The toilet seat trap: Why we need to stop silence around haemorrhoids

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It is the one health condition almost everyone has heard of, many have experienced, and yet few people are comfortable talking about.

In Swahili, we call it bawasiri. In English, haemorrhoids or piles. Whatever we call it, it is a condition that is still often discussed in whispers, if it is discussed at all.

Haemorrhoids are normal vascular cushions within the anal canal. They only become a problem when they become enlarged or symptomatic. Yet despite how common they are, they are often surrounded by embarrassment, misinformation and repeated self-treatment.

Modern life has inadvertently turned the toilet into a sanctuary. For some people, it has become a favourite reading chair or a designated doom-scrolling station. But spending prolonged periods on the toilet, particularly when combined with constipation, a low-fibre diet and straining, can contribute to haemorrhoidal symptoms.

And then the cycle begins. You are in pain, so you avoid going to the toilet. You avoid the toilet, and your stool becomes harder. The stool becomes harder, so you strain. You strain, and the symptoms get worse. It is a frustrating cycle that can leave people suffering in silence or repeatedly treating themselves without knowing exactly what is causing their symptoms.

Perhaps the most important misconception to address is the belief that any rectal bleeding is simply bawasiri. Haemorrhoids can cause bright-red rectal bleeding, but they are not the only cause. Anal fissures, inflammatory bowel disease, colorectal polyps and colorectal cancer can also cause rectal bleeding.

This does not mean that everyone who sees blood has cancer. It means we should not automatically assume that bleeding is haemorrhoids, particularly when it is persistent, recurrent, unexplained or accompanied by other concerning symptoms. Please do not diagnose yourself from the toilet bowl. If you have rectal bleeding, particularly if it keeps happening, speak to a healthcare professional and have the cause properly assessed.

Haemorrhoids are also common during pregnancy, particularly in the second and third trimesters, when the growing uterus increases pressure on the blood vessels in the pelvis.

The same caution applies to how we treat symptoms. Pharmacy creams and ointments can be useful for relieving itching, irritation and discomfort, but symptom relief is not necessarily the same as treating the underlying cause. If bleeding continues, symptoms keep returning, pain becomes significant, or you develop a new lump, it is important to move beyond repeated self-medication and seek a proper clinical assessment.

If you have been buying the same cream every few months for years, perhaps it is time for a different approach. Don't keep treating a symptom without finding out what is causing it.

The good news is that the road to recovery rarely begins in the operating theatre. Most people with haemorrhoids do not need surgery. The first step is usually to address the things that are making the haemorrhoids angry in the first place: constipation, straining, inadequate fibre and prolonged toilet sitting. For some patients, increasing fibre and fluids, treating constipation and avoiding prolonged sitting and straining during bowel movements may be enough to settle their symptoms.

For others, particularly when symptoms persist, or the haemorrhoids are more advanced, procedures may be appropriate. Depending on the type and severity of the haemorrhoids, these may include office outpatient procedures such as rubber band ligation, or day-case surgical procedures for haemorrhoids that require more definitive treatment. The appropriate approach depends on the individual patient and requires proper clinical assessment.

So no, a diagnosis of bawasiri does not automatically mean you are being booked for theatre. There is a range of treatment options, and the aim is to choose the least invasive approach that is appropriate for the individual patient.

Another myth we need to put to rest is that haemorrhoids are a sign of poor hygiene. They are not. Haemorrhoids are normal vascular cushions that can become enlarged or symptomatic. Constipation, straining, prolonged toilet sitting and increased pressure around the pelvic and anal veins are much more relevant factors.

In fact, you can sometimes make things worse by becoming too enthusiastic about cleaning. Repeated wiping and scrubbing can irritate the sensitive skin around the anus and worsen itching and discomfort. Gentle cleaning is enough. Excessive scrubbing is not.

Fortunately, there are simple things you can do to improve your bowel habits and reduce the risk of symptoms becoming worse. Eat more fibre. Vegetables, fruits, whole grains and legumes can help produce softer stools that are easier to pass. Drink enough fluids and maintain regular fluid intake throughout the day. Avoid straining and try not to spend prolonged periods on the toilet, particularly while scrolling on your phone. Don't repeatedly ignore the urge to pass stool, as this can allow it to become harder and more difficult to pass. And if you regularly struggle with constipation, speak to a healthcare professional about appropriate treatment.

Most importantly, know when to seek help. Persistent or recurrent rectal bleeding, significant or worsening anal pain, a new lump around the anus, changes in bowel habits, unexplained weight loss, or symptoms that keep returning despite treatment should be properly assessed.

Bawasiri is common, and rectal symptoms are something healthcare professionals deal with regularly. There is no need to suffer in silence or repeatedly treat yourself without knowing what is causing the problem.

Haemorrhoids are common and treatable. They are not something to be ashamed of, and having symptoms does not mean that you have done anything wrong. Pay attention to your bowel habits, eat enough fibre, drink enough water, avoid prolonged periods on the toilet and avoid straining.

And if something changes or does not feel right, don't simply assume it is bawasiri. Get it checked.

Sometimes the cause is straightforward and treatment is simple. And when it is something else, identifying the cause early can make a difference.

There should be no shame in talking about bowel health. The more comfortable we become discussing these symptoms, the less likely people are to suffer unnecessarily or delay getting the care they need.

The writer is a general Surgeon at The Nairobi Hospital