I’ve been offered an operation to remove a prolapsed haemorrhoid but I’m worried it will be painful and leave me incontinent.
Robert Cherry, Bedford.
Dr Scurr replies: Haemorrhoids, or piles, are swollen veins in the lower rectum or anus.
Risk factors include constipation, straining during bowel movements, pregnancy and heavy lifting, as these all increase pressure in blood vessels, making haemorrhoids more likely.
Symptoms include pain, bleeding, itchiness and discharge.
Risk factors of haemorrhoids include constipation, straining during bowel movements, pregnancy and heavy lifting, as these all increase pressure in blood vessels, making haemorrhoids more likely (picture posed by model)
Small haemorrhoids often get better on their own if you address the underlying cause (such as eating more fibre), but in the interim, you can buy over-the-counter creams to ease the pain and irritation (containing ingredients such as zinc oxide, that protects the pile against being irritated by stools, for instance). Painkillers, cold packs and constipation treatments can also help.
Large haemorrhoids may protrude – or ‘prolapse’ – through the anus: these may shrink back, but for chronic piles the only effective treatment is removal.
The non-surgical options include banding, in which a tight surgical elastic band is applied around the haemorrhoid, cutting off its blood supply and causing it to wither then drop off (this can take a week or so).
Other non-surgical alternatives are infrared light, gentle electric currents and injections of a chemical solution: all of these ‘destroy’ the rogue blood vessels, shrinking the haemorrhoid.
You’ve been offered the surgical option, a haemorrhoidectomy, where the piles are cut out under general anaesthetic. While I understand your concerns, the operation has been refined over the years: any discomfort should resolve within a week or two.
The surgery does carry a risk of damage to the anal sphincter, the ring of muscle that keeps the contents of the bowel in place, leading to incontinence, but it is rare and shouldn’t be a reason for you to decline surgery. You say you’re 78 and generally fit, and so the anaesthetic should not present a great risk. I encourage you to go ahead with the operation.
My partner has received an appointment to have yet another Covid vaccination, this will be his eight or ninth; he has asthma. Is another Covid jab necessary?
A. Haywood, Newport, S. Wales.
Dr Scurr replies: I’ve often been asked this and I fear the issue here is a failure in public health messaging, which your letter gives me an opportunity to put right. The fact is there’s been too much misguided speculation about the Covid boosters and their benefits – which is a worry, as Covid is now with us for good. The point with a booster – any booster – is it’s not a guarantee you won’t get ill. I myself, after six injections, caught Covid in July, and the productive cough lasted weeks.
But without the injections, the consequences of infection may be far worse – research shows that while vaccines may not prevent infection they prevent severe illness, hospitalisation or death.
And the reason we need a new booster every year is because the virus, SARS-CoV-2, continues to mutate, meaning it can evade the immunity you might have gained from previous infections, or the earlier vaccinations. The vaccines are updated to protect against newly emerging strains.
Vaccines, like all drugs, carry a risk of side-effects and there’s no doubt a small group of people have suffered as a result of their AstraZeneca Covid jabs, as we’ve seen in the reports about their efforts to seek damages.
There is a rare risk of myocarditis, inflammation of the heart muscle; most cases have been in younger men and have been mild, with full recovery. I’ve seen one such case, a colleague aged 60, but I stress this complication is rare and, in my view, outweighed by the benefits. I’d urge your partner to have both jabs.
IN MY VIEW… Cookery lessons are vital for children
Chefs In Schools is a charity working to reduce childhood obesity by training school cooks to prepare nutritious meals from scratch
All of us working in healthcare worry about the obesity crisis and the burden this is placing on individuals and the already overstretched NHS.
I’m convinced that if we’re to find a solution to changing the way our nation eats, it will come from educating our children.
That means training their taste buds to appreciate good quality, simple food from an early age rather than developing a desire for junk food and ultra-processed foods laden with salt, sugar and saturated fats, which are easy to overeat. So I was so thrilled to hear about Chefs In Schools, a charity working to reduce childhood obesity by training school cooks to prepare nutritious meals from scratch, baking bread daily, and teaching this approach.
It may be too late to captivate many adults with a new way of eating, but this approach must become mainstream to save our children.
Key to this is offering chefs an attractive wage – is this really too much to ask when the health of a future generation is at stake?
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence. Always consult your own GP with any health concerns.