bottoms up: piles and other problems
by Jenny Bryan
a fistula – and its treatment
When David woke up to find blood and muck in the bed and a hole in the skin near his anus, he had no choice but to seek medical help – despite the embarrassment of having his bottom examined. His wife thought it could be cancer.
Anal fistula – David's diagnosis – is fortunately not common and can happen to anyone. It usually follows an abscess resulting from a bacterial infection in a small gland just inside the anus. The abscess itself is a collection of pus – a yellowish fluid containing bacteria, cell debris and the white blood cells which have been trying to kill the bacteria. Without treatment, the infection may spread into and destroy surrounding tissue. When an anorectal abscess bursts or is drained, it may leave a new opening in the skin near the anus, leading back to the gland where the abscess started. Faeces and other debris may leak from this 'extra anus'.
Surgery was the only option for David and for most people with anal fistulae. If the fistula is allowed to heal by itself from the outside, further abscesses may develop inside the tunnel. Instead, the fistula has to be opened up and the tunnel converted into a groove which will heal from the inside out.
'They cut me from my bowel to my scrotum, left it open, and put two stitches in so I could go to the toilet, otherwise I'd have been incontinent. The worst part is everyone looking at my bits and pieces down below. I've never had so many people look down there before, but I've got used to it,' says David.
Opening up an anal fistula sounds simple enough but, because of its position and the high risk of further infection, an anal fistula can take some time to heal. Like David, many people with anal fistulae suffer weeks or months of discomfort and embarrassment with a fistula which refuses to heal properly. David needed a series of small operations before his fistula was finally on the mend.
treating piles
Fortunately, piles can usually be treated without surgery. Sometimes it is enough to eat more fibre and take a faecal softener or bulking agent such as bran or methylcellulose to make bowel movements easier. A painkilling cream or gel can be smeared on the piles themselves to relieve the discomfort and reduce the swelling. Warm baths and ice packs can also relieve symptoms, as can taking pressure off the anal area when sitting down (eg: by sitting on a rubber ring).
If piles don't respond to simple measures, banding may get rid of piles altogether. It is not as brutal as it sounds! It takes only a few minutes to put tiny rubber bands around the piles. They are positioned where there are no nerve endings so there is no pain from the banding itself. Bowel movements may be uncomfortable for a few days. But after a few weeks the piles, starved of blood and nutrients, should drop off. Both Jean's and Fred's piles responded well to banding.
'Since I've had the banding done, I've had no trouble at all. I should have had it done years ago. You have these things and you keep putting them off, which is silly because it's far better to get them out of the way,' says Fred.
Some piles don't drop off or they are in a place that makes banding difficult. Other options are to inject them with a chemical solution to make them shrink, or to remove them surgically. This can be done using a hot wire to separate the swollen blood vessel from its base and seal the underlying tissue. If the haemorrhoids are very large, more extensive surgery may be needed to remove them and repair the damaged anal tissue.
In general, haemorrhoidectomy is a much shorter, simpler operation than it used to be, and people can usually go home within a day or two of surgery. They may be uncomfortable for a few days while the wound heals and it takes about six to eight weeks for the bottom to heal completely. During this time it's particularly important to ensure that faeces are soft and easy to pass. A high-fibre diet and regular exercise will help reduce the risk of subsequent constipation, leading to straining and recurrent piles.
Tony recently had his piles surgically removed after 30 years of discomfort and embarrassment. He tried creams and injections, to no avail. After his haemorrhoids were removed under general anaesthetic, he was able to go home the same day. After a few days of discomfort, easily treated with a few painkillers, he was wondering why he hadn't had the operation before:
'Having lived with this for years and been very uncomfortable for the last 10 years, if it's finished now, it's well worth the discomfort of the operation.'
(January 2001, resources updated January 2005)
