Gyn Chronicles
Haemorrhoids
By Dr . Maureen Owiti
As I pen my column piece on this beautiful day in the new year , it can ’ t escape me that we are witnessing the effects of climate change . Who can remember the last time it rained in January ?
Would have loved to put that emoji of the lady asking questions . Anyway , it is a beautiful and wonderful day and only something very disturbing would make someone not see the wonder that is creation and the day .
That would be Sheena as she calls me frantically and is in excruciating pain and needs an urgent appointment . In my usual fashion I ask her to take paracetamol to at least make her a bit more comfortable as I wait for her to arrive .
When her file comes , I ask for Sheena to come in and she enters walking like a duck . If not for the look on her face , it was actually quite comical but I have to maintain my composure at risk of offending my client . One could tell that she had quite a bit of discomfort . She has been escorted by her spouse Gilbert who at this time also looks like he is at his wits end .
I jump right into doctor mode and already start thinking what the possibilities are and two things immediately cross my mind ; it is either a Bartholin ’ s abscess ( boil resulting from blockage of a duct in the private parts ) or haemorrhoids which are either thrombosed or infected .
What is of interest is that Sheena is 5 months pregnant and I feel the more likely diagnosis is haemorrhoids , but history is everything .
The problem started yesterday when she was going to the toilet . The pain was very severe and she has only gotten very minimal relief with the paracetamol . She also felt there was a swelling in her anus and it felt like it was on fire . She also reported occasional blood on the tissue after going for a long call .
I enquired about her bowel habits and she reported that she had been having hard stool and straining quite a bit to pass stool for most of the pregnancy . On hearing this I asked about her fluid intake : she reported due to the pregnancy she still had aversion to food and was unable to drink enough water . “ I just don ’ t want to eat anything and I find the taste of water offensive !” Being in her second trimester I would have expected these symptoms to have subsided but unfortunately in about 5 percent of women these symptoms can persist for the entire pregnancy .
She looked at me expectantly hoping against hope that there was something I could do for her . We proceeded to do the physical exam : baby was growing well right on schedule but around her anal area there was a swelling about the size of a small grape that was quite inflamed . The diagnosis was obvious : Thrombosed external haemorrhoids in pregnancy .
Thrombosed haemorrhoids occur when either an internal or external haemorrhoid fills with blood clots . The name comes from the word “ thrombosis ,” which means clotting . Thombosed haemorroids can become tender and very painful .
On seeing this I asked if any other family members suffered the same and she reported that her father , brother and sister had been treated for haemorrhoids . What exactly are haemorrhoids ?
They are swollen veins in the anus or lower rectum and are similar to varicose veins . When they develop inside the rectum they are known as internal haemorrhoids . They can also develop under the skin around the anus and these are known as external haemorrhoids .
Haemorrhoids occur in both sexes but the prevalence in general population is about 4 % and is highest around the ages of 45-65 . Intriguingly , it is more common in Caucasians and in people of higher socio-economic status .
Haemorrhoids occur in both sexes but the prevalence in general population is about 4 % and is highest around the ages of 45- 65 . Intriguingly , it is more common in Caucasians and in people of higher socioeconomic status .
So , it is fascinating to note as this is not a disease that is limited to women then one would wonder why a gynaecologist is
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