Hemorrhoids, anal fissure, and their impact on driving

Hemorrhoids

More than half of the population will suffer at some time symptoms of hemorrhoids and they will use self-medication.

The most common symptom is terminal rectorrhage, that if is maintained, can cause anemia, and prolapse; also, pruritus, perianal burning, anal hypertonia, and pain for acute hemorrhoidal crisis or complication added as thrombosis or fissure.

Hemorrhoidal prolapse with secondary thrombosis can become more complicated with anaerobic infection, necrosis, and ulceration of hemorrhoidal nodes, constipation and fecal impaction secondary to pain.

The prevention of hemorrhoidal symptoms is based on dietary measures avoiding spicy food, alcohol, chocolate, cola drinks, tea, coffee, mint and treating constipation with plenty of liquids, moderate exercise and diet with fiber.

It is advisable not be seated or standing up for a long time in order to prevent hemorrhoidal congestion, hence, the position of the driver in long journeys, for at least two hours seated, damages the haemorrhoids.

Adding to it that the seat contains no cloth, the heat, and perineal sweating will macerate the prolapses causing burning, pruritus, and increased sphincter tone.

The use of NSAIDs and drugs with astringent effects such as anxiolytics, antidepressants and codeine, should be avoided.

It is very important to protect hemorrhoids with fecal bulk increasers such as Plantago ovata. Laxatives should not be used continuously.

Magnesium carbonate and lactulose are useful, because they increase water in the stools by osmotic effect, and in association with fecal bulk increasers have a good action.

Treatment with paraffin oil in acute hemorrhoidal episodes lubricates feces and promotes defecation with less pain, reducing sphincter tone.

Analgesics are mandatory in the treatment of acute hemorrhoidal conditions and, among them, ketorolac trometamol is very useful.

This drug has a platelet aggregation inhibition effect and should not be administered with NSAIDs and ASA, for the increased risk of bleeding. It can in addition cause water retention and edema.

With ketorolac, some patients can suffer somnolence, lightheadedness, dizziness, insomnia, or depression, so at the start of treatment the patients should be warned to maximize their caution when driving.

Other adverse reactions to this drug include anxiety, depression, seizures, headache, reduced ability of concentration, insomnia, paresthesia, nervousness, etc.

The frequent creams for topical anal use often contain corticoids that cause dermal maceration, overinfection, contact dermatitis, skin weakness and difficult healing.

Venotonic drugs with flavonic fraction containing diosmin are increasingly used because they inhibit inflammation, reduce edema and increase venous tone.

Diosmin and troxerutin do not interfere with the ability to drive, though some mild gastrointestinal disorders and headache have been described as adverse reactions.

Patients who cannot control their hemorrhoidal disease with diet-hygiene, postural and medical measures require surgical treatment.

Advice on Hemorrhoids

The patient with hemorrhoids can drive, but should be advised that the seats used for the driver should be padded with cloths and not be made up of leather or plasticized.
In general hemorrhoids are annoying and if the driver is paying much attention to burning, itching and need for evacuating the rectum, he can be distracted while driving.
He should be recommended to attempt to defecate in the morning before leaving home, so that it does not interfere while driving to work.
It is better to get up 10 minutes before and devote time to defecation, with subsequent washing, than driving uncomfortable and with risks.
In long trips, he should stop more frequently, walking and drinking liquids in order to prevent constipation.
He should not hold feces while driving and should be advised to stop for evacuating the rectum when he needs it, thus protecting the hemorrhoids.
Acute hemorrhoidal episodes or their complications such as acute thrombosis or penetrated fissure prevent from driving until the episode has been solved.
The patient undergoing hemorrhoidal surgery should not drive until pain, bleeding, typical post-operative discomfort have subsided, and bowel movements have returned to normal, which usually takes 2-3 weeks.
The patient should respect the periods without driving after surgery, and the expert should advise in this regard.

Anal fissure

It is a common ailment, highly related to episodes of stress, hypertonia of the sphincter that is not relaxed to let fecal bulk pass, and this forces and breaks the anus causing a wound of variable depth.

It is also frequently associated with constipation, hemorrhoids, alcohol abuse and very seasoned food.

Superficial fissures cause burning, pruritus, and mild bleeding when finishing defecation.

Chronic fissures worsening with these anal discomforts cause uncomfortable driving that the patient relives with self-medicated ointments.

Deep fissures cause in the patient such a severe pain, that leads to urgent care and immediate treatment. It can be associated with rectorrhage, general involvement and sometimes, fecal impaction.

Some case requires urgent surgery, with internal sphincterotomy and extraction of the fecaloma.

The treatment of the acute episode is based on a diet without residues with plenty of liquids and paraffin, together with potent analgesics and anxiolytics for one week, then indicating a fiber-rich diet, without irritants and with plenty of liquids, fecal bulk increasers and treatment of constipation.

Patients who do not improve with the prescribed care and have persistent chronic fissure require internal sphincterotomy. The postoperative period is easy, and the patient recovers to drive within two weeks, if there are no complications.

Advice on Anal fissure

The acute episode of deep anal fissure prevents from driving for the severe pain.
The treatment with potent analgesics and anxiolytics the first days, improves the symptoms but causes side effects on driving, such as somnolence in the driver, that should be warned to maximize caution when driving.
The patient with superficial anal fissure can drive, but should be recommended that the driver’s seat is made of cloth, and not of leather or plasticized.
In general. the troublesome anal fissure, and if the driver is paying much attention to his burning, pruritus and the need for evacuating the rectum, can distract from driving.
He should be recommended to try to defecate in the morning before leaving home, so that it does not interfere with driving to work.
It is better to get up 10 minutes earlier and spend some time for defecation with subsequent washing, than to drive uncomfortably and with risks.
In long trips, he should stop more often, walking and drinking liquids to prevent constipation.
He should not hold feces when driving and should be advised to stop in order to evacuate the rectum when he needs it, thus avoiding forcing the anus and deepening the fissure.
The patient should respect the periods without driving after surgery, and the expert should advise in this regard.