Haemorrhoids: carrying on from Mr. Ormond

Passively complementing the anal mechanism of continence, haemorrhoids, when diseased, can be described as “anal varices”. Like varices, they´re prone to swelling, leading to prolapse, bleeding, itching and pain, in relation to the intensity and frequency of the aggressions to which they are exposed.

The conception of the anus as a “private part” makes discussion around it uncomfortable. The perception that who listens will not understand and that one matter might lead to another possibly even more intimate leads, commonly, to the persistence of undiagnosed symptoms, leading to lack of or insufficient or inadequate treatment.

The manner of the doctor and his experience in approaching the proctological patient, in what eases understanding and anticipation of complaints, are determinant aspects of the comfort the latter may come to feel during the first meeting. The privacy the office provides, the format in which the physical examination takes place and the explanations provided are crucial to the establishment of a trusting relationship.

The execution of a lower endoscopic exam is almost always indicated, even when haemorrhoidal pathology, explaining the symptoms, is clearly evident. Not all proctological complaints derive from unhealthy haemorrhoids. Alternative or concomitant diagnoses maybe serious and require intervention which may not only be different but time-sensitive. Screening is mandatory and to deny it is negligent.

The treatment of diseased haemorrhoids should include education and acquirement of sound hygienic and nutritional habits, independently of the intention to operate, otherwise risking maintenance or recurrence after adequate complementing interventions. The use of medication is usually transient, allowing for the benefits of recovered healthy behaviour to take place.

Surgery is reserved for refractory cases, or those which are more advanced or complicated, when conservative resolution is time-costing and unendurable.