SOME of our readers have asked me to write about constipation, haemorrhoids or piles. Piles are conditions that are a resultant of chronic and continuous constipation. Worldwide, nearly 50 per cent of the people have had this problem of piles at some time in their life. All age groups, young and old, males and females, are affected.
Because the problem deals with a very private part of the human anatomy, those who tell you about it must have a lot of confidence, and trust in you. Those who do open up with you, they give a history of severe, excruciating, or persistent pain in or around the anal opening. Sometimes, other people complain of bleeding after opening the bowel.
They can also tell you they experience severe pain on the back of their feet, the heel. They can’t wear shoes or walk comfortably. When I first got a patient complaining about pain on his heel I was buying gas from a petrol station but I couldn’t associate it with piles.
Certainly, although the problem of piles is quite common, the topic was not covered when I was studying at my medical school. I think it was an oversight. If you ask the patients further they will tell you that they open their bowel once in three or more days and the bowel opening is associated with pain.
When they go to the toilet, they really take time to come out because they will be struggling to defecate. If it is a child, the house girl or the mom will be asking him/her several times, are you done? To their disappointment they will receive an answer, I’m not yet! When you ask about the patient’s eating habits they will tell you they drink very little amount of water.
Even when they do, the type water they drink is damn cold, right from the fridge. They rarely eat fruits and vegetables. If they drink any water they will say they like drinking cold water often while munching the food.
If you examine the patient you will see some protruding masses, clumps, cushions of tissues that are full of blood inside or around the bottom of the rectum and anus. I have had several patients with piles in my practice and I am going to describe some of them. Back in 1977, I was working at Kilimanjaro Christian Medical Centre. We had a famous Member of Parliament then who came to see us at the surgical clinic. My colleague examined the patient and I was there to assist. The senior doctor decided to schedule our patient for surgery and discharge him after the procedure on the same day. Although the patient had surgery, I did not hear my colleague counseling him about eating and drinking habits.
Nevertheless, the problem was not resolved. Recalling back when I was still a medical student one of my patients, an advocate then, was complaining about bleeding piles and he was using some Dulcolax suppositories to insert in the anus. Later on, while servicing my vehicle at a gas station on Shekilango road in Dar es Salaam, one of the attendants there complained that he was experiencing severe pain on his heels. He could not wear his white rubber shoes because of pain. I advised to use some cushions in his shoes. As I mentioned earlier, I could not associate the pain in his feet with piles.
That did not solve the problem. During the last five years I bought a book on “Health in your Hands” by Devendra Vora. The book teaches you how to use acupressure to diagnose, prevent and treat various conditions. One of the topics covered in the book is on the diagnosis, prevention and treatment of constipation, of hemorrhoids or piles.
In order for me not to forget the main points I would like to share with you some of the points I advise my patients these days. First, I tell them to develop a habit of chewing their food properly before they swallow. Even when the food is very sweet, it must be chewed at least 12-15 times prior to swallowing.
Second, they should never drink cold water. Third, they should always drink Lukewarm or hot water just like the one we use to prepare a cup of tea or coffee. The water should be drunk, first thing in the morning just before brushing their teeth. Four, they should not use laxatives to release constipation. Five, as much as possible each meal should be balanced, having a protein, starch, fat, vegetables and fruits. The meal should have a series of vegetables, and there must be at least one fruit (papaya, pineapple, banana or avocado). Six, in as much as possible they should avoid eating fried or roasted red meat.
Seven, before going to open their bowel they should make sure they have drunk at least two to three glasses of water. Eight, before sitting on the toilet seat, they should hold their chin with their two thumbs as if they are pushing it up wards and bending the neck backwards. When they do that they will feel the urge to open their bowel and the stuff comes out freely in a gush. Nine, I advise them to practice what Dr Vora says.
“Sun Pranayam exercises. This is done while seated or in a relaxed mood. The patient is advised to bend each finger towards the base of the thumb on the palm. He should tighten the bent finger with thumb while he tries to count one, two, and three up to ten. Remember when one finger is held at a time, the other fingers are kept straight. Now the trick here is that during bending of fingers the exercise has to be done on both hands, each one separately at the same time.
If a patient tries to open his/her bowel and it does not come out, I advise them to apply cooking oil on the middle finger and try to insert into the anus gently and try to rub around so that the walls get lubricated. The problem with most women is that they like keeping long nails. I usually advise most women to keep their nails short. If they have to keep long nails then I suggest they keep them only on the right hand because they need the left for washing their private parts. After washing they should thoroughly clean the hands with soap and water.
Ten, when dealing with a constipated child, I ask the parent to apply oil on the smallest finger and insert it into the anus of the child while the child is lying down on the left side. The procedure needs gentleness, so you should explain what you are going to do in order to help him or her release the impacted fecal matter from the anal opening.