GmTc: Medical Journal (Hemorrhoids)

Rochester, MN, June 04, 2015 (GMN) - One might heard of medical term called “hemorrhoids” or knows someone who is diagnosed and experience with but do not know the causes of it. In Ethiopia rural communities, people have no hope to find the treatments that cure the hemorrhoids; unlike other countries have varieties of treatments.

The only treatment that rural community can get is self-medication from over the counter, such as haemorrhoidal ointment, cream, and suppositories. In Western world, the treatment can be perform by health professional to inject medicine in an internal hemorrhoid which can creates a scar and close off the hemorrhoid. Another treatments; Prolapsed hemorrhoid which health professional often removed hemorrhoids by using rubber-band ligation, coagulation or cauterization, and possibly surgery. According to Villalba, H and Abbas, A. M., 2007 Hemorrhoids caused by an abnormal enlargement of the veins that present the anus; these two veins are inside the rectum and another is under the skin around the anus. Haemorrhoidal tissue is thought to be helpful in holding back stool at rest and cushioning the sphincter muscles when empty the bowels.

Hemorrhoids seem to be common when person get holder and everyone can be diagnose once in life time. When person experiences bulge veins, it can be caused by straining the movement of the bowels or sitting too long on the toilet. Procedures like Colonoscopy or Endoscopic are recommended for person older than age 50 years (Siddiqui, D. et al, 2014).  Others factor such as pregnant woman during child birth, those who are obese, and people with liver disease may also affect by hemorrhoids.

On my last visit to Gambella, Ethiopia in 2014; I have met with young people age 25 to 40 years old, who were diagnosed with hemorrhoids. I asked myself why this happening to young people under the age of 50 in Gambella. This disease is always affecting older people. After I thought about it, I realized that this could be something to do with their life style. Gambellan people need to be educated about this kind of disease throughout the rural communities.

The myth for the hemorrhoid does not make sense when people trying to linked or describe the disease characteristics. Most people think that the cause of the disease is due to lack of well-constructed latrine but scientifically not true and they never thought of other causes.  Because of unknown cause of the disease, people often stereotyping the disease based on its symptoms and the characters of it. Lack of knowledge about the disease sometimes brought confusing or misleading in the communities.  

The majority of local communities assumed that the latrine they are using has only one hole that blowing air out so when person sitting on the toilet, it would blow hot air into rectum and cause larger intestine to disrupted and bleed and then I said to myself this explanation makes no sense. As I set back reading about hemorrhoids how it cause, symptoms, and prevented; I noticed that this has to do with diet which people consumed in Gambella areas.

The main staples foods in Gambella are maize, teff, and Surgam which has no fiber left after pounding or grinder. When maize is pounding in traditional way, it loses the fibers that could have help person to maintain healthy lifestyle and benefiting for it. As a consequence cause constipation and make harder for person to move stool easily.  Lack of eating fibers seems to be main issues in Gambella, people tend to eat more meat rather than eating more vegetable and they ate meat every meals. Other factor that I thought could cause hemorrhoid is lack of using toilet paper during childhood. Most ingenious people used small pieces of stick, solid soil, small rock, grass, leaf, and wood stick to clean or wipe themselves with it after bowel movement, as the results of irritating and infecting the rectum.  Of course, hemorrhoid is rarely dangerous when left untreated and can be repeatedly painful; fortunately, there’s a lot of options treatment to cure the disease.

Thousands of poor Ethiopian, particularly Gambellan people lives in distressed regions of the Ethiopia which are chronically sick afflicted by a host of hidden diseases that are not being monitor and diagnosed or treated. Ingenious people hid their symptoms until it got to worst case scenario; most often lead to recurrent due to lack of medical term and lack of knowledge about the hemorrhoid’s symptom. Sometimes people felt ashamed to themselves when telling someone that they have hemorrhoid because of location where the disease is present in the body and hidden the symptoms, even marriage couple won’t talk about it. According to American Gastroenterological Association, 2004, many people specially women have passed encounter with hemorrhoids during pregnancy but by midlife, hemorrhoids often become an ongoing complaint, by age 50 about half of the population has experienced one or more of the classic symptoms which includes rectal pain, itching, bleeding, and possibly chronic pain.

How to prevent hemorrhoid? 

The best ways to prevent hemorrhoids are to change lifestyle and eat fibers to keep stools soft so that it can pass easily. According to Siddiqui, D. et al, 2014 to reduce symptoms one must follow these tips:

* Eat high-fiber foods; such as fruits, vegetables, and whole grains

* Drink plenty of fluids, six to eight glasses of water a day and other liquids each day to help keep stools soft

* Use bathroom or toilet as soon as possible when feel the urgent

* Exercise

* Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus. 

Siddiqui, D. et al.,  2014, also indicated that adding more fiber into diet or fiber supplement, such as Metamucil, Citrucel, and Fiber Con along with adequate fluid, fiber softens stools can makes them easier to pass, and reduce pressure on hemorrhoids. High-fiber foods include broccoli, beans, wheat and oat bran, whole-grain foods, and fresh fruit help decrease haemorrhoidal bleeding, inflammation, and enlargement. They may also reduce irritation from small bits of stool that are trapped around the blood vessels. 

   REFERENCES

American Gastroenterological Association. (2004). American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterology; 126:1461.

Siddiqui, D. et al. (2014). Gastrointestinal endoscopy. Devices for the endoscopic treatment of hemorrhoids.

  doi:10.1016/j.gie.2013.07.021.

Villalba, H and Abbas, A. M.  (2007). Hemorrhoids: Modern Remedies for an Ancient Disease. 

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