CHAPTER ONE

1.1 Introduction

Haemorrhoids, as anarectal disease, obstruct and increase straining during bowel movement (Omole et al., 2019). They are commonly known as piles especially when they become abnormal and unmanageable Haemorrhoids manifests internally, externally or both. The symptoms include painful defecation, bleeding, blood stain on stool, feeling of incomplete defecation among other.

According to Merriam webster (2020), Haemorrhoid is an abnormal mass of dilated and enlarged blood vessels in swollen tissue that occurs internally in the anal canal or externally around the anus, that may be marked by bleeding, pain or itching.

According to William et al (2018) haemorrhoids are dilated (enlarged) veins in the walls of the anus and sometimes around the rectum usually caused by untreated constipation but occasionally associated with chronic diarrhoea.

According to Mayo clinic (2019), Haemorrhoids are swollen and inflamed vein in the rectum and anus that cause discomfort and bleeding. Haemorrhoids are usually caused by straining during bowel movement, obesity or pregnancy.

Obesity will induce the release of inflammatory cytokines and acute phase proteins which will eventually activate the innate immune system and affect metabolic homeostasis, which contributes to the formation of haemorrhoids (Lee et al., 2018). It was proven by two studies conducted in Australia and Korea that there was an association between obesity and haemorrhoids (Lee et al., 2018), (Riss et al., 2017)

Similar to this study, (Peery et al., 2015) showed that there is no association between obesity and the presence of haemorrhoid. However, this was in contrast with the postulated theory that obesity was associated with haemorrhoids (Lee et al., 2018), (Riss et al., 2017). Obese people will have high intra abdominal pressure, contributed by their high level of body fat, visceral fat, therefore, provoking venous congestion of the distal rectum and contributing to the development of haemorrhoids (lohsiriwate 2019).

Among the haemorrhoids patients male made up 51.5% whereas, females is made up of 48.55. This was in contrast to some studies, which stated that female had high prevalence of haemorrhoids (Lee et al 2018), (Riss et al., 2017).

Johonson and sonnenbarg (2018) estimated a prevalence of 4.4% IN US ADULT, Riss et al in a study of 2015 patient attending for coleretal cancer screening found that 38.93%  suffered from haemorrhoids are asymptomatic in about 40%  of individual.  According to Norma E Marco 2020, haemorrhoids are vascular spaces forming cushions above the anal canal which allows the passage of gas without stool and cause clinical problems only when they become engorged and prolapsed with resulting pains, bleeding itching and discharge.

According to Emaka (Ray et al., 2019), haemorrhoids are leading cause of lower gastrointestinal bleeding with high impact on quality of life.

According to Halverson (2019), haemorrhoids are arterio venous vascular plexuses that surround the distal rectum and the anal canal. Haemorrhoid are present in individuals from birth and become symptomatic when enlarged, inflamed thrombosed or prolapsed. The development of symptomatic haemorrhoid is related to a combination of factors including venous engargement and weakening of the scaffold of connective tissue that supports these vascular structures and overlying mucosa. Evaluation of haemorrhoids starts with clantying and individual primary symptom.

According to V Lohsinwate (2017), haemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushion. They affect millions of people around the world and represent a major medical and socio- economic problem. Multiple factors have been claimed to be the etiologies of haemorrhoids development including pregnancy, constipation and prolong straining.

Globally, it is difficult to ascertain the prevalence of haemorrhoids (Lee et al., 2020). The prevalence is yet to be studded but it is estimated that at some point the disease will affect 50% to 85% of world population worldwide the prevalence of symptomatic haemorrhoids is estimated at 4.4% in the general population (Robertson and B.S.C 2017).

In Nigeria, the incidence and prevalence of haemorrhoids may not be known (Omole and Adegboye 2019).

1.2 Statement Of Problem

Kaidar- person et al (2019) found that many individuals suffer from the condition without seeking medical consultation. Patients are reluctant to seek medical help because of embarrassment or the fear, discomfort and pain associated with the treatment. Based on experience Cleator (2020), confirmed that haemorrhoid is a common cause of distress and it’s treatment are often unsatisfactory as a result of its reoccurrence or complications.

The origin of haemorrhoids is not clear but the risk factor associated with its emergence have been identified. This causative factor include chronic constipation, inadequate dietary fiber, prolonged coughing and standing, age etc. (Krausa et al., 2016), (Cho et al., 2019), Nevertheless, there is no known study that has paid attention whether people are aware of this risk factor.

The investigator during her community experience, witnessed many cases where women complained of haemorrhoids. A woman complained  that anus used to protrude out when she was pregnant and she thought it will go away when she put to birth but it did not go after birth and she started feeling pain she decided to come and consult. Again the investigator in her community has seen many women of child bearing age who complained about haemorrhoids (pile). When she asked about the cause, they were pregnant they had it, some said they had constipation for weeks and after sometimes she took stool softener and when she went to stool she found out that she had pile (haemorrhoids). The condition persisted before she decided to seek medical treatment. The investigator had also suffered from this condition for years. The investigator also found out that many people complain that medication does not work for it but its only herbs that can help. The investigator on her side found out that it is very difficult for the disease to be treated.

All this prompted the investigator to find out women’s knowledge on the causes and prevention of haemorrhoids (pile).

1.3 Research Objectives

1.3.1 General Objectives

• To determine the knowledge of women in limbola on haemorrhoid, its causes and prevention.

1.3.2 Specific Objectives

• To find out the respondents’ knowledge on the cause of haemorrhoids

1. To determine the respondents knowledge on the prevention of haemorrhoids.

1.4 Research Question

• What do women know about the causes and prevention of haemorrhoids.