressure.

An early symptom of hemorrhoids is internal bleeding with fresh bright red blood, which can worsen into a mucous discharge. There may also be itchiness and discomfort.

The degree of the problem comes under four classifications:

* first degree involves bleeding, usually without any other symptoms;

* second degree involves bleeding and the descent of the hemorrhoid during defecation, with it returning upon the cessation of straining;

* third degree involves the descent of the hemorrhoid during defecation, but it may have to be replaced manually;

* fourth-degree hemorrhoids are irreducible and can cause thrombosis. The later is always accompanied by severe pain.

Treatment

Early stage hemorrhoids can be treated with oral and suppository medications; most suppositories lubricate and relieve irritation in the anus. Accompanied by oral medication, they improve the tone of the swollen vein and improve blood circulation in the area to prevent thrombosis.

Another alternative is elastic band litigation placed on or above the internal hemorrhoid.

For more serious hemorrhoid cases, injections are used to constrict the swollen vein and prompt it to collapse, while surgery is needed to remove the prolapse and thrombose.

"After the surgery the blood can flow to the area through other vessel," he said.

To prevent hemorrhoids or a flare-up, lifestyle changes, particularly focused on diet, will be needed.

Dharmika stressed the importance of a high-fiber diet and drinking plenty of water to create a moist and tender stool. Exercise also helps improve peristaltic movement and ensure routine bowel movements.

He also cautioned about food choices which may exacerbate the problem. "Avoid consuming spicy food because it will aggravate irritation in the anus ... "

Natural fiber, contained in vegetables and fruits, are the best bulk producers, although people are increasingly turning to fiber substitutes now widely available in supermarkets and drugstores. Dharmika did not believe there would be a problem with daily consumption of the products.

Laxatives also stimulate peristaltic movement, shorten the water-absorbing phase and enable the soft mass to reach the rectum.

They can also ease the problem of a low-fiber diet, but long- term use can lead to a sluggish bowel, weakening the natural peristaltic movement and forcing a person to take higher dozes of laxatives to enable a bowel movement.

Dharmika advised people who experienced internal bleeding while defecating to seek medical attention, because bleeding from the anus may also be triggered by polyps, a tumor, cancer or other blood vein irregularities within the digestive tract.