An anal affair: Dealing with piles

Sunday September 12 2010

By Stella Nakakande

Because most people do not see a doctor when they have piles, the disease often progresses and can make going to the toilet a very horrid affair, not to mention affect your general health, writes Stella Nakakande

Piles, scientifically called Haemorrhoids, are small, blood-filled swellings, caused by dilated (varicose) veins of the rectum or anus, that cause anal bleeding, itching and discomfort, explains Dr Henry Bukenya of Trinity Medical Centre in Kawempe.

Piles can be defined as either internal or external, although the latter are less common. In the latter case, the swellings are located on the outside of the anus.

Types of piles
Although piles develop from inside your anal canal, they can hang down out of your rectum. There are different grades of piles. First degree piles are swellings on the inside lining of your anal canal. They may bleed but can’t be seen from outside the anus. Second degree piles are larger and stick out (prolapse) from the anus when you have a bowel movement, but return on their own afterwards.

Third degree piles are similar, but hang out from your anus and only return inside when pushed back in. Fourth degree piles permanently hang down from your anus and they can’t be pushed back inside. They may become extremely swollen and painful if the blood in them clots. External piles are swellings that develop from below the anal cushions. They can be more painful than the other types of piles.

Although sometimes haemorohoids occur with no apparent reason, there are a number of causes, most notably prolonged and repeated constipation, the doctor says.


“Haemorrhoids can also be brought on by increased pressure in the abdomen,” Dr Bukenya explains. This is commonly so for pregnant women, especially if they tend to lift heavy objects and strain while passing faeces.

At times, occasional diarrhoea and complications from chronic liver disease, hepatitis and tumours of the liver could also lead to piles.
Also, as one ages, the support structures in the rectum weaken and cause piles. If you’re born with a weakness in your rectum or have a family history of piles, you may also fall victim to this condition.
Dr Bukenya explains that the disease occurs in three stages. “They are placed equidistant around the circumference (distance around a circle) of the anus. They are like a clock, with a placing of three, nine and 12,” he says.

The symptoms of piles range from temporary and mild to persistent and painful. There is pain sometimes, especially when passing faeces. This pain is felt around the ring-like fissures around the anus. Piles are also characterised by bleeding at the end of defaecation or after.
The swellings are uncomfortable and sometimes tend to disappear.

However, some are persistent and hang outside the anus. For these, the only relief comes after applying pressure. This is the terminal stage of the disease or otherwise stage three. For this stage, surgery called haemorrhoidectomy is performed, Dr Bukenya says. Surgery is however not a prerequisite if the disease is in its first or second stages.

There are forms of treatment. “Bowel regulation using a high fibre diet to soften the stool is advised,” he recommends. Patients are therefore advised to eat cabbage, bamboo shoots popularly called malewa, cerereals like Weetabix, fruits, spaghetti, brown rice, beans, peas and other foods rich in fibre.

Doctors also recommend the use of irritant fluids, especially when bleeding associated with piles persists. At times, scelorising agents like liquid paraffin, medically applied by the doctor, are injected around the swollen vein. The sclerosant, otherwise called a hardening agent, causes the vein walls to collapse and the haemorrhoids to shrivel up. This method is normally used for the very small haemorrhoids. Laxative drugs may also be prescribed to prevent constipation and soften the stools.

Forceful dilatation of the anus can be done when a person is completely anaesthetised. However, sometimes piles do occur even after all this treatment.

Having a fibre-rich diet softens the stool.
Pregnant women should avoid lifting heavy objects or straining when passing stool or faeces. They are advised to sit as opposed to squatting when passing stool. Women who are pregnant for the very first time are more prone, the doctor says, “Their muscles are still weak.”
Taking plenty of fluids, a recommended daily amount of water being about eight glasses of water or two litres, is advised.
Avoid excessive consumption of alcohol because it is said to be dehydrating.

Do not delay going to the toilet. Delay may result in bigger and harder faeces forming, which are much more difficult to pass.
Avoid straining (pushing too hard) when one goes to the toilet.
People with haemorrhoids are advised to avoid medicine that causes diarrhoea and should only take it on a doctor’s recommendation.
Exercise is said to be good for haemorrhoid patients, for it aids the muscles.

Regular warm baths may relieve irritation and help to keep the anal area clean.