Bleeding From Your Bottom

As with most healthcare issues in Malaysia, we often wait until we reach a dire situation before seeking medical intervention.

By then, extreme measures have to be taken to remedy the situation.

Dr Meheshinder says, “Patients delay treatment because they are embarrassed, as nobody likes showing their backsides; they also relate it to surgery or they fear incontinence.

“So they seek treatment elsewhere and are misdiagnosed, which is sad.

“They might have had the symptoms for years and when I examine them, they have stage 4 colorectal cancer.

“Piles don’t turn cancerous, but they may coexist with cancer, hence if you have bleeding, it is important to go for a rectal examination with a clinician to make sure you’re not missing out anything.

“Patients above 45 should perform a colonoscopy to rule out the risk of malignancy.

“I’m paranoid about this because a lot of times, I’ll catch a polyp or a tumour.”

The ageing process is also a risk factor as the ligaments in the area tend to disintegrate.

Thus, the mechanism that holds them in place weakens and prolapses, causing the patient to strain while defecating.

“Even if you have a little thread sitting in your anal canal, you will feel uneasy; that’s how sensitive the area is.

“With internal haemorrhoids, we can solve the problem in the clinic by using rubber band ligation, ” he says.

Rubber band ligation is a procedure in which the haemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the haemorrhoid.

The choice of procedure depends on the symptoms and severity of the problem, but usually, a conservative approach is taken, i.e. dietary changes, drinking adequate water, eating fibre, etc.

If all these have been addressed and no improvement is seen, then drugs are prescribed.

“If things still don’t work, then we advocate something more invasive, such as surgical modalities.

“There are so many techniques out there to address the issue of pain, but despite the procedures, the incidences of recurrence are still there if no lifestyle modifications are made.

“If it is not bothering you, there is no need for surgery.

“When you overdo things, that’s when you run into problems, ” points out Dr Meheshinder.

He was speaking at the Don’t Sit On It Lah roundtable session organised by French-based pharmaceutical company Servier Malaysia recently.

Also at the session was consultant general and vascular surgeon Datuk Dr Ho Teik Kok, who adds, “Most of the time, patients suffer from constipation, and when they strain, the pressure is transmitted downwards to the legs and veins, and can lead to chronic venous disease (CVD).”