Patients` chosen hygienico-customary habits

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WELLNESS AND EDUCATION
CHAPTER XV
¹Department of Anatomy Silesian Piasts University of Medicine in Wrocław
Katedra i Zakład Anatomii Prawidłowej
Uniwersytetu Medycznego im. Piastów Śląskich we Wrocławiu
2
Department and Clinic of Gastrointestinal and General Surgery
University of Medicine in Wroclaw
Katedra i Klinika Chirurgii Przewodu Pokarmowego i Chirurgii Ogólnej
Uniwersytetu Medycznego Wrocław
Out-patient Clinic Multi-Medyk Ltd Wrocław
Niepubliczny Zakład Opieki Zdrowotnej Multi-Medyk
Spółka z Ograniczoną Odpowiedzialnością
3
4
Department of Oral Anatomy Silesian Piasts University of Medicine
in Wroclaw
Zakład Anatomii Stomatologicznej
Uniwersytetu Medycznego im. Piastów Śląskich we Wrocławiu
SŁAWOMIR WOŻNIAK1,3, KRYSTYNA MARKOCKA-MĄCZKA2,
MIROSŁAW TRZASKA1, MAREK SYRYCKI1,
ZYGMUNT DOMAGAŁA1, KATARZYNA STASZAK4
MICHAŁ PORWOLIK1, BOHDAN GWORYS1
Patients’ chosen hygienico-customary habits concerned
with proctologic complaints in ambulatory practice
and educational possibilities in that subject
Wybrane zachowania higieniczno-zwyczajowe pacjentów
zgłaszających dolegliwości proktologiczne w praktyce ambulatoryjnej
i możliwości edukacji pacjentów w tym zakresie
Słowa kluczowe: oddawanie stolca, nawyki w oddawaniu stolca, żylaki odbytu,
edukacja proktologiczna
Key words: defecation, defecational habits, hemorrhoids, proctologic education
INTRODUCTION
The name hemorrhoid is derived from greek words haema (blood) and rhoos
(flow). Hipokrates was first to use that term in 460 year before Christ. The beginning and history of the battle against hemorrhoids are very large and started many,
many years ago. At the beginning of our centuries (41 year) Dioscorides in Rome
described aloe in hemorrhoid therapy. Galen (lived in 130-200 yrs) used leeches
besides aloe. In old Chinese and Japanese medicine acupuncture and moxibustion
(use of moxa) were applied. In nowadays Schafik described the same mechanism in
constrictors of anus (the same mechanism in hip-bath in oak-bark fluid) [23]. Saint
Fiakr (proctologists’ patron) used kriotherapy in hemorrhoid treatment (sat on cold
stone and prayied). Celsus (in 25 yrs) tried ligation of the hemorrhoids.The hemorrhoids are very often occured disease of anal region. That structures are anatomical
basement for anal control of defecation [4,16, 17]. More than 80% of adult persons
suffered or will suffer from that inconvenience. The presence of incomplicated hemorrhoids is not painful, because they are situated in the region of visceral inervation.
They are not vulnerable for any cutting, piercing or compression. That disease is
manifested by bleeding from the anus (often after defecation - when used toilet paper), eczema and itching of the anal region [1]. The blood is bright and fresh.
The main role in development of this disease plays constipation, concerned with
deregulation of many functions of large intestine, among them changes in anal
sphincters. There are several symptoms of constipation like: rectal tenesmus,
scybala, ineffectual effort to defecate, dyschesia, incomplete, rare defecation. The
definition of constipation include less than 3 defecations a week, the weight of feces
less than 35 grams a day, forced tenesmus for more than 25% of defecation, delayed
time of passage through alimentary tract or colon. The criterias for establish the
constipation are collected in the III Rome Criterias of functional constipation. The
Bristol Stool Form Scale (BSFS) was created to describe the state of feces. Type I
and II are characteristic for constipation. The aim of this scale is to improve the
contact with the patients when describing the symptoms (patient can show the picture of stool – educational function) That scale is described in Table I.
