{"id":21437,"date":"2020-02-03T09:29:26","date_gmt":"2020-02-03T01:29:26","guid":{"rendered":"https:\/\/www.columbiaasia.com\/malaysia\/?post_type=health-article&#038;p=21437"},"modified":"2024-02-15T09:40:40","modified_gmt":"2024-02-15T01:40:40","slug":"bleeding-from-your-bottom","status":"publish","type":"health-article","link":"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/bleeding-from-your-bottom\/","title":{"rendered":"Bleeding From Your Bottom"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"21437\" class=\"elementor elementor-21437\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b92652c e-con-full e-flex e-con e-parent\" data-id=\"b92652c\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-891ecb8 elementor-widget elementor-widget-heading\" data-id=\"891ecb8\" data-element_type=\"widget\" id=\"subtopic-01\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h3 class=\"elementor-heading-title elementor-size-default\">Enlarged haemorrhoids can become so unpleasant, especially if left untreated, that the person suffering from them has to use a special pillow to sit down anywhere.\n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f1e3b51 elementor-widget elementor-widget-text-editor\" data-id=\"f1e3b51\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>If you don\u2019t want to increase your risk of getting piles, refrain from using your electronic gadget in the toilet.<br \/><br \/>You can be king of the throne, but make sure you don\u2019t overstay your \u201cvisit\u201d, because prolonged use of smartphones while on the toilet seat is a contributor to haemorrhoids, also known as piles.<br \/><br \/>This \u201cToilet Newspaper Syndrome\u201d is described as long hours of sitting on the toilet seat because the individual is engrossed with reading materials.<br \/><br \/>\u201cPeople have this habit of reading seated on the toilet and this should be avoided.<br \/><br \/>\u201cMake sure there are no reading materials or gadgets in the toilet.<br \/><br \/>\u201cJust go in, do your stuff and come out. Retrain your toilet habits to prevent haemorrhoids, \u201d says consultant general and colorectal surgeon Datuk Dr Meheshinder Singh.<br \/><br \/>Haemorrhoids are the displacement of cushions of blood vessels under the anal wall lining.<br \/><br \/>When the walls of these vessels are stretched, they become irritated, inflamed and start bulging.<br \/><br \/>Then the haemorrhoidal cushions, which are a natural part of the body\u2019s anatomy that aids bowel movement, either swells inside (internal haemorrhoids) or outside (external haemorrhoids).<br \/><br \/>Internal haemorrhoids don\u2019t cause any pain and usually don\u2019t require treatment unless they start to bleed, while external haemorrhoids are painful and cause discomfort and bleeding.<br \/><br \/>Haemorrhoids can develop from increased pressure in the lower rectum due to excessive straining during bowel movements, sitting for long periods of time on the toilet, being sedentary, having chronic diarrhoea or constipation, obesity, pregnancy, having anal intercourse, eating a low-fibre or high-spice diet, regular heavy lifting, family history and ageing.<br \/><br \/>Although haemorrhoids can be unpleasant and painful, they can be easily treated in the early stages.<br \/><br \/>Unfortunately, the majority of patients are too embarrassed to consult a doctor.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e4a674a elementor-widget elementor-widget-spacer\" data-id=\"e4a674a\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-con{--container-widget-width:100%}.e-con-inner>.elementor-widget-spacer,.e-con>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));--align-self:var(--container-widget-align-self,initial);--flex-shrink:0}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container,.e-con>.elementor-widget-spacer>.elementor-widget-container{height:100%;width:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty,.e-con>.elementor-widget-spacer.elementor-widget-empty{position:relative;min-height:22px;min-width:22px}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon,.e-con>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon{position:absolute;top:0;bottom:0;left:0;right:0;margin:auto;padding:0;width:22px;height:22px}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2215279 elementor-widget elementor-widget-heading\" data-id=\"2215279\" data-element_type=\"widget\" id=\"subtopic-02\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Why so shy ?<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-73fece0 elementor-widget elementor-widget-text-editor\" data-id=\"73fece0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>As with most healthcare issues in Malaysia, we often wait until we reach a dire situation before seeking medical intervention.<br \/><br \/>By then, extreme measures have to be taken to remedy the situation.<br \/><br \/>Dr Meheshinder says, \u201cPatients delay treatment because they are embarrassed, as nobody likes showing their backsides; they also relate it to surgery or they fear incontinence.