Embarrassing illnesses – in the spotlight again
Health professionals are familiar with the raft of diseases and disorders which fall under the heading of 'embarrassing illnesses'. Despite the fact that few patients want to talk about them the public is endlessly fascinated as repeat seasons of 'Embarrassing Illnesses' and 'Embarrassing Bodies' on television have proved.
Probably top of the list on the embarrassment scale is anything to do with the back passage. Flatulence, itching, constipation and bleeding are all felt to be somehow shameful and patients often fail to present until the condition has become acute.
Bleeding on passing stools is very often a sign of haemorrhoids but it is vitally important to make a thorough investigation. With bowel cancer still in second position as Britain's biggest cancer killer1 any rectal bleed must be treated as potentially serious.
Once pre-cancerous conditions have been ruled out and haemorrhoids diagnosed, treatment will be required. For Grade I and II haemorrhoids an adjustment to diet and possibly a short term mild laxative, plus a cream or suppository for topical relief may be enough.
However if the patient presents with Grade III or IV prolapsed haemorrhoids a surgical intervention may be proposed. In the past , health professionals may have hesitated to recommend open surgery as its aftermath could be extremely painful and the patient would require considerable follow-up in terms of home visits and analgesia.
The introduction of stapled anopexy - also known as Procedure for Prolapse & Haemorrhoids (PPH) - in 1995 has received NICE recommendation in which PPH is found to promote a shorter recovery with less associated pain2. It can usually be done as a day case and the need for postoperative analgesia has been found to be much decreased. PPH reduces the enlargement of haemorrhoid tissue and, according to clinical studies, offers patients significantly less pain and faster recovery time than patients who undergo conventional haemorrhoidectomy procedures.3,4,5
Using a stapling device, the PPH procedure essentially ‘lifts up’ and repositions the prolapsed mucosa, or anal canal tissue, and reduces blood flow to the internal haemorrhoids. PPH results in less pain than conventional procedures because it is performed above the ‘pain line’, or dentate line. The advantage is that this affects few nerve endings or the removal of haemorrhoidal cushions which are a functional part of the anatomy. Typically PPH is suitable for patients with second degree haemorrhoids after failure of other therapies, and third and fourth degree haemorrhoids.
As with any surgical procedure, the procedure for prolapsed & haemorrhoids may present risks. Patients should consult with their doctors to discuss which type of procedure is appropriate for them.
Patients often wonder what causes haemorrhoids, or piles. Whilst there may be a hereditary factor, constipation is the main cause of piles. Being overweight, straining to open the bowels, sitting too long on the lavatory, standing or lifting too much can all make piles worse.
Good advice to help people prevent piles may include:
1. More fibre in your diet. Fresh fruit, leafy vegetables and whole grain breads and cereals are good sources of fibre.
2. Drink plenty of fluids (except alcohol).
3. Do not read whilst on the lavatory. Sitting and straining too long encourages swelling
4. Exercise regularly
5. Don’t put off going to the lavatory if you feel the need to open your bowels
6. If you do suffer from constipation, avoid laxatives, except the bulk-forming kind
PPH is widely available around the UK and in 2007 over 3,000 PPH procedures were performed. Patients can find out more by phoning the confidential PPH helpline on 0800 028 2231, staffed by trained health professionals, or they may like to visit www.allaboutpph.co.uk.
If any reader would like a PPH desk pack, comprising scribble pad, pen and informative leaflet, please go to the 'contact us' page of the CareMail website fill in your contact details, then copy and paste the following words: please send me the PPH desk pack.
References
1. NHS Bowel Cancer Screening Programme
2. http://guidance.nice.org.uk/IPG34
3. Racalbuto, A et al. Hemorrhoidal stapled prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. International Journal of Colorectal Disease, 2004; 19: 239-244
4. Rowsell, M., Bello, M., Hemmingway, D.M. Circumfrential mucosectomy (stapled haemorrhoidectomy) vs. conventional haemorrhoidectomy: randomised controlled trial. The Lancet, 4 March 2004; 355: 779-781
5. Boccasanta, P. et al. RCT between stapled circumferential muscosectomy and conventional circular hemorrhoidectomy on advanced hemorrhoids with extermal mucosal prolapse. American Journal of Surgery, 2001; 182(1): 64-68
Published in partnership with the Royal College of Nursing's Practice Nurse Association
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