Table I. Bristol Stool Form Scale
Typ
1
2
3
4
5
6
7
Description
Separate hard lumps
Sausage shaped
Sausage with cracks on its
surface
Like a sausage or snake
Soft blobs (clear-cut borders)
Fluffy pieces with ragged
edges
No solid pieces
Notices
Hard to pass
Lumpy
Soft and smooth
Easy to pass
A mushy stool
Watery – entirely liquid
To diagnose constipation, the symptoms mentioned above must be present in last
3 months and they must be persistent (appeared more than 6 months before diagno166
Sławomir Wożniak, Krystyna Markocka-Mączka, Mirosław Trzaska,
Marek Syrycki, Zygmunt Domagała, Katarzyna Staszak, Michał Porwolik,
Bohdan Gworys
Patients’ chosen hygienico-customary habitss concerned
with proctologic compli-ants in ambulatory practice and educational possibilites
in that subject
se). That problems with passage of the feces through the large intestine are caused
by the life manners, diet habits, drugs, stress and mental disorders (for example
depression) [8, 13, 26]
Constipations are more often after 60 years, when hemorrhoids decrease in that
group [3, 12-15, 18-19, 25]. The next factor to develop that disease is changing in
the statue of supporting tissues close to the anus [25]. The changes in the arteriovenous anastomoses (so called cavernosus corps) lead to hemorrhoids. The main
artery to deliver blood to that region is superior rectal artery (a branch of inferior
mesentery artery). The outflow from that vessels takes place by veins to portal venous system or inferior vena cava. The role of unsufficient content of intestine that
leads to increased pressure inside intestine, seems to be persuading [5, 7]. The diet
low in fiber leads to that state and the long-lasting enlargement of the internal venous vessels occurs [2]. Other factors that lead to hemorrhoids are diarrhea, pregnancy, sitting tribe of work (for example driver or IT specialist) or chosen sport
activities (cycling, horse-riding, long-race running) or tumors of small pelvis [6, 1011, 20-22, 24]. The grade of hemorrhoids can be established on rectoscopy and correlation with hygienic and life manners can be established as well. The correction of
that manners during the patient”s interwiev can be performed. The typical staging of
hemorrhoids was applied [1-6, 9].
The stages of hemorrhoids:
 I stage – hemorrhoids are situated in anal canal (are seen in rectoscope). May
protrude on tenesmus. Do not pass from the anus.
 II stage – can be seen outside the anus on tenesmus, but withdraw spontaneously
 III stage – fall out during defecation and must be replaced with hand
 IV stage – permanent outside the anus (unreducible)
The aim of this paper is to analysed the chosen hygienic habits and life activities of patients with hemorrhoids and possibilities of education in that field.
MATERIAL
24 persons - 70 women and 54 men aged from 16 through 94 years (female),
mean 52.9 yrs±17.57, and from 23 through 82 years (male), mean 50.92 yrs±17.04.
The weight of female was from 49 through 140 kilograms, mean 70.92±15.14, and
height from 148 through 187 centimeters; mean 163.6±6.93. The weight of male
was from 53 through 120 kilograms; mean 82.8 ±13.61, and height from 160
through 198, mean 175.5± 6.94. BMI of female was from 18 through 55, mean
26.56 ±5.79, and for male from 17 through 40, mean 26.92 ± 4.49. proper range
was established as 18,5 – 24,9.
167
METHOD
The examination was performed with rectoscope by one surgeon (SW) in assist
of one nurse. The data were collected by questionnaire – the patient was obliged to
answer the questions. The data as follow – frequency of defecation, sitting toilet
time (to defecate), sport activity and time spend on tv watching or siting with computer were collected. The frequency of defecation was collected: the patients’ answers were divided into groups composed of – every day (one or several times), every 2-3 days or rare. Sitting toilet time was as follow – lower than or exactly 2 minutes, longer than 2 minutes lower than 3 minutes, longer than 3 minutes lower than 5
minutes, and the last group more than 5 minutes. Sport activity was named as none,
small – no longer than 1 hour a week, medium – 1-2 hours a week, and great - more
than 2 hours a week. Computer sitting or tv watching (at home or at work) was grouped as follow: below 2 hours a day, 2-4 hours a day, 4-6 hours, 6-8 hours a day or
more than 8. After the rectoscopy the patients’ answers were analysed and discussed. The right solutions for inadequate and/or wrong habits were proposed. The
follow up was a routine procedure. The data were collected in Excell and next analysed with statistical methods and Statistica 10.0 software. Independence chi-square
test was used for qualitative variables. The level of significance was typical –
p=0.05.
