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Hemorrhoids 101: A Pain You and Napoleon May Have in Common

It’s time for a breather from heavy and “serious” topics, such as Alzheimer’s, cognoscopies and optimised sleep for brain health. That’s why this week we focus on a seemingly trivial complaint, a ”pain” many people have but are too embarrassed to admit: hemorrhoids! Laugh as you may but this is no laughing matter: major history events have frequently turned on such trivial matters.

The topic under discussion is actually inspired by a documentary I saw a few weeks ago at the film festival FID MarseilleHow Glorious It Is to be a Human Being, by Mili Pecherer — that elevated the hemorrhoid into its central metaphor: in her film, the 30-year old Mili walks around with a huge burden on her back, an inflatable bag in the shape and appearance of a hemorrhoid, that everyone becomes instantly curious about. The hemorrhoid even has a name, Alfred. Milli told me she named him/it after “Alfred the Great”, King of Wessex, “who defeated many Vikings and was known as a merciful and enlightened ruler. He was a devout believer who suffered a lot from hemorrhoids. He received this painful ailment as a divine reward, sent by God at his own request to assist him in resisting carnal desire”.

This idea actually goes back to the Old Testament, which sees hemorrhoids as a biblical punishment, as depicted in the 1st book of Samuel: “And the men that died not were smitten with the emerods: and the cry of the city went up to heaven.”

But Milli doesn’t take the old text for granted, she comes to grips with this idea which she beautifully deconstructs when she states: “Alfred the hemorrhoid is the image of my existential burden. He represents the notion of “sitting uncomfortably” in life. When you sit uncomfortably, you are afraid all the time that you might fall. And sometimes you feel lost, as you have the feeling that all the rest are “sitting comfortably”. And you are ashamed of being lost, because it’s not fashionable anymore. Just as you are ashamed of your hemorrhoids, even though you haven’t done anything wrong and it doesn’t mean anything about who you are.”

Digging deeper into the subject, it appears that this proctologic condition has been noted in the writings of various other cultures throughout history: Babylonian, Hindu, Greek, Egyptian. A quick search on PubMed will reveal texts dating back to Hippocrates, as well as a 48-page Turkish treatise from the 15th century, composed, interestingly enough, upon the request of a statesman of the time!

And that statesman was no exception. Legend has it that Napoleon lost the battle of Waterloo due to very painful thrombosed hemorrhoids, as this article, pun very much intended, makes clear: Piles of Defeat. Napoleon at Waterloo

First off, let’s clarify the terminology: if we talk about hemorrhoids, everybody has hemorrhoids, all the time, even you. Hemorrhoids are a highly vascular structure that cushions the anus and helps to keep it closed in cases of pressure in the abdominal cavity, such as when you’re sneezing. So they are actually a very useful thing. They only become a problem when they are chronically inflamed. Inflamed hemorrhoids are known as piles but popular culture uses the two terms interchangeably so for the purposes of good communication, we might as well perpetuate the mistake. 

How do you know if you have “hemorrhoids”? For one, your bottom is itching, and you may notice mucous or bright red blood on the toilet paper.

Hemorrhoids aren’t created equal though, being divided into four categories: Stage 1 — those that protrude only inside the anal canal; Stage 2 — those that protrude outside but go back in spontaneously; Stage 3 — those that require you to push them back manually (yuk!); and Stage 4 — protruding hemorrhoids that don’t go back in no matter what you do. 

Internal hemorrhoids (Stage 1-2) are only rarely painful or cause itching. Pain from hemorrhoids occurs when they become strangulated from prolapse and with thrombosis. 

In the US, Europe and other industrialised areas, hemorrhoidal disease is extremely common. Some individuals become afflicted in their 20s, but symptoms don’t become evident until the fourth decade. Estimates indicate that 50% of over 50-year olds have symptomatic hemorrhoidal disease at one time or another and up to one third of the total US population has hemorrhoids to some degree. 

What causes them? Anything that causes an increase in your abdominal pressure, resulting in excessive venous pressure e.g. long periods of standing or sitting, physical exertion, lifting heavy weights, straining on the loo, pregnancy, constipation, being overweight, increasing age, as well as liver congestion, excessive alcohol intake, stress, lack of vitamin C. And as with most conditions, there’s a genetic component. 

Interestingly enough, and something that sheds light on their prevention and treatment, hemorrhoids are rarely seen in parts of the world where high-fiber, unrefined foods diets are consumed. Lack of sufficient fiber in the diet is a huge contributor to hemorrhoids, since it causes more straining during bowel movements, which raise the pressure in the abdomen, increase pelvic congestion, weake the veins and obstruct venous return.

Therefore the treatment of hemorrhoids centres on dietary and lifestyle changes. A diet rich in vegetables, fruit and legumes is a must, not only for its high-fibre content but also for its flavonoid contribution. Flavonoids are the most common phlebotonic agents used for treating hemorrhoids, since these food compounds increase vascular tone, reduce venous capacity, decrease capillary permeability, facilitate lymphatic drainage and have anti-inflammatory effects. If there’s only one thing you’ll take away from this article, take this one: flavonoids for hemorrhoids. 

Sometimes however diet is not enough, especially if the condition is severe, which may require higher amounts. This is when flavonoid preparations such as rutin, diosmin, hesperidin and HERs (hydroxyethylrutosides) come to the rescue. 

On top of that, there are many topical treatments containing plant-derived chemicals, such as witch hazel, cocoa butter, Peruvian balsam, zinc oxide, allantoin (a by-product of uric acid). Hydrocortisone cream on the other hand will only create a vicious circle: although it helps with itching initially, prolonged use of this agent will often aggravate the pruritus ani. 

As a last resort, there’s surgical treatment: rubber-band ligation, hemorrhoidectomy.  Or cryosurgery – which involves the application of liquid nitrogen or nitrous oxide to the hemorrhoid, which causes destruction of the venous plexus, scarring and eventual tissue replacement. 

Poor Alfred!

As you may have realised by now, Xpomet is unlike other healthcare conferences, we aim to offer an unforgettable experience that is open for everyone, public and professionals alike. That’s why we also run the Arts Festival: a place for play and inspiration, enjoyment and wonder. By bringing together learning with fun, Xpomet shows that the healthcare industry thrives better when placed within an artistic framework. With this in mind, mark your diary for Xpomet© Medicinale – The Future of Health Festival to take place between 10–12 October 2019 in Berlin.