Dr Abdullah Iqbal, a general surgeon at Hill Park General Hospital, Karachi talks about piles and colon cancer and some issues related to surgery
SN: What are the common issues you deal with?sni
I have dealt with a wide range of conditions and diseases like obesity, rectal bleeding, various types of cancers, varicose veins (dilated blood vessels), piles, infections and digestive disorders like colitis, GERD and ulcers etcetera. Surgeries like gall bladder removal, hernia repairs and appendectomies are also done by general surgeons.sni
SN: What are piles?sni
Piles also known as hemorrhoids are swollen and inflamed veins in the rectum and anus. They can cause a lot of discomfort and make it difficult to perform daily activities. Common symptoms are pain, itching and bleeding during and after bowel movement. Feeling of fullness in the rectum, leakage of faeces and hard lumps around the anus are also some examples.sni
SN: Is spicy food the major culprit for piles?sni
Eating spicy food may worsen piles but it does not cause it. Piles can be caused by factors like straining during bowel movement, sitting for longer time on toilet seat, obesity and aging. Moreover, some studies suggest that genetics may play a role in developing piles but others deny this. More research is needed to determine whether there is a genetic link or not.sni
SN: Who is more prone to developing piles?sni
Piles can affect anyone at any age but certain factors increase the risk. For example, pregnant women and obese individuals are more likely to experience this problem. Aging can also contribute as the body does not respond to strain as efficiently as in young age. Other than family history, chronic diarrhea and a low-fiber diet can be possible risk factors.sni
SN: Patients with piles avoid consulting doctor due to fear of surgery. Do all the cases require surgery?sni
Surgery is not always necessary. Various modes of treatment like dietary changes, lifestyle modifications and medications can be used depending on severity of the disease. Furthermore, there is no chance of recurrence after surgery. Bleeding can occur later due to other causes.sni
SN: Suggest some natural ways to prevent piles.sni
Increase intake of fiber-rich foods like fruits, vegetables, whole grains and legumes. They soften stool and reduce pressure and discomfort. Drinking plenty of fluids throughout the day helps relieve constipation, which can worsen piles. Similarly, regular physical activity improves blood circulation and encourages regular bowel movements. This reduces pressure on anus. Also practice good hygiene; gently clean the area with warm water and a mild soap and dry it afterwards. If using toilet paper opt for a wet wipe or damp cloth instead of dry toilet paper. Also avoid using perfumed products.sni
SN: How can symptoms be relieved at home?sni
Few things can be done to ease the symptoms. For example, increase fiber intake and take sitz bath. Soak your body in shallow bath of warm water for 15 minutes. This will reduce inflammation, itching and irritation. Another way is to apply cold compress or use hemorrhoid cushions. It reduces swelling and pressure on affected area.sni
Over-the-counter creams, ointments and suppositories can help reduce itching and discomfort. Furthermore, avoid lifting heavy objects, straining during bowel movements, spending too much time on toilet seat and other activities that may aggravate the symptoms.sni
SN: What is the difference between a fissure and a fistula?sni
Fissure is a tear in the tissue lining anus. It is caused by trauma to the anal canal, often from hard stools or diarrhea. Some symptoms of a fissure are sharp, knife-like pain during or after bowel movement, followed by a burning sensation in the anal area. The affected part may also be tender to touch.sni
Whereas fistulas are caused by an infection. It occurs when an abscess has formed and the pus has tracked down to the anal canal. Symptoms of a fistula may include persistent drainage of pus or blood from the area, inflammation, redness, swelling, tenderness, pain and itching.sni
SN: Can fissure develop into fistula, piles or other colorectal issues?sni
Fissure may share similarities with other anal problems like hemorrhoids or fistulas. But they are not the same and do not convert into either one. Moreover, unlike other anal conditions, fissures do not transform into cancer.sni
SN: What are the home remedies for anal fissure?sni
There are many ways to treat it at home. For example, soak a cloth in warm water and hold it against the affected area several times a day for at least five minutes. This will relax the muscles and reduce discomfort. Another option is to fill a bathtub or bucket with few inches of warm water, add a few drops of essential oil and sit in it for at least 10 minutes.sni
Applying petroleum jelly or coconut oil-based cream on the affected area will reduce irritation. Also taking fiber supplement will help soften stool, which can reduce the risk of fissures developing in the first place.sni
Wrong-side surgery is very rare but a serious medical error that can have significant consequences for patients. Most common cause of this is miscommunication between the surgical team
SN: Is it normal to have blood in stool sometimes?sni