RESULTS
In the examined group the advance of diseases was established. The detailed data
are collected in table II. There were not statistical differences (p=0.274).
Table II. Hemorrhoids in examined groups
Staging of
hemorrhoids
O
I
I/II
II
II/III
III
III/IV
łącznie
N
1
13
15
35
5
0
1
70
Examined group:
N (F 68, M 51, T 119)
K
M
T
%
N
%
N
%
1.4
0
0
1
0.8
18.6
5
9.4
18 14.5
21.4 14 25.9 29 23.5
50.0 32 59.3 67 54.0
7.2
1
1.8
6
4.8
0
2
3.6
2
1.6
1.4
0
0
1
0.8
100
54 100 124 100
The female patients defecation rate was as follow: 63 defecated every day (1 or
several times), 5 women every 2-3 days, 2 patients rare. In male group – there were
47 patients that defecated every day, 4 every 2-3 days, 2 rare than every 2-3 days, 1
male did not give the defecation rate. The sitting toilet time was as follow in female
group – shorter than 2 minutes 3 women, longer than 2 minutes, but shorter or equal
to 3 minutes 10 patients, from 3 minutes through 5 minutes 18 women, longer than 5
168
Bohdan Gworys
in that subject
minutes 39 individuals. In male group the same ratio was as follow – below 2 minutes were 8, form 2-3 5 patients, 3-5 4 persons, more than 5 – 35 men, 2 did not
know. Sport activity – female without any – 3, small – 9, medium – 20 women, great
in 26, no answer form 12. In male group no activity in 7, small – 3, medium 19,
great 21, no answer from 4. Watching tv or computer sitting (at home or at work) grouped in female – below 2 hours – 20, 2-4 20, 4-6 hours – 5 women, 6-8 hours 1,
more than 8-1, no answer in 23 patients. In male group – below 2 hours – 10, 2-4
hours 20, 4-6 8 persons, 6-8 – 4 persons, more than 8 – 6, no answer from 6 patients.
The Bristol Stool Form Scale (BSFS) was shown to the patients (picture of feces).
The all patients had no problems with showing their type of stool. In the next step
the differences between patients without varices and with the most advanced varices
were compared. The patient without varices was female (KM) 64 yrs old, weight –
77 kg, height – 167 cm, BMI – 27.7, defecated rare than 2-3 days without any special provocation procedure, She did not stop the defecation, defecated irregular. The
stool was solid, she used to spend in toilet up to 5 minutes, used toilet paper. Her
sport activity is medium, she used to spend on tv or computer from 4 through 6
hours. On the opposite side (the most advanced diseease) was other women (JJ) 76
yrs old, 67 kg, 164 cm, BMI 25, did not answer on the question concerned frequency. She defecated after coffee intake, did not stop defecation ahich occurred at morning. She used to sit in toilet long (more than 5 minutes). No sport activity,
tv/computer between 4-6 hours a day.
DISCUSSION
Female mean age was 52.9 yrs±17.57 and male mean 50.92 yrs±17.04. So the
mean age of our patients was similar to that of the others [1-3,6-10, 12-15, 18-26].
The staging of the group was similar to that observed by others authors. The patients
were informed about the prophylactic methods and advices to prevent hemorrhoids –
1. regular and unstopped passage of stools, changing in diet habits – 2. drinking or
eating before defecation, 3. hygiene of anal region (washing anal region after defecation). Others advices concerned diet – 4. high in fibers, 4. fruits, 5. fluids, 6. exclude chocolate, 7. strong tea (constipation risk), 8. alcohol and 9. hot species (local
congestion in small pelvis). The last group of recommendations are concerned with
sport activity – 10. undertake adequate to individual health state, 11. resignation of
strength competitions (lifting conduct to increase in prelum abdominale), 12. cycling, 13. horse-riding, 14. long-running). 15 - the few breaks while sedentary lifestyle at work (exercises, walking) According the patients: easy to done were 2, 4, 5, 6,
7, 8, 9, 11, 12, 13, 15. Difficult to introduce were 1, 3, 10, 14. The communication
between doctor and patient was excellent when used the BSFS scale. The patient
could point at the picture with :his/her” stool and it took very little time and was
extremely easy [13]. In the selected patients without hemorrhoids and the most advanced disease the parameters were similar, so the data to analyse were with no
169
meaning. Our thoughts that patients spent too much time in toilet (prolonged toilet
sitting) found conformation in our study. A lot of patients try to read books or newspapers during defecation. The improvement in that field is very difficult to achieve.
