Do I need surgery for piles? Pile treatment options in Nigeria

Step one: soften the stool and stop straining

Piles are swollen blood vessels in and around the back passage. Hard stools and straining make them worse. For most people the first fix is in the kitchen and the toilet:

• Drink plenty of water through the day, more in hot weather
• Add fibre: beans, oats, vegetables, unripe plantain, fruit such as pawpaw, oranges and mango
• Go when you feel the urge, and do not sit on the toilet for long scrolling your phone
• Do not strain; a small footstool under your feet helps
• Keep active: walking helps the bowel move

Creams, suppositories and short-term medicines

Pharmacy creams and suppositories can ease itching and pain. Steroid creams should only be used for a short time. A bulk-forming laxative such as ispaghula husk helps if diet alone is not enough. Avoid codeine-based painkillers where possible, because they cause constipation.

A word about jedi-jedi remedies

Many people in Nigeria call piles and other bottom problems 'jedi-jedi' and buy herbal mixtures or strong purgatives to 'wash it out'. Purgatives can cause diarrhoea and dehydration, and none of them shrink piles. More importantly, the same symptoms, bleeding and a lump, can come from an anal fissure, a polyp or, less commonly, bowel cancer. Get examined rather than treating yourself for months.

Clinic treatments before surgery

If piles continue despite the above, a surgeon may offer rubber band ligation: a small band is placed above the pile, which then falls off within about a week. It is done in clinic without a general anaesthetic. Injections or other heat-based treatments are alternatives for some piles. These suit small to medium internal piles and can be repeated.

When surgery is the right choice

A haemorrhoidectomy, where the piles are cut away, is usually advised for large piles that stay outside or have to be pushed back, piles that keep returning after banding, combined internal and external piles, or repeated bleeding causing anaemia. It is the most effective treatment, and recovery is more painful than with banding, so the surgeon will explain the trade-off.

Bleeding that needs a proper check

Bright red blood on the tissue is common with piles. See a doctor promptly, and expect a test such as a colonoscopy, if you are over about 50, if the bleeding is dark or mixed in the stool, or if there is a change in your bowel habit, weight loss, tiredness, or a family history of bowel cancer.

Common questions