Retired government employee Surekha Naik has battled severe hemorrhoids, generally known as piles, for 30 years. The 60-year-old resident of Rourkela, Odisha, says after two failed surgeries for the condition, naturopathy and home remedies have given her some relief.
People over the age of 50 are more likely to develop hemorrhoids, which can affect their quality of life and occasionally indicate a serious condition.
As people grow older, maintaining a robust lifestyle with the right nutrition and adequate amount of exercise plays an important role in preventing certain health conditions that affect the ageing population more than younger people. Some of these include diabetes, heart disease, stroke and hemorrhoids. Age is a major risk factor for hemorrhoids, say experts.
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“I tried many medications and therapies, but only got temporary relief,” says Naik. “Now, I strictly follow a high-fibre diet and home remedies to prevent recurrence. Consuming natural laxatives and foods such as papaya, soaked raisins and cooked drumstick leaves has helped to some extent.”
Elderly persons must not ignore hemorrhoids, especially when there is bleeding without pain, and must seek help early, says Dr Suraj Subramanian, consultant general surgeon at Fortis Hospitals Vadapalani, Chennai.
What are piles?
When the bunch of veins lining the rectum and anus become swollen because of the strain put on them and start bulging, they are called hemorrhoids or piles. Depending on where the veins are located, they can cause bleeding from the rectum/anus or severe pain and discomfort.
The most common cause of hemorrhoids in the elderly is constipation.
Symptoms of piles
- Itching in and around the anus
- Pain and irritation in the anal region
- Painful bleeding after passing stool
- Painless bleeding
- Swelling around the anus
- Bluish-coloured lumps near the anus
- Pain in the bottom, while sitting or walking
- Mucous discharge.
Risk factors in older people include advancing age, constipation, obesity, decreased intake of fibre-rich foods and sedentary lifestyle.
There are two types of hemorrhoids :
- Internal hemorrhoids develop within the lower rectum and usually do not cause any pain. Sometimes, there may be painless bleeding through the anal opening, which the patient may notice while cleaning up after passing stools or when the stool is covered with blood on the outside. Internal hemorrhoids can sometimes become prolapsed, which means that they descend from the lower rectum and push out through the anus. These can be painful.
- External hemorrhoids are formed around the anus and cause swelling under the skin lining the opening. They can irritate the muscles that surround the anus (the internal and external sphincter muscles), and cause itching, pain and discomfort. When blood clots form within the hemorrhoids (thrombosed hemorrhoids), they block blood flow to the surrounding tissues, leading to debilitating pain. The connective tissues in the lower rectum may also get damaged as a result of hemorrhoids.
“When the patient has internal hemorrhoids, without severe pain, bleeding or any other adverse symptoms, treatment may not be needed,” says Dr Dominic Benjamin, head of geriatrics at Bangalore Baptist Hospital and geriatrician, ageing specialist and diabetologist for older adults at Age Well Clinic, Bengaluru.
Dr Benjamin adds that doctors could recommend better hydration, laxatives for constipation and advice against straining during bowel movements. “For external hemorrhoids with bleeding and intense pain, a hemorrhoidectomy surgery or minimally invasive procedures such as stapled hemorrhoidopexy may be recommended,” he says.
“Painful bleeding from the anal region is usually indicative of fissures, ulcers or thrombosed hemorrhoids (with blood clots), while painless bleeding could imply other complications. Internal hemorrhoids can be a sign of increased pressure in the portal system, which means that undiagnosed cancer in the pelvic or abdominal region, colorectal cancer and chronic liver disease may manifest in the form of hemorrhoids. It is important to check for other symptoms such as weight loss, bloated abdomen along with rectal bleeding.”
While modifying lifestyle factors and dietary habits is important in preventing piles, the underlying causes for chronic constipation, if any, need to be addressed.
“Hypothyroidism, low magnesium levels in the body, certain medications such as antidepressants (taken for psychiatric conditions) and nerve-related reduced transit time of the intestine are some of the medical causes of chronic constipation, which if ignored, will lead to hemorrhoids,” says Dr Suraj. “It’s important to check for these medical causes and address them accordingly.”
How to prevent piles
- Stay active and increase mobility.
- Practise age-appropriate exercises.
- Maintain ideal body weight.
- Avoid straining during bowel movements.
- Eat a fibre-rich diet — more than 30gm of fibre per day.
- Ensure regular toilet habits and avoid sitting on the toilet seat for a long time.
- Drink lots of water and stay hydrated.
Hemorrhoids: diagnosis and treatment
The doctor will do a physical examination and tests to check for bleeding from the rectum, and to rule out any underlying conditions. Oral medications and topical creams may help in bringing down the pain and swelling. Ice packs gently placed over the anus can also give relief. The doctor may also recommend sitting in a warm water bath for a few minutes daily to reduce pain and irritation.
For internal hemorrhoids that do not respond to conventional therapy, a procedure called rubber band ligation may be used, wherein the doctor will insert an anoscope (a tube-like device with a light at one end) into the anal canal and, through this, use a device called ligator to hold the hemorrhoid and tie it with rubber bands, so that it will shrink on its own. Hemorrhoidectomy, a minimally invasive surgical procedure, can also remove the hemorrhoids.