No it is not normal. It should be evaluated by a medical professional immediately to avoid complications. Different diseases and conditions can cause this bleeding like hemorrhoids, fissure, ulcerative colitis (inflammation and ulcers in colon), Crohn’s disease, irritable bowel syndrome, polyps, diverticulitis (development of small sacs in intestinal lining) and even cancer. Some of these can be serious medical conditions and others can be minor.sni
SN: How common is colon cancer in Pakistan?sni
Colon cancer is a growing concern in Pakistan. Poor diets and unhealthy eating habits have been identified as major contributing factors to the alarming increase. It was initially considered an old age disease but now younger individuals are getting affected too. This is because they are not consuming enough fresh fruits and vegetables whereas simultaneously overconsuming processed foods and foods high in saturated fats and refined sugars. Moreover, sedentary lifestyles are allowing bad dietary habits to take hold.sni
SN: Some signs and symptoms of colon cancer are similar to other colo-rectal issues. How can a layman identify he is suffering from this cancer?sni
Seek medical help if you experience change in bowel habits or stool consistency, rectal bleeding, blood in stool, abdominal pain, cramping, bloating, discomfort, fatigue, unexplained weight loss and feeling that bowel does not empty completely.sni
SN: What are the chances of complete recovery in colon cancer?sni
Several factors play a role in this. Most important is the stage of disease. Generally, stage one has the greatest chance of recovery. Those at stage one usually have a five-year relative survival rate of up to 90 percent. Then patients at stage four have a five-year relative survival rate of only seven to 10 percent. But this can vary individually.sni
SN: Can colon cancer be prevented?sni
Yes, it is one of the most preventable forms of cancer. Maintaining a healthy lifestyle by exercising regularly and eating a balanced diet that includes plenty of fruits and vegetables, especially those high in fiber and getting enough calcium, vitamin D and folate can help reduce the risk. Avoiding all forms of tobacco can play a role too.sni
SN: Can misdiagnosis lead to unnecessary or wrong surgeries? Also how can it be avoided?sni
Yes, it is very common. Commitment to patient safety and proper training and education of medical professionals can help prevent this situation. Doctors must attend seminars and conferences regularly, read new researches and journals and stay updated about latest technology and treatments.sni
Introduction of robotic surgery has made the surgical procedure more efficient and accurate. Moreover, it has led to decrease in the possibility of surgical errors
SN: There have been cases of medical negligence like surgeons operate left leg when right leg requires treatment. What causes this negligence?sni
Wrong-side surgery is very rare but a serious medical error that can have significant consequences for patients. Most common cause of this is miscommunication between the surgical team that leads to confusion over the side of the body on which the surgery should be performed. Complex medical case, understaffed or overworked team, improper use of WHO pre-operative checklist or an incorrect marking on the patient’s body are other causes of wrong-side surgery.sni
SN: How can a patient prevent misdiagnosis and unnecessary surgeries?sni
It is difficult for the patients to avoid them. However, the best way is to find reputable and experienced professionals who specialize in the field. Avoid quacks; those who claim to be medical professionals but lack the credentials to back it. Also stay away from touts; those who claim to provide quick and easy solutions regardless of the actual situation.sni
SN: Some patients fear surgery, even minor one. How are such issues addressed?sni
Unfortunately, counseling services are not widely available. However, I do practice a policy of open discussion with patients. I encourage them to talk about their feelings, fears and anxieties. When possible, I also try to connect them with other patients who have undergone a similar procedure. This initiative has had positive results. Hopefully in the future more counseling services will be available.sni
SN: What is the responsibility of a healthcare professional if a patient expresses his concern and fear?sni
They must listen and empathize with their worries. Also make sure to ask what the patient is specifically worried about. Then try to reassure them with accurate information. For example, in case of anxiety over anesthesia, I explain the process and address patient’s questions. If the patient is still very anxious, I always have the option to opt for general anesthetic (if possible). Alternatively, if the procedure itself allows, I can switch to a more localized form of anesthetic.sni
SN: What are the current advancements in the field of surgery? Where does Pakistan stand?sni
The advancements in the recent years have been remarkable. For example, introduction of robotic surgery has made the surgical procedure more efficient and accurate. Moreover, it has led to decrease in the possibility of surgical errors. It is not widely available in Pakistan yet due to lack of proper resources and training. However, hopefully it will be available soon and majority will benefit from it. The current surgery systems are still extremely advanced and effective and are being used in different areas of medical treatment.sni
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