At the Proctology outpatient clinic, all syndromes surrounding the exit of the body are treated. A well-known condition is hemorrhoids; one in three Dutch people sometimes has to deal with or suffer from this. Surgeon and proctologist Steve de Castro tells about it.

What exactly are hemorrhoids?
Steve: “There are pads made of erectile tissue around your sphincter muscle. Those cavernous bodies contain blood vessels that close your sphincter, actually your anus, air and watertight. But in some people, especially those with poor bowel movements and hard stools, the abdominal pressure can cause those cavernous bodies to swell. As a result, they no longer stay in place, but come out or hang out.”

Can anyone get hemorrhoids?
“Everyone has those pillows. That is the minimum degree. It's the same with you, with me, with everyone. Those are your hemorrhoids and they have a normal function. So if you have grade 1 hemorrhoids, you have no complaints and everything looks normal. When they swell there are grades.”

What do these grades look like?
“With second-degree hemorrhoids, the pads swell to such an extent that they can cause complaints, such as blood loss and itching, and they also come out when pressing hard. They always go back in quickly after that. Grade 3 is the same but then they go out and stay out. Sometimes this is 1 minute, sometimes 5 and sometimes you have to push them back with your finger. This is difficult and also hurts. At grade 4, the hemorrhoids are so big and pulled out that they won't go back in."

When do people with complaints come to the Jan van Goyen Medical Center?
“People come to us from grade 2, because from grade 2 annoying complaints can occur.”

How do you treat hemorrhoids?
“We do a lot with rubber band ligation; Also known as rubber bands. This is a beautiful, simple treatment with fast results. If someone comes to us with complaints, we will have a conversation and carry out the treatment immediately. The rubber bands are applied within a few minutes. After that it is uncomfortable for 1 or 2 days, but it gives a good improvement and rarely complications. Incidentally, this treatment is always reimbursed by the health insurer. In case of severe hemorrhoids or hemorrhoids that do not respond to the rubber bands, we will proceed to surgery.”

Can hemorrhoids come back after treatment?
“Yes, hemorrhoids can always come back. That is why it is wise to adjust your lifestyle in addition to the treatment. Make sure your stools are softer by watching your diet, drinking plenty of fluids, eating fiber, etc.”

What harm can it do if you do not have hemorrhoids treated while you do have symptoms?
“Nothing in itself, but if you are a bit older and have red blood loss, you should do a colonoscopy to rule out a tumor. It is classic that the blood loss comes from a higher tumor.”

Do you find that your patients don't like talking about hemorrhoids?
“Yes, our profession is veiled in embarrassment. People find it a barrier to talk about it and I understand that. That's why I try to put them at ease by giving a lot of information and breaking that taboo. Gradually, by just talking about pooping a few times, I notice that people feel a little more at ease.”

I think people also wonder if you find your work boring. Is this so?
“Everyone thinks it's dirty what I do, but that's absolutely not true. It sounds crazy, but people take an enema and that's not bad at all. I actually like the work because you can make people really happy when their problem is solved.”

What do you do besides proctology?
“I am a gastro-intestinal surgeon at the OLVG. In addition to proctology, I therefore also treat rectal cancer, stomach reductions and abdominal wall fractures. Because proctology is common, we have bundled this in the Jan van Goyen, so that we get everything in one place and there is a special proctology consultation hour. That is very efficient and effective. We are also working on bringing in new techniques, so I really like that!”

What do you also like about working at Jan van Goyen Medical Center?
“I like the small scale and the staff. I also like the fact that it is so service-oriented. This is a beautiful clinic where people are allowed to work.”

More information about our proctology outpatient clinic can be found here.