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Anal varicose veins (haemorrhoids) – an embarrassing problem

Despite the fact that diagnosis with haemorrhoids has been increasing in number, they still remain a rare topic of discussion between patients and doctors. The persons affected usually feel awkward about the problem and more than once cannot present the troublesome symptoms of the affliction to their doctors. Why is this? Should you be ashamed of having haemorrhoids? How do you diagnose haemorrhoids? How can you treat anal varicose veins?

Are haemorrhoids a disease or merely a symptom?

Haemorrhoids are viewed as a disorder by the affected, but in reality they are not classified as such. They are only a symptom of a disorder called venous insufficiency. Haemorrhoids, also known as anal varicose veins or piles, are exposed and dilated veins of the rectal plexus (i.e. the system of veins that reach the rectum). There are two types of haemorrhoids: internal (inside of the anus) and external (visible on the outside of the anus). Haemorrhoids can also be classified in a four grade scale of size:

  • Stage one: the piles are dilated but do not extend outside.
  • Stage two: the haemorrhoids extend outside during defecation and retract into the anus when evacuation has finished.
  • Stage three: the piles fall out during defecation and it is necessary to drive them back into the cavity by hand.
  • Stage four: the piles are on the outside of the anus and become coagulated.

How do you diagnose haemorrhoids?

External haemorrhoids are lesions you can find on your own. They are evident as swollen, dark veins (caused by high volumes of the blood within) which are round and convex. The internal haemorrhoids can be diagnosed only in a special examination: colonoscopy, anoscopy or rectoscopy.

Why do haemorrhoids form?

The first cause of haemorrhoids is venous insufficiency. The disease in turn results from genetic conditions (independent of your actions) or environmental factors (i.e. habits or vices, which are something you can control). Symptoms of venous insufficiency include varicose veins of the legs and of the anus, which are haemorrhoids.

Other causes of haemorrhoids include prolonged sitting, frequent defecation preceded by heavy constipation and often diarrhoea. It has been proven that pregnancy also results in increased rate of diagnosed piles in female patients. Pregnant women are at higher risk of haemorrhoids due to restricted mobility, hormonal changes and variations in blood circulation. Hypertension of the portal vein and long distance running are also among the causes of haemorrhoid formation.

Anal varicose veins and symptoms which suggest their presence

As said before, it is easier to diagnose external haemorrhoids than internal haemorrhoids. However in both types it is possible to determine specific symptoms which should alert you about the actual presence of varicose veins in the rectum. The symptoms of haemorrhoids include:

  • pain in the anal area during or immediately after defecation;
  • itch and burning sensation in the rectum;
  • a sense of incomplete evacuation;
  • blood in stool (usually light red and in small amounts);
  • falling out of piles from the anus (applies to internal haemorrhoids).

What is the proper treatment of haemorrhoids?

There are several ways to treat haemorrhoids. The method depends on the size of haemorrhoids and the decision should be made by a doctor (a specialist at best, i.e. a proctologist). In advanced haemorrhoids surgical treatment can be administered apart from pharmaceutical treatments. In usual cases, doctors recommend symptomatic treatment by administration of oral and/or topical preparations.

Oral drugs are used to improve circulation and tightness (permeability) of blood vessels. Laxative preparations are also orally administered (e.g. the drug Alax). As for topical formulas (like ointments or suppositories), the expected effect is alleviation of itching, reduction of bothersome pain and burning, as well as inhibition in potential development of bacteria, fungi and viruses.

Ointment, suppository or pills... which should you choose?

Sometimes doctors adapt the therapeutic form to the preferences of the patient. This is good to know then if any of the treatments can be too inconvenient for us to choose. It is important to maintain a consistent and systematic treatment.

Tablets in the treatment of haemorrhoids

Taking pills is undoubtedly the easiest way. But is it effective enough to cure the irritating anal varicose veins?

The group of pharmaceutical drugs for treatment of haemorrhoids include laxatives and circulation improving drugs. Laxatives contain substances that have three vectors of action: by swelling (fibres, bran, pectins), coating (liquid paraffin) and absorption of water to liquefy the faecal mass (osmotic laxatives). Laxatives are used to prevent constipation, one of the major causes of haemorrhoids. Circulation improving and blood vessel sealing drugs are not only used to treat haemorrhoids, but also varicose veins of the legs. The leading drugs of this group are diosmin, aescin, vitamin C, rutoside, and extracts of Ruscus aculeatus and rue.

