When Hemorrhoids Hit Like the Titanic – A Disaster We Don't See Coming

The Hidden Catastrophe of Hemorrhoids

While commonly dismissed as a minor inconvenience, hemorrhoids represent one of the most underestimated health problems globally — much like the Titanic was seen as unsinkable until disaster struck.

Up to 50% of the population over 50 experience symptoms (NIH, 2020).
️Only 4% seek timely care due to embarrassment or misdiagnosis.
Late care leads to thrombosis, anemia, prolapse, or chronic pain.
Standard treatments emphasize symptom suppression over root causes.

Why the Titanic Analogy Matters

Like the iceberg that tore through the Titanic, the real danger of hemorrhoids lies beneath the surface:

Iceberg Metaphor	Hemorrhoid Reality
Big & Serious	Symptoms may escalate from itching to severe bleeding and prolapse if left untreated.
Un-anticipatable	Episodes can flare unpredictably due to diet, stress, constipation, or lifestyle changes.
Indirect Causes	Poor pelvic support, sedentary behavior, and vascular dysregulation often go unnoticed.

Internal Grade III & IV Hemorrhoids Management

Figure highlights persistent challenges—loss of mucosa and anal cushion, submucous, diffuse, and circular fibrosis, as well as unaddressed hemorrhoids—underscoring their significant impact on advanced hemorrhoid management.

Suboptimal hemorrhoid treatment often leads to recurrence and/or long-term complications. Preserving epithelial barrier integrity is crucial for preventing a cascade of chronic inflammation, fibrosis, and ultimately, stricture formation [27]. Strictures progress slowly, often remaining asymptomatic until advanced stages, making it challenging to study early pathological events.

Loss of anal cushions: Leads to compromised air and water-tight seals and anal lip functionality (e.g., EH, LHP, Sclero, and SH) [12].
Loss of Mucosa: Results in sensory deprivation and fibrosis (e.g., EH) [28].
Diffuse Fibrosis: Impairs ease of defecation [5] – predisposes to recurrent fissures (e.g., EH) [22].
Submucous Fibrosis: Causes fixed mucosa, sensory loss, and recurrent fissures (e.g., LH and Scl) [24].
Circular Fibrosis: Often seen in SH, it compromises rectal accommodation [6].
See – DOI: 10.5772/intechopen.1009663

Effective Solutions: Finding Your Path to Relief

Control or cure: A persistent dilemma in hemorrhoid management
Existing treatments often face a trade-off between control and potential cures (Figure 3), with high recurrence rates or/and complications. Excisional techniques may cure but cause significant pain and fibrosis, while less invasive methods provide relief yet often result in recurrence [29]. .

This dilemma stems from prioritizing immediate symptoms over long-term function and prevention of recurrence [30] Too many methods: A double-edged sword in hemorrhoid management
Hemorrhoid management involves various treatments, such as EH, RBL, DH-HAL, IRC, HLP, Scl, LHP, SH, and STARR, each offering distinct benefits. However, the dilemma of selecting the right approach acts as a double-edged sword [30].
DOI: 10.5772/intechopen.1009663

5PF: The Lifeboat in Misguided Waters

Conventional treatments like banding or laser may harm more than heal.

Preserves anatomy and continence
Reduces distensibility without damage
Minimizes recurrence
Patient-tailored approach

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📢 Conclusion: Let’s Not Repeat the Titanic Mistake

Ignoring this problem because it's hidden or taboo is a disaster in slow motion.

5PF offers a proactive and preventive solution — before complications sink in.