We tend to NOT talk about things that are related to that region. The behind. In medical terms, the “anus.” It is quite difficult to mention this portion of the body, but it does, like all other parts of the body, have conditions and today I would like to mention one of these conditions in this column. (If you do have any questions about this matter, feel free to ask through the e-mail. Patient confidentiality will be definitely secured)
A hemorrhoids is a swelling of the vascular beds that surround the sphincter of the the anus.
It is a condition that is mostly found in humans, for humans are the only species that walk on two legs which adds extra pressure to the sensitive structures around the anus and the vascular walls of the arteries and veins.
Recent Korean reports say that there has been a great increase in the incident of hemorrhoids in middle to high-school students. The reports say, the reason for the increase is the change of diet to a more “Westernized” form and the long hours of sitting on a chair. What the reports are saying is that less fiber diet may lead to this problem. Irregular bowel habits (constipation or diarrhea) and spending long times in the toilet is also, one of the causes. Obesity and pregnancy that lead to increased abdominal pressure for a long period of time maybe also one of the factors that lead to hemorrhoids.
The symptoms of hemorrhoid may be obvious such as bleeding and rectal pain to not so obvious like itching. The external hemorrhoid (e.g. hemorrhoids that are on the outer surface and visible) are more often painful while the internal hemorrhoids aren’t — which leads to greater problems due to the lack of awareness. Naturally the symptom for internal hemorrhoids tends to be bleeding, blood mixed feces (hematochezia), and prolapses.
In hospitals we “grade” the patients according to the severity of the disease. Grade 1 means there aren’t any prolapses of the anus, whereas grade 2 means there is prolapse while defecating. In a grade 3 situation, there is prolapse with defecation that does not spontaneously resolve. it is from grade 3 that patients may need surgical intervention. Grade 4 is prolapse irrelevant of defecation, that does not resolve.
Diagnosis of a visually protruding hemorrhoid may be easy, but in quite a few cases, visualization using endoscopy maybe needed to correctly diagnose the situation. (Especially in patients with an internal hemorrhoid)
If you have a condition, more severe than grade 3, it would be wise to go to a specialist (in general surgery) for consultation. In a less severe state (grades 1 and 2) a diet with plenty of fiber and water, and sitz bath might just do the trick. If slight swelling and pain is observed an over the counter Nonsteroidal anti-inflammatory drugs may do the trick.
Please remember, do NOT be shy to report this condition and make a consultation. Like so many other conditions, it is better to know it earlier in the process. If you see blood after wiping, any symptoms mentioned above, it is wise to just get to the doctor for a thorough examination.
▲ Illustration by Dr. Jay
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