Thirty-year-old Joyce Kagirimpundu, a mother of one, has just received treatment at Polyclinique de I’Etoile at Sainte Famillie in Kigali. Among the medicine prescribed is anucort-HC rectal, a common medicine used to treat a condition known as hemorrhoid.

Dr Daniel Gahungu, a general practitioner, says whereas the condition is not well-known to the public, they treat about five patients every month, adding that the condition is more common in adults than children.

He also says people with heart failure, liver problems, cancer of the liver and alcoholics are at higher risk of getting hemorrhoid. Obesity, lack of exercise, sitting for long hours continuously can also lead to hemorrhoid.

What is hemorrhoid?

Gahungu says hemorrhoid manifests as swellings in the lower part of the rectum, the lowest part of bowel which expels fecal matter from the body. These swellings can be external or internal, and they may come along with pain and a lot of discomfort.

"Normally, this occurs due to swelling of the veins in the lower part of rectum or anus. The hemorrhoids may be situated externally or internally to the lumen. At times the swelling or congestion of the veins can be severe, which may cause rupture as well as bleeding,” he says.

"When one strains to pass hard stool or impacted stool, pressure is exerted on the group of small veins present at the lower end. As a result, they become engorged and rupture, which is a result of chronic constipation,” Gahungu says.

When the condition can occur

Difficulty in defecating, blood in the stool, pain in the rectum as well as a swollen stomach or legs, are just some of the common symptoms which show one is suffering from hemorrhoids.

Bosco Hagenimana, a medic at University Teaching Hospital of Kigali (CHUK), says the symptoms can be mild or severe, depending on the onset and amount of venous network affected.

"There is construction of good circulation of the blood when the veins around and in the rectum are dilated with blood (vein failure). Here, the blood is forced to go back to the rectum, thus bringing about the swelling,” he says.

Hagenimana says that pregnant women are also prone to getting the condition, explaining that, this is because of the pressure in the stomach causes the veins to lean against each other, constricting the blood from circulating well. "Advanced pregnancy, especially, exerts pressure on the veins, forcing the veins to rupture. If the woman is constipated, this adds to the pressure, aggravating the condition,” he adds.

Treatment

According to Aline Gihoza, a nurse at Rwanda Military Hospital Kanombe, dealing with the causes is the most effective way of doing away with hemorrhoids, but this can only be achieved if the condition has not reached a complicated stage where only surgery is required. If the factor inducing hemorrhoids is persistent, then the suffering will continue.

"Taking adequate amounts of water, high fiber food and exercise should be part of our routine in order to do away with constipation. If there is a chronic cough, it should be treated. Again, lifting heavy weights is not advisable for patients with hemorrhoids,” she says.

Gihoza points out that surgery is always the best way of dealing with severe hemorrhoids. However, she cautions that surgical removal of hemorrhoids may carry the risks of a major surgery, including infection and bleeding. If the reason for causing the hemorrhoids continues, there is a high risk of the condition recurring, therefore, surgery is best avoided.

Gihoza advises that taking a hot bath is one of the simple treatments which can be done.

"One should take a small tub or basin full of hot water and sit on it 2 or 3 times daily. This helps the hemorrhoids to reduce in size and shrivel,” she advises.

"Also, a patient suffering from hemorrhoids should clean the perineal region very well with a wet tissue immediately after passing stool or urine as this aids in keeping the hemorrhoids suppressed,” she adds.

Sometimes, adrenaline or anucort-HC rectal may be given or injected at the lower end of the affected area, which helps to reduce the size or even remove the hemorrhoids. On the other hand, specific creams and jelly can be used to apply at the affected area.

Complications, such as too much bleeding, rapture of the veins, as well as protruding of the hemorrhoids outside of the rectum are among most of the risks that may come along with the condition. For this reason, Gahungu advises that one should try all other measures to treat the causes before going for surgery.