The data concerned with sport activity were similar to our expectations. To our surprise the data concerned the time spend on tv watching or computer were not so
large as we expected. The sport activity declared by the patients was similar to that
expected by us. Most of the patients were very nervous before the examinations –
they were aware of cancer detection. The only possibility to educate them was after
examination. We want to emphasis the initial role of rectoscopy in the diagnosing
process. In some cases the preparation for the examination was very bad – so the
examination was repeated. After the rectoscopy the patient was sent to lab unit to
perform the examination of the stool. The feces occult blood test was perform to
further diagnostic process. If any doubts during that diagnostic process occurred
(positive FOBT for example) the patients were send immediately to colonoscopic
examinations. The patients stayed in follow-up several months after procedure. The
procedure was performed in ambulatory unit.
CONCLUSIONS
The most often observed hemorrhoids were diagnosed in II stage. (F- 50%, M
59,3%). Defecation rate – 90% of women (63 F) and 87.04% of male (47 M) defecate every day (one or several times). The sitting toilet time – in female (39 F) –
55,71%; in male (35 M) – 64.81% was up to 5 minutes. Sport activity – in female
(26) – 37.14% and in male (21) – 38.88% described as up to 2 hours a week; 20
women (27.02%) and 19 men (35.18%) declared 1-2 hours a week. Tv/computer
sitting – below 2 hours – in women (20) – 28.57 % and in male (10) – 18.51. the
time 2-4 hours in female (20) – 28.57% and in male (20) – 37.02%.
LIMITATIONS
The patients can’t describe the duration of defecation precisely (they do not observe the time). The sport activity difficult to analyse – standard activity (medium)
two times a week 30 minutes. The duration of watching tv and computer working –
the patients answers include the time spent at work (not precisely). The groups were
small. The season of the year was not taken into consideration.
REFERENCES
1. Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, Bonatti H:
The vascular nature of hemorrhoids. J Gastrointest Surg, 2006, 10, 1044-1050.
2. Alonso-Coello P, Mills E, Heels-Ansdell D, Lopez-Yarto M, Zhou Q, Johanson
JF, et al. Fiber for the treatment of hemorrhoids complications: a systematic
review and meta-analysis. Am J Gastroenterol. 2006;101(1):181–188.
3. Bielecki K., Dziki A. (red): Proktologia. Wyd Lek PZWL. Warszawa 2000.
4. Bochenek A., Reicher M.: Anatomia człowieka. PZWL Warszawa 1992.
170
Bohdan Gworys
in that subject
5. Chauhan A, Thomas S, Bishnoi PK, Hadke NS: Randomized controlled trial to
assess the role of raised anal pressures in the pathogenesis of symptomatic early
hemorrhoids. Dig Surg. 2007, 24, 28-32.
6. Delco F, Sonnenberg A. Associations between hemorrhoids and other diagnoses.
Diseases of the colon and rectum. 1998;41(12):1534–1541.
7. Deutsch AA, Moshkovitz M, Nudelman I, Dinari G, Reiss R: Anal pressure
measurement in the study of hemorrhoid etiology and their relation to treatment.
Dis Colon Rectum, 1987, 30, 855 – 857.
8. Fox A, Tietze PH, Ramakrishnan K: Anorectal conditions: hemorrhoids. FP
Essent. 2014, 419, 11-19.
9. Ganz RA: The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol. 2013, 11, 593-603.
10. Haas PA, Fox TA, Haas GP: The pathogenesis of hemorrhoids. Dis Colon Rectum. 1984, 27, 442-450.
11. Haas PA, Fox TA Jr: Age related changes and scar formations of perianal connective tissue. Dis Colon Rectum. 1980, 23, 160-169
12. Johanson JF1, Sonnenberg A: The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990, 98, 380-386.
13. Layer P., Rossien U: Gastroenterologia praktyczna. Elsevier Urban & Partner.
Wrocław 2013.
