Are we becoming a nation of hypochondriacs, getting overly paranoid about our health, or just taking better care of ourselves? Five new draft health technology assessments (HTAs) from the Health Information and Quality Authority (Hiqa) show that twice as many people as before are being referred for gastrointestinal procedures. The number of elective (non-emergency) colonoscopies undertaken in the publicly funded healthcare system increased by 67 per cent between 2005 and 2012, from 39,936 to 66,760.The number of elective endoscopies carried out increased by nearly 44 per cent, from 41,803 in 2005 to 60,038 in 2012.Why is this? Fear of cancer is obviously one reason, yet only 8 per cent of patients over 50 years of age with rectal bleeding have colorectal cancer.
Haemorrhoids (piles) result from the swelling of blood vessels or anal cushions in the lower anal canal. There are two types: external and internal. A HTA on referral thresholds for haemorrhoid procedures has shown that half the Irish population "experience symptomatic haemorrhoid disease at some point in their lives, with the peak incidence of symptomatic disease between the ages of 45 and 65 years".
A majority of symptoms arise from internal haemorrhoids, which can prolapse through the anal canal, leading to bleeding. Haemorrhoids are graded from I-IV based on their appearance and degree of prolapse. The type of treatment depends on the extent of the prolapse and includes rubber- band ligation, injections, open and stapled haemorrhoidectomy and artery ligation surgery.The number of elective haemorrhoid procedures increased by almost 52 per cent between 2005 and 2012, "largely driven by the nearly four-fold increase in rubber-band ligation", the HTA said. A total of 7,704 patients underwent treatment for piles in 2012, at an average cost of €1,028 per patient. For first-degree haemorrhoids Hiqa recommends non-surgical strategies such as increasing dietary fibre (roughage) and avoiding constipation.
Unfortunately, all the extra tests and procedures do not mean we are looking after ourselves better. Piles and other gastrointestinal problems are an inevitable consequence of Irish eating habits. Scientific Recommendations for Healthy Eating Guidelines in Ireland (2011), from the Food Safety Authority of Ireland, recommends that adults eat 25g of fibre or more every day. Studies carried out by the authority found that the average Irish adult eats 15g or less a day and 83 per cent of Irish adults do not eat enough fibre. It is no surprise that so many have piles and other gastrointestinal problems. Many foods are low in fibre so including enough in the daily diet is not easy. Adults need three slices of wholemeal bread (eight grammes of fibre),four tablespoons of baked beans (8.7g), one bowl of stewed prunes (seven grammes), and three tablespoons of brown rice (2.5g) every day, or other combinations of fruit, vegetables and wholegrain – not white – cereals and pastas to reach the 25g daily target. Contrary to popular belief, breakfast cereals have very little fibre, most containing between a third of a gramme and five grammes. Even so-called high fibre brands such as granolas, which look as if they are full of roughage, have only between two and five grammes of fibre.
What are we to make of the huge demand for gastrointestinal procedures, which far exceeds supply? People seem to be relying on technology and medical treatments to solve health problems caused by unhealthy eating. According to Hiqa, at the end of March 2014 there were 331,281 patients on the outpatient waiting list database collated by the National Treatment Purchase Fund. This can't go on. The health system must be reorientated to provide the necessary behaviour-change programmes.
All patients who attend their GP for health problems that can be ameliorated by healthy eating and increased physical activity, including piles, obesity and diabetes, must be offered appropriate support. At the very least, patients with grade I haemorrhoids should have their fibre intake monitored before medical procedures are considered. Although making health and wellbeing changes is not easy, eating more fibre is an easier change to make than most, and it is surely easier than having painful surgery.