Suppositories and ointments in the treatment of haemorrhoids

The majority of patients think that administration of suppositories is more difficult and less comfortable than externally applied ointment. This is certainly so, but do not forget that suppositories have an advantage over external ointments. The suppositories act on the outside of the anus and inside the rectum. With this significant advantage, some manufacturers of haemorrhoid ointments have introduced intrarectal applicators. The applicator easily introduces the ointment into the area that would be occupied by a suppository.

There are currently many preparations available at pharmacies in the form of ointments, gels or suppositories to treat haemorrhoids. It is good to understand what ingredients reduce the problems caused by haemorrhoids. They include:

  • Herbal extracts of oak bark, Potentilla roots and witch hazel, as well as compounds of bismuth, ichthyol, tannin or zinc oxide. The advantage of the listed ingredients is a soothing and styptic action.
  • Strong anti-inflammatory agents – corticosteroids (prescription drug only).
  • Anaesthetic substances (which eliminate the sensation of pain), such as lidocaine and bezocaine (available in liquid powders, Aesculan and Neo-Aesculan).
  • Ingredients with antiseptic, i.e. disinfecting action (e.g. propolis).
  • Substances which alleviate itching and burning (menthol).
  • Ingredients characterised by sealing of blood vessels (including chestnut seed extract – Aesculan ointment, Neo-Aesculan gel).

What preparations are worth recommending?

The preparations useful in the treatment of haemorrhoids should include at least one of the aforementioned ingredients. In order to ensure safety of use, it is good to choose agents of plant origin. Also remember about the risk of allergic response to ingredients and the comfort of use (application).

Alax – oral herbal preparation which prevents and cures constipation

Alax is a drug used in the treatment of constipation. The drug contains pulverised juice of aloe leaves and a dry extract of buckthorn bark. The aloe vera extract is a strong laxative, whereas the buckthorn bark extract is less potent. It is the varying potency of the components that when combined in the Alax preparation complement their therapeutic action. What is also important to patients is that the preparation of choice must act quickly. Alax brings about the therapeutic effect relatively soon, which is approximately eight hours after administration.

Aesculan and Neo-Aesculan – formulas with intrarectal applicators

Aesculan and Neo-Aesculan feature nearly identical composition, but each is in a different form: ointment and gel, respectively. Both drugs contain the extract of chestnut bark and lidocaine hydrochloride. Aesculan contains a slightly higher concentration of chestnut extract.

Aesculan and Neo-Aesculan are intended for the treatment of haemorrhoids. Extract of chestnut bark ensures an anti-inflammatory and styptic effect, while lidocaine hydrochloride reduces pain (it is an anaesthetic).

How do you administer Alax, Aesculan and Neo-Aesculan?

Alax should be taken immediately before sleep and washed down with a glass of boiled lukewarm water. Expect bowel movement the morning after.

Aesculan ointment and Neo-Aesculan is administered with the enclosed cannula which needs to be screwed to the tube tip first. Administer 0.5 to 1 g of the drug into the rectum (a strip about two centimetres in length). In external haemorrhoids, the application can be limited to the outside surface of the anus.

Prevention of haemorrhoids

Three basic recommendations are the foundation of haemorrhoid prevention: modification of dietary habits, regular defecation and daily physical exercise.

Haemorrhoids and diet: can haemorrhoids be prevented by proper nutrition?
As said before, constipation is one of the predisposing factors of haemorrhoid formation. Constipation occurs mainly from badly composed diet. What is the diet then which enables avoiding constipation and protects against anal varicose veins? The proper diet that can properly control the labour of intestines is a high fibre diet, or high residue diet. "High residue" means that only a part of the food intake is assimilated, whereas the rest (and a major one) provokes evacuation of the bowels. High fibre diet liberates the system from constipation and aids in the prevention of haemorrhoids.

Physical exercise – an aid in haemorrhoid prevention

Physical activity is a part of prophylactics of numerous diseases and this also applies to haemorrhoids. Persons with haemorrhoids should do special exercise involving tension of rectal muscles (and pulling the anus into the rectum) followed by relaxation. The exercise should be long enough and frequently repeated (several times a day).