14. Loder PB, Kamm MA, Nicholls RJ, Phillips RK: Heamorrhoids: pathology,
pathophysiology and aethiology. Br J Surg. 1994, 81, 946-954.
15. Lohsiriwat V: Hemorrhoids; from basic pathophysiology to clinical management. World J Gastroenterol: 2012, 7, 2009-2017.
16. Marciniak T.: Anatomia prawidłowa człowieka. PZWL Warszawa 1964.
17. Moore KL., Dalley AF., Agur AMR.: Clinically oriented anatomy. Lippincott
Williams&Wilkins Baltimore 2010.
18. Mounsey AL, Halladay J, Sadiq TS: hemorrhoids. Am Fam Physician 2011, 15,
204-210.
19. Peery AF, Sandler RS, Galanko JA, Bresalier RS, Figueiredo JC, Ahnen DJ,
Barry EL, Baron JA: Risk factors for hemorrhoids on screening colonoscopy.
PLoS One, 2015 25, e0139100.
20. Poskus T, Buzinskienė D, Drasutiene G, Samalavicius NE, Barkus A, Barisauskiene A, Tutkuviene J, Sakalauskaite I, Drasutis J, Jasulaitis A, Jakaitiene A:
Heamorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG 2014, 121, 1666-1671.
171
21. Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, Stift A: The
prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012, 27, 215-220.
22. Sardinha TC1, Corman ML:
82(6):1153-1167.
Hemorrhoids. Surg Clin North Am. 2002,
23. Shafik A: Role of warm bath in inducing micturition in postoperative urinary
retention after anorectal operations. Urol Int. 1993, 50, 213-217.
24. Sun Z, Migaly J: Review of Hemorrhoid Disease: Presentation and Management.
Clin Colon Rectal Surg 2016, 29, 22-29.
25. Teramoto T, Parks AG, Swash M: Hypertrophy of the external and sphincter in
haemorrhoids: a histometric study. Gut. 1981, 22, 45-48.
26. Zindel J, Inglin R, Brügger L: Necessary and unnecessary treatment options for
hemorrhoids. Ther Umsch. 2014, 71, 737-751 (article in German.
STRESZCZENIE
124 osoby (70 K, 54 M) w wieku od 16 do 94 lat, średnia 52.9±17.57 lat dla kobiet i
od 23 do 82 lat dla mężczyzn, średnia 50.92±17.04 lat. Osoby te, zgłaszające się do
badania rektoskopowego poproszono o wypełnienie krótkiej ankiety dotyczącej nawyków związanych z oddawaniem stolca oraz aktywności sportowej i ilości czasu spędzanego dziennie na oglądaniu telewizji lub przed komputerem. Jednocześnie po badaniu
analizowano wspólnie z pacjentem odpowiedzi na pytania ankiety i dawano zalecenia
dot poruszanych zagadnień. Zbierano podstawowe dane fizykalne – waga i wzrost. Dokumentowano zaawansowanie choroby żylakowej odbytu. Nie stwierdzono obecności
żylaków odbytu u 1 kobiety, natomiast u 1 kobiety stwierdzono zaawansowanie III/IV
stopień. Przeważali pacjenci z II stopniem zaawansowania żylaków – wśród kobiet było
to 35, a mężczyzn 32. Najtrudniejsze do zmiany w zakresie nawyków było – wg pacjentów - oddawanie regularne stolca, zamiana papieru toaletowego na podmycie oraz zmiany w zakresie aktywności sportowej.
ABSTRACT
124 persons - 70 women and 54 men aged from 16 through 94 years (female),
mean 52.9 yrs±17.57, and from 23 through 82 years (male), mean 50.92 yrs±17.04
examined with rectoscopy were asked to fulfill the short questionaire. The questions
were concerned with defecation habits and sport activities and time spend by tv or computer. After the examination the education was conducted. The basic demographic data
were collected. The advance of the hemorrhoids was established. In 1 female normal
state was diagnosed, in 1 the III/IV. The II stage of hemorrhoids was diagnosed in 35
female and 32 male. This stage was prevalence. According the patients the most difficult
to change was regular defecation, and changing the washing after defecation instead of
toilet paper. The increase in sport activity was difficult to reach.
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Patients` chosen hygienico-customary habits

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