HEALTH CENTRE: Let’s Talk About Piles/Hemorrhoids

Hello guys, I’ve had to come out of retirement to write a few words on piles, as it seems to be a major ailment that plagues our community, especially the gay men who bottom.

I’ll try to keep this as simple as possible, and if I miss any point or misyarn on anything, I’d appreciate the input of other healthcare professionals, especially proctologists, if we have any in the house.

What is Piles (Hemorrhoids)?

First things first, everyone has hemorrhoids. Together with the anal sphincter muscles, they help to prevent anal leakage whenever the pressure in your abdomen rises, for example when you’re coughing or lifting heavy objects. They only turn into a problem when they become inflamed, swollen or start to bulge.

Causes of Piles

Though piles can be hereditary, generally anything that increases abdominal pressure for a long time will lead to the formation of hemorrhoids at some point. These causes include low fibre diet, chronic constipation, persistent diarrhea, constant lifting of heavy weights, pregnancy, spending too much time on the toilet seat, standing and sitting for too long, obesity, anal intercourse, tumors, liver disease etc.

Types of Piles and Their Symptoms

You have external and internal piles.

External Piles are generally painful and itchy, and can bleed easily especially with movement or when seated. They are always visible and located around the opening of the anus.

The internal ones are generally not visible, not painful and are mainly associated with mucoid discharge and bright red bleeding after stooling. They become visible when they bulge outside the anus especially when passing out stool.

Internal Piles are divided into 4 stages

1. They don’t bulge outside the anus.

2. They bulge outside the anus when you strain BUT they return inside on their own when you stop straining.

3. They bulge outside the anus, don’t automatically go back in after you stop straining, and you need to push them back in yourself.

4. They can no longer be pushed back into the anal cavity and are always outside, exposed.

Treatment of Piles

Please always consult your doctor before you embark on treating any ailment. I’m aware of financial challenges, long waiting times etc that plague us, but it’s still the best in the long run.

Seeing a doctor will ensure that the proper diagnosis is made and the right course of treatment initiated. The last thing you need is treating huge warts or an anal tumor/abscess at home, thinking they are piles.

Stage 4 Internal Piles will definitely need surgical intervention.

Stages 3 and 2 can be managed for a while at home to see if it passes or not. Nonsurgical procedures like rubber ligation and sclerotherapy can be used here if available. If the symptoms persist and worsen, surgical intervention will be needed.

Stage 1 can be managed easily at home.

External Piles are generally treated like Stage 4 Internal Piles.

If the pain you’re experiencing from whatever type of piles you have suddenly hits a whole new level or the bleeding becomes insane, you’ll most probably need surgical intervention, regardless of the stage.

Management of Piles at Home

The management of piles at home is focused on not worsening the inflammation and swelling going on down there. And so, you need to adhere to the following:

1. Increase your water and fiber intake, most especially if the pile was caused by chronic constipation.

2. Hard stools can be softened using drugs like Bisacodyl aka Dulcolax.

3. If your pile is caused by persistent diarrhea, you will need to see a doctor to get it under control. The reason you need to see a doctor and not rely on Imodium is to determine the cause of the diarrhea. If you’ve having infectious diarrhea, any drug that seeks to stop that diarrhea will only worsen the infection.

4. Resist the urge to strain as that will increase pressure in the abdomen and make the situation worse.

5. Always defecate as soon as you have the urge to go and don’t sleep on the toilet seat.

6. Use paracetamol to alleviate the pain. Be wary of drugs like Ibuprofen, because if you’re actively bleeding, they can make the bleeding worse

7. Sitting in warm sitz baths will help to soothe the area. Just make sure this bath isn’t replicating a toilet seat.

8. Always keep the area clean and dry.

9. Avoid spicy and fatty foods.

10. Do not wipe your bottom with tissue paper. It’s preferable to just rinse off with warm water.

11. Lying on your stomach will help reduce the pressure on the piles.

12. Drugs like Anusol can be used to reduce irritation, swelling and itching around the area. Daflon 500mg can also be used to improve the health of the blood vessels and have been shown to be effective, even in acute attack of Piles. Please consult your doctor before using these drugs.

High Fibre Foods

If you’ve got the means, just invest in Psyllium Husk powder and rest. That’s what I use to keep me regular, to lose weight and control mild episodes of diarrhea. I take 20-30g once in 2 days.

Warning: It can affect the absorption of nutrients and medication, so tread carefully.

Regular Nigerian foods high in fibre include Corn, Sweet Potatoes, Yam, Garri, Beans, Groundnut, Coconut, Tiger Nut, Cabbage, Carrot, Watermelon, Spinach aka Green, Whole Wheat Bread or swallow.

NOTE: Too much fibre can cause diarrhea, so proceed with caution. I don’t experience diarrhea when taking Psyllium Husk. I just make sure to take loads of water so it doesn’t cause constipation instead. Weird, right?

Warm Baths/Sitz Baths

Sitz baths help to reduce irritation, improve blood flow and prevent superimposed infection. A sitz bath looks like the image below. You can also do it in a properly scrubbed bath too.

Into sufficient warm water to keep your anal region well covered, add table salt to taste. The water should be warm NOT hot. Aim for about 37° Celsius to 39° Celsius.

Each session should last 15 minutes and you can repeat it up to 4 times a day, depending on how comfortably it fits in your schedule. Try to sit in a way that’s relaxed and you can’t feel pressure around your anus as though you were sitting on a toilet seat trying to pass stool.

A KDian once reported that “people who generally do sitz bath before bottoming confess to having a better bottoming experience than those who just douche and have the sex”. Well, let’s talk anal intercourse, shall we?

If you’re a Bottom, SUSPEND all anal activities till further notice, even if your useless boyfriend threatens to dump you. Your health should always come first, not some useless relationship.

If you’re a Top, now is the time to be very supportive of your partner and not be a douchebag. The ailment known as Piles is some serious shit!

Continuing anal sex, while having active piles, is a recipe for disaster and could end your bottoming career for life.

Monster dicks and rough pounding during sex may look exciting in porn, but please note that often times than not, drugs are involved. Drugs like poppers and what-have-you are used to reduce inhibition and make pain less noticeable. The minute you numb the pain, you lose the ability to know when your anus has had enough and is being wrecked to infinity and beyond.

Always prioritize your health. Resist the urge to be a world-renowned bad bitch in bed at the expense of your health. Because your lovers will move on to other asses while you might find yourself confined to a bed space due to complications from piles.

If you have easy access to top quality healthcare, then by all means, proceed as you wish! YOLO!

Hope this helps in some way. Bye, guys.

Written by Francis

FROM THE EDITOR: And if you are a resident of Lagos, you can always get treatment and consultation for your issues with piles from the Centre for Population Health Initiatives, located in Yaba. They dedicate Mondays, Wednesday and Fridays to the treatment of hemorrhoids and such anal ailments.