By Henrylito D. Tacio
Someone once said: “Nothing can be said about our politics that has not already been said about almoranas.”
Almoranas, which are similar to varicose veins, are an undesirable condition that is very unpleasant and can interfere with your life. The uneasiness is tough to eliminate when the piles – as they are also known – get intense as well as itchy.
The swollen veins, which occur in the lower portion of the rectum or anus can be internal (when it develops inside the rectum) or external (under the skin around the anus). From time to time, nearly three out of four adults will have almoranas, statistics show.
Of the country’s total population, some 40% to 60% of Filipinos suffer from almoranas, reports Dr. Joseph C. Bocobo, past president of the Philippine Society of Gastroenterology (PSG). In fact, it is ranked No. 7 in the top ten most inquired household diseases, according to the Filipino Doctors website.
“Almoranas disease is a common disorder that I usually encounter in my daily clinical practice,” reveals Dr. Bocobo, who is an active consultant at the Institute of Digestive and Liver Diseases, and Liver Disease and Transplant Center at the St. Luke’s Medical Center – both in Global City and Quezon City.
“I see patients complaining of fresh blood during defecation, either dripping or staining the toilet paper, especially if the stool is hard and they strain,” Dr. Bocobo relates. “Many of them would undergo a colonoscopy which, most of the time, confirms the diagnosis of internal almoranas, upon exclusion of other possible causes of bleeding, or the colon is identified to be unremarkable or normal.”
The PSG life fellowbares that some patients go through the same procedure for other indications (referring to screening for colon cancer and suspected inflammatory bowel disease). In some instances, there are some incidental findings of engorged internal almoranas.
There are also patients, although not common, who come to his clinic complaining of painful lump(s) or swelling in the distal anal canal aggravated by a bowel movement and, on perianal examination, the identification of thrombosed external almoranas would be established.
Aside from almoranas, there are also people who see doctors either because of chronic venous disease (CVD) or chronic venous insufficiency (CVI). CVD refers to abnormalities of the venous system of long duration manifested by symptoms and signs indicating the need for investigation or care. CVI, on the other hand, is an advanced CVD due to functional abnormalities of the venous system producing edema, skin changes, and venous ulceration.
More than half (52.5%) of Filipinos suffer from CVD, according to Dr. Jonathan James Bernardo, chairman of the research ethics board of Ospital ng Makati and secretary of the Philippine Society of Vascular Medicine.
CVD is more than just a cosmetic problem. “Most of our patients are just familiar with the particular veins and the varicose veins and maybe a few of them will realize that edema and other skin changes may also occur with chronic venous disease,” Dr. Bernardo said.
Symptoms of CVD include heaviness, burning, aching, pain, fatigue, itching, cramping, and restless legs. Patients need to know that “these symptoms – especially the pain, aching, and the fatigue – would occur later on during the day.”
Among the risk factors for developing CVD are smoking, diet, constipation, sport, position at work, clothing stiffness, and heaviness in the legs that are exacerbated after prolonged standing or sitting with the heart or during menstruation for women.
“Just like any disease entity, CVD starts with certain risk factors or the patient’s exposure to risk factors,” Dr. Bernardo said. “More elderly patients, the more they become more prone to develop chronic venous disease. The female gender is also more prone to CVD. Patients who are obese or are overweight are more highly prone to develop CVD.”
Like any disease, CVD is most treatable in its earliest stages. Some basic treatment strategies include avoiding long periods of standing or sitting, regular exercise, losing weight, elevating the legs, wearing compression stockings, and practicing good skin hygiene.
Vascular medicine or vascular surgery specialists typically recommend a combination of treatments. In fact, there is a medicine that acts rapidly on venous tone. It is called micronized purified flavonoid fraction (MPFF).
“MPFF is able to improve venous tone because it decreases the metabolism of more adrenalin,” Dr. Bernardo explained. “And we know that more adrenalin when it attaches itself to alpha-adrenergic receptors results in smooth muscle cell contraction.
“That’s how MPFF reacts on venous stone and because it’s micronized even within an hour, at the start of an hour, you can already see the result because of venous stone,” he added.
Like CVD, there are also effective options available to treat almoranas. Many people get relief with home treatments and lifestyle changes.
Some people with almoranas undergo hemorrhoidectomy, a surgery to remove almoranas. Surgery can be done with a knife (scalpel), a tool that uses electricity (cautery pencil), or a laser.
According to Dr. Bocobo, most of the patients who come to his clinic have not self-medicated although a few have taken an underdosed oral drug, applied a topical ointment or cream, or used a suppository.
Dr. Bocobo’s treatment protocol consists of a high-fiber diet, such as fruits, vegetables, wheat and oats, and micronized purified flavonoid fraction (MPFF) diosmin and hesperidin.
“The recurrent bleeding rate is approximately less than 10%, which is normally among patients noncompliant with the prescribed treatment regimen,” Dr. Bocobo reports. “For those who thoroughly follow the instituted medical care, the outcome is a lot better.”
Relief of almoranas symptoms, such as pain and bleeding, is experienced immediately, improving more significantly in the days after as they proceed with their course of therapy. This leads to total control of the hemorrhage.
In his practice, Dr. Bocobo has yet to come across patients with more severe grades of Almoranas disease. If there are such patients, they would immediately go directly to surgeons for operative procedures.
“For those patients I encounter with thrombosed external almoranas, I give my usual treatment regimen with the addition of a hot sitz bath for 5 minutes twice a day until the discomfort is gone,” Dr. Bocobo says.
“Moist heat is convincingly another factor that alleviates pain due to its ability to decrease anal canal pressure,” he continues. “I do find this management effective since at least five of those patients that I can recall have successfully responded, with adequate follow-up post-medication, and so far, no recurrence, saving them from an excisional procedure.”
Dr. Bocobo claims that none of his patients – to whom he has prescribed MPFF – has ever reported any adverse reaction or untoward side effect with the medication.
The 1000 milligram MPFF, which improves blood flow in the veins, is used in the treatment of acute or chronic almoranas. It must be swallowed as a whole and should not be chewed, crushed or broken. Patients are advised to take the medicine for as long as the doctor recommends.
If the patient stops treatment too early, the symptoms may come back and the condition may worsen. Patients are advised to tell their doctors about other medications they are taking as some may affect, or be affected by the medicine. – ###