People want to know how long their haemorrhoids will last

PUNCH

Almost as though it was planned from a singular source, a flurry of questions arose over the past several days, demanding to know in nearly identical terms how long this condition actually lasts.

It seemed quite strange, and one female patient sent such monstrous-looking swellings around her anus that one feared they might even rupture, causing serious bleeding.

So, rather than try to answer all the questions individually, I decided to answer all the curious readers with a single essay.

There is no prescribed duration for how long a haemorrhoid or pile will last, and it is important to understand from the outset that even at the point of examination in the hospital, it is not possible to say categorically how long a haemorrhoid will persist.

Starting from the size of these swellings, the small ones can clear up on their own within a few days without requiring any treatment. The larger ones may take several days to retract into the anus and will usually be accompanied by significant pain and discomfort that may be bad enough to prevent some people from sitting properly.

If any of these two types has not resolved within a matter of days, it will be important to have a doctor examine the patient and offer some kind of treatment.

This condition arises from small clusters of veins within the anus and the lower part of the rectum, both of which make up the last part of the large intestine. Haemorrhoids develop when the clusters of veins we referred to above become distended with blood due to irritation or pressure exerted on them. Such pressure can arise from pregnancy, for example, or from the growth of a tumour just above that region, increasing the amount of blood pooling within those veins. This development can cause pain and other types of discomfort, such as itching and an awareness that something odd has happened in the anus. These problems can impair daily activities such as sitting down or walking and make them considerably more stressful.

There are two types of haemorrhoids: internal and external. On the whole, this is not a condition that develops suddenly. It takes a considerable amount of time to do so. There are certain factors that increase the likelihood of developing the condition, such as not eating sufficient amounts of fiber in the diet and living a sedentary lifestyle. Other factors include straining while passing stool, chronic diarrhoea from any cause, and chronic constipation. People who habitually pass stools only once every 3 or 4 days are at risk of developing this problem. Others may belong to the opposite end of the intestinal disease spectrum, suffering from long-standing diarrhoea in which they pass loose or watery stools more than 3 times a day.

Haemorrhoids are common in pregnant women, among whom they cause a wide range of problems. They are often most severe during the third trimester of pregnancy when the weight of the baby pressing down on the veins in the pelvis and rectum has reached its maximum, just prior to delivery. The growing womb also adds its weight to that of the baby, making the pressure on those veins truly immense. In addition, the changes in the woman’s hormonal makeup cause a relaxation in the tone of the vessels in that region of the body, further aggravating the swelling.

To make matters worse, these physical and hormonal changes are liable to cause certain gastrointestinal problems, resulting in constipation or diarrhoea that can worsen the pregnant woman’s condition. Furthermore, the intense straining that occurs during childbirth almost always ensures that much of this pressure is transmitted directly to the veins in the rectum, anus, and pelvis. As a result, the distended veins are likely to pop out through the open anus as the baby descends through the birth canal. This is particularly a likely complication of prolonged or obstructed labour. Women giving birth vaginally to heavy babies weighing more than 3.5 kilograms are especially likely to experience this problem. A prolonged second stage of labour also significantly increases the risk of developing haemorrhoids.

There is also the possibility of developing haemorrhoids after childbirth. Women who experience haemorrhoids during pregnancy, as mentioned earlier, can go on to develop piles following delivery. There may be a delay of a couple of days, but it still happens. It is believed that childbirth increases the risk of developing haemorrhoids by as much as eight times. Among this group, women who undergo natural delivery through the vagina or with the aid of instruments such as vacuum extraction or forceps are particularly at risk.

While male patients do not experience pregnancy, it is clear that if they lead sedentary lives and mostly eat refined foods that lack adequate fiber, they too are prone to developing haemorrhoids. In men, it is important to conduct investigations to ensure that there are no growths in the large intestine before making a hasty diagnosis. Important examinations such as contrast x-rays, like a barium enema, or, preferably, various types of endoscopies, are performed to rule out any such associations. A shorter endoscope called the proctoscope, which has a limited range, is used to look into the anus and rectum. If further examination is needed beyond this region, a procto-sigmoidoscope is used, as it can examine the part of the large intestine leading to the rectum.