Based on the steady number of prescriptions that I receive for treatment of haemorrhoids, and the number of enquiries from clients for recommendations for haemorrhoid relief, I believe that haemorrhoids are fairly common among our people.

Haemorrhoids, also known as 'piles', are swollen, inflamed veins in the back passage (anus and lower rectum). There are internal haemorrhoids which remain on the inside of the anus, and external ones which protrude outside the anus usually causing pain and irritation. The finger may be used to gently push back an external haemorrhoid (best done by a medical doctor), and sometimes it may retreat on its own. Haemorrhoids affect men and women but in our homophobic culture, bleeding haemorrhoids are an unwelcome complication, especially for men.

Symptoms of haemorrhoids include:

Bleeding during or shortly after bowel movements.

Pain and/or itching in the region.

Swelling (sometimes a hard lump) around the anus.

Leaking of faeces.

Repeated straining

Haemorrhoids may be the result of repeated straining during bowel movement, which is itself the result of constipation. The veins around the anus (rectal veins) may stretch, swell or bulge when they are under pressure. The increased pressure may be due to:

Obesity

Pregnancy

Long hours of sitting

Anal sexual intercourse

Liver disease which may cause high blood pressure in the portal vein.

Water retention experienced by women during premenstrual period which may lead to constipation.

Diarrhoea

Excessive consumption of some drugs like alcohol, caffeine and tobacco smoke.

There is some tendency to experience haemorrhoids as we grow older since the tissues which support the veins in the rectum may weaken during the ageing process. Also, we may inherit from our parents the tendency to develop haemorrhoids.

Prevention and treatment

Since constipation is one of the main culprits which lead to haemorrhoids, preventing constipation with lifestyle changes may prevent them in many cases. Increasing daily intake of fluids and fibre-rich foods like oatmeal, fruits and vegetables is key. Exercise is also helpful, as is reducing straining during bowel movement.

There are many effective options for treating haemorrhoids and they fall into two main groups:

1. Soothing creams, ointments and suppositories which act directly on the anus and rectum to relieve pain and irritation. Sitting in a container of warm water (warm Sitz bath) is also soothing. Placing an ice pack on an external haemorrhoid for 20 minutes has been shown to relieve itching and swelling.

The soothing products usually contain an antiseptic to prevent infection; an astringent which promotes healing of the skin; a vaso-constrictor which encourages the rectal vein to contract; a mild local anaesthetic to deaden the pain caused by the haemorrhoids, and/or a mild steroid to relieve and calm down the inflammation in and around the anus. These ingredients include peru balsam, ephedrine, bismuth oxide, witch hazel, zinc oxide, aluminium acetate, benzyl benzoate, lidocaine, pramocaine, hydrocortisone, prednisolone and fluocortolone.

2. Just as the increased intake of fluids and fibre-rich foods prevents constipation and haemorrhoids, a mild bulk-forming laxative (like psyllium such as Metamucil or wheat bran) or softening laxative (like mineral oil or liquid paraffin) is sometimes recommended to ease the passage of faeces, which in turn reduces the pain experienced by people with haemorrhoids.

Surgery to remove the haemorrhoid (haemorrhoid-ectomy) or rubber-band ligation to cut off the blood supply to the haemorrhoid or other procedures are last resorts when haemorrhoids are severely and persistently painful and continue to be troublesome.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.