<br \/><br \/>\u201cSo they seek treatment elsewhere and are misdiagnosed, which is sad.<br \/><br \/>\u201cThey might have had the symptoms for years and when I examine them, they have stage 4 colorectal cancer.<br \/><br \/>\u201cPiles don\u2019t 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\u2019re not missing out anything.<br \/><br \/>\u201cPatients above 45 should perform a colonoscopy to rule out the risk of malignancy.<br \/><br \/>\u201cI\u2019m paranoid about this because a lot of times, I\u2019ll catch a polyp or a tumour.\u201d<br \/><br \/>The ageing process is also a risk factor as the ligaments in the area tend to disintegrate.<br \/><br \/>Thus, the mechanism that holds them in place weakens and prolapses, causing the patient to strain while defecating.<br \/><br \/>\u201cEven if you have a little thread sitting in your anal canal, you will feel uneasy; that\u2019s how sensitive the area is.<br \/><br \/>\u201cWith internal haemorrhoids, we can solve the problem in the clinic by using rubber band ligation, \u201d he says.<br \/><br \/>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.<br \/><br \/>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.<br \/><br \/>If all these have been addressed and no improvement is seen, then drugs are prescribed.<br \/><br \/>\u201cIf things still don\u2019t work, then we advocate something more invasive, such as surgical modalities.<br \/><br \/>\u201cThere 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.<br \/><br \/>\u201cIf it is not bothering you, there is no need for surgery.<br \/><br \/>\u201cWhen you overdo things, that\u2019s when you run into problems, \u201d points out Dr Meheshinder.<br \/><br \/>He was speaking at the Don\u2019t Sit On It Lah roundtable session organised by French-based pharmaceutical company Servier Malaysia recently.<br \/><br \/>Also at the session was consultant general and vascular surgeon Datuk Dr Ho Teik Kok, who adds, \u201cMost 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).\u201d<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b477b88 elementor-widget elementor-widget-spacer\" data-id=\"b477b88\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-942855e elementor-widget elementor-widget-image\" data-id=\"942855e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"836\" height=\"300\" src=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2020\/02\/health-article-bleeding-from-your-bottom-01.jpg\" class=\"attachment-full size-full wp-image-21446\" alt=\"\" srcset=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2020\/02\/health-article-bleeding-from-your-bottom-01.jpg 836w, https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2020\/02\/health-article-bleeding-from-your-bottom-01-300x108.jpg 300w, https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2020\/02\/health-article-bleeding-from-your-bottom-01-768x276.jpg 768w\" sizes=\"(max-width: 836px) 100vw, 836px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c935846 elementor-widget elementor-widget-spacer\" data-id=\"c935846\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e71082a elementor-widget elementor-widget-text-editor\" data-id=\"e71082a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"color: #2e2e2e; font-family: roboto, Helvetica, Arial, sans-serif; font-size: 13px;\">Constipation, which can lead to piles, can also lead to CVD, which includes varicose veins.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4976c2b elementor-widget elementor-widget-heading\" data-id=\"4976c2b\" data-element_type=\"widget\" id=\"subtopic-05\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Pressure on the veins<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6b9f9e8 elementor-widget elementor-widget-text-editor\" data-id=\"6b9f9e8\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Those with occupations involving a lot of standing, such as hawkers, teachers, chefs, factory workers, those in the food and beverage, and retail service, cabin crew, nurses and those who wear heels for long durations, are at risk of developing CVD.<br \/><br \/>Pregnant women are the subset of patients at risk of developing both haemorrhoids and CVD.<br \/><br \/>According to the 2019 Chorus (Chronic Venous And Haemorrhoidal Diseases Evaluation And Scientific Research) Study published in the Wiley Online Library, more than 50% of patients seeking help for piles also have CVD.<br \/><br \/>\u201cMost patients are unaware of CVD (they only know of varicose veins) and how it can progress to more severe stages leading to leg ulcers.<br \/><br \/>\u201cThey often present at very late stages, \u201d says Dr Ho.<br \/><br \/>In both haemorrhoids and CVD, there is increased pressure in the veins that could be caused by various factors, such as damage to the valves \u2013 these send blood back to the heart in one direction and prevent backward flow.<br \/><br \/>He explains: \u201cWhen the veins get distended due to prolonged standing etc, it leads to reflux where blood is not able to go back to the heart.