PT HEALTH WATCH: Untreated piles can lead to anaemia, severe pain – Expert

Haemorrhoids, commonly called piles, are a frequent but often misunderstood health condition in Nigeria. Despite how common they are, many people delay seeking treatment until symptoms worsen.

Speaking with PT Health Watch, Shola Fasiku, a general surgeon at the University of Ilorin Teaching Hospital, said the condition is common but underreported because most patients do not visit the hospital for haemorrhoids until they experience serious discomfort or complications.

Mr Fasiku explained that haemorrhoids are swollen veins in the lower rectum or anus, a medical condition that is frequently dismissed or casually referred to as “piles”.

What are haemorrhoids?

Mr Fasiku said haemorrhoids are “dilatations of the inner cushions,” referring to the inner columns in the rectum where veins terminate.

He noted that haemorrhoids are graded from one to four based on severity.

“First-degree haemorrhoids are internal. Second-degree haemorrhoids protrude during straining but reduce on their own. Third-degree haemorrhoids also come out during straining but require manual pushing to return inside. Fourth-degree haemorrhoids remain outside and cannot be pushed back in,” he said.

He added that the fourth degree is one that sometimes gets thrombosis and causes pain.

Haemorrhoids vs rectal bleeding

Mr Fasiku explained that many people assume that any rectal bleeding is piles; he, however, clarified that while haemorrhoids are a common cause, not all rectal bleeding is the same.

He explained that in haemorrhoids, the blood often appears as bright red drops before or after passing stool.

“Haemorrhoids and piles are the same, but the bleeding from haemorrhoids is usually bright red blood,” he said.

He added that this differs from bleeding caused by tumours in the rectum, where blood may mix with the stool.

Dangers of untreated piles

Mr Fasiku warned that untreated haemorrhoids can lead to serious complications over time.

He noted that the commonest symptom that the patient presents with may be bleeding, as the patient is losing blood every day.

He added that chronic blood loss can gradually result in anaemia. “The blood in the patient’s body may become so low that the patient starts feeling symptoms like dizziness, fainting spells,” he explained.

“In severe cases, it can even cause what we call anaemic heart failure and can lead to death.”

However, he noted that this does not happen suddenly, as it will take a long time, depending on the degree of bleeding from the haemorrhoid.

He added that severe, untreated haemorrhoids can also progress to thrombosis, a condition that causes intense pain.

Herbal mixtures as a cure

Mr Fasiku said while haemorrhoids are treatable, claims about herbal cures are difficult to verify, noting that treatments such as ligation or surgical removal can effectively address the swollen veins.

He expressed caution about herbal remedies, warning that herbal mixtures may have unintended effects on other organs.

He said the reason is that some patients who self-medicate with herbal preparations later present with other health issues unrelated to haemorrhoids.

“Prescription is a big issue when it comes to herbs. So that’s why we are not so confident to say patients should look for herbal mixtures,” he added.

Who is at risk?

Mr Fasiku listed several factors that increase the risk of developing haemorrhoids, such as pregnancy, noting that multiple pregnancies can increase the risk.

“Anything that raises pressure in the abdominal or venous system can predispose a person to the condition. Chronic constipation, which forces a person to strain during bowel movements, is another major factor,” he said.

“Also, if the patient is having chronic constipation and has to strain all the time to pass stool, the patient is predisposed to having haemorrhoids,” he said.

Other risk factors include chronic cough, diarrhoea, abdominal tumours such as large fibroids, and ascites, a condition where fluid accumulates in the abdomen.

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On diet, Mr Fasiku explained that diet plays a key role in both prevention and management, while advising patients to take high-fibre foods, fruits, vegetables, and plenty of water.

“Anything that will reduce constipation, such as beans, which are high in fibre, can help soften stool and reduce straining,” he explained.

Treatment options

Mr Fasiku said doctors usually begin with conservative measures and office-based procedures before considering surgery.

He noted that conservative management, which includes rubber band ligation and sclerotherapy are commonly used for grade one, grade two, and some grade three haemorrhoids.

“For grade four and some later part of grade three, you have to do surgery for the patient, what we call haemorrhoidectomy,” he said.

He emphasised that early presentation and proper medical evaluation remain key to preventing complications.