dr. Steve de Castro: 'Taboo should be broken'

'About one in four Dutch people has to deal with hemorrhoids. Yet there is a huge taboo on it. And that's a shame, because people let their hemorrhoids often do not treat because of this,' says Dr. Steve de Castro works as a proctologist at the Jan van Goyen Medical Center and as a gastro-intestinal surgeon at the OLVG. 'They can then grow enormously, causing patients to experience even more complaints. Some to such an extent that they become socially isolated.'

What is a hemorrhoid?
'There are cushions made of erectile tissue around your sphincter muscle. Those cavernous bodies contain blood vessels that close off your sphincter, actually your anus, airtight 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 they come out or hang out. 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.'

The grades
'In second-degree hemorrhoids, the pads swell to such an extent that they can cause complaints, such as blood loss and itching. When pushed hard, they come out, then they always go back in quickly. 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 it hurts. In grade 4, the hemorrhoids are so large and pulled out that they no longer go in. From grade 2 people come to us, because from grade 2 annoying complaints can occur.'

What can you do to prevent hemorrhoids?
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 and eating fiber.'

What types of treatments are there?
Rubber band ligation (rubber bands)'If someone comes to us with complaints, we start a conversation and carry out the treatment immediately. We do a lot with rubber band ligation; Also known as rubber bands. This is a beautiful, simple treatment with fast results. The rubber bands are applied within a few minutes. After that it is uncomfortable for one or two days, but it gives a good improvement and rarely complications.'

Cut or Staple
'In case of severe haemorrhoids or haemorrhoids that do not respond to the rubber bands, we will proceed to surgery. There are several options for this, whereby the classic method is cutting out the hemorrhoid. Stapling hemorrhoids with a staple gun often also gives good results.

Laser
'We can treat patients with very small hemorrhoids that cause very persistent blood loss with laser treatment.'

'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. The majority of our patients experience it as very pleasant once they have taken the step to come to us. That also makes my work fun, I can make people really happy when their problem is solved.'