<br \/><br \/>\u201cThe blood then pools back to the leg and increases pressure, leaving more white cells in the blood.<br \/><br \/>\u201cThis damages the valves and causes the white cells to go out through the skin. That\u2019s when the skin starts to darken.<br \/><br \/>\u201cInitially, just the veins are visible (spider veins, varicose veins).<br \/><br \/>&#8220;There may also be pain or cramps in the leg, especially in the evening. This gets better in the morning as the fluids are drained while sleeping.<br \/><br \/>\u201cWhen it gets worse, patients start getting venous eczema, itchiness and skin ulcers.<br \/><br \/>\u201cA minor knock can cause bleeding because of the high pressure in the veins.\u201d<br \/><br \/>Treatment for CVD also depends on its stage.<br \/><br \/>Oral drugs are effective in relieving pain and swelling.<br \/><br \/>Factors to work on include losing weight, not wearing tight clothing, especially in the tummy\/thigh areas, wearing proper shoes (avoid high heels) and wearing compression stockings.<br \/><br \/>Dr Ho says, \u201cIf it\u2019s more serious, when there are ulcers, patients need surgical intervention or injections.\u201d<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07fd084 elementor-widget elementor-widget-spacer\" data-id=\"07fd084\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f6166b6 elementor-widget elementor-widget-heading\" data-id=\"f6166b6\" data-element_type=\"widget\" id=\"subtopic-06\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">No urge to poo<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6b9fb75 elementor-widget elementor-widget-text-editor\" data-id=\"6b9fb75\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Three years ago, freelance writer Yvonne Lee Shu Yee, 47, embarked on a guided tour to Japan, and for seven days, she didn\u2019t poo!<br \/><br \/>She had always suffered from constipation due to prolonged sitting to teach music, but never sought medical advice, preferring to get solutions from the pharmacy.<br \/><br \/>\u201cI always read in the toilet whenever I tried to pass motion. It was a struggle so I would always strain and bleed.<br \/><br \/>\u201cI was \u2018successful\u2019 once every four or five days, \u201d she recalls.<br \/><br \/>But in Japan, Lee just didn\u2019t have the urge, despite feasting on all sorts of Japanese delights.<br \/><br \/>\u201cOn the return flight, I wanted to poo, but I couldn\u2019t, so when I arrived home, I bombed seven days worth of sushi!<br \/><br \/>\u201cFrom all that straining and bleeding, I nearly collapsed and my husband rushed me to the clinic.\u201d<br \/><br \/>She eventually saw a surgeon and was diagnosed with Grade 4 haemorrhoids. Surgery was the only option.<br \/><br \/>Today, Lee has learnt her lesson and has made numerous lifestyle modifications.<br \/><br \/>One thing for sure is no more reading in the toilet!<br \/><br \/>On how often one should have a bowel movement, Dr Meheshinder says, \u201cIf your pattern has been like that, e.g. five days once all the time, I wouldn\u2019t worry about it, but if the pattern changes, then seek advice.\u201d<br \/><br \/>Adds pharmacist Datin Mariani Ahmad Nizaruddin, \u201cA lot of clients don\u2019t really present all their symptoms to us. They don\u2019t tell until we ask.<br \/><br \/>\u201cThey prefer anything topical instead of drugs. Often, they like to use enemas, which can complicate matters.<br \/><br \/>\u201cPharmacists are trained to understand the patient\u2019s complaint and medical history before providing the right advice or encouraging them to see a doctor.<br \/><br \/>\u201cIt would be ideal to have a system sharing these medical information between patients, pharmacists and doctors, \u201d she says.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-139f74d elementor-widget elementor-widget-spacer\" data-id=\"139f74d\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4784454 elementor-widget elementor-widget-spacer\" data-id=\"4784454\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64bf17b jteHAlandingLastTxt elementor-widget elementor-widget-text-editor\" data-id=\"64bf17b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<i>This article first appeared in <a href=\"https:\/\/www.thestar.com.my\/lifestyle\/health\/2019\/12\/18\/bleeding-when-you039re-on-the-toilet-might-mean-haemorrhoids\">The Star Online, 18 December 2019<\/a>.<\/i>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Enlarged haemorrhoids can become so unpleasant, especially if left untreated, that the person suffering from them has to use a special pillow to sit down anywhere.<\/p>\n","protected":false},"author":2,"featured_media":21440,"template":"","topic":[103,95,117,94],"language":[137],"class_list":["post-21437","health-article","type-health-article","status-publish","has-post-thumbnail","hentry","topic-diseases","topic-general","topic-general-surgery","topic-health-wellness","language-en"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - 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