Is it all Hemorrhoids or ‘Koh Koh’?

Cancer screening Colon Cancer Colonoscopy Disease Control Erectile Dysfunction Folk Medicine Hemorrhoids

In a recent conversation with an old friend I realized they had medical issues which drove our conversation towards a totally different path. Well this very nice conversation had me going all the way back 35 years ago. This conversation took me back to a bus ride from Accra to Cape Coast from the Tantri station at Kaneshie, Accra. I still remember the many trips from Accra to Cape Coast as a student in boarding school. Traveling with the State Transport buses which were much more comfortable usually spared you the ordeal should I say special experience with the herbal drug peddlers.

Just as the bus is pulling out onto the main road to start the 3 hour journey one of these ubiquitous herbal drug peddlers will join the bus. They usually stand in the small space just behind the driver in the entry way into the bus with their Ghana-must-go bag usually full of various odd creams, powders and concoctions mostly tied up in small plastic bags or paper packets or recycled soda bottles.

On my first few encounters with these peddlers I was almost enthralled at the sheer gift of gab that these sales persons possessed. By my second year in school I realized that many of these guys were mere charlatans. They were sales people who were extremely adept at making everyone on the bus believe they had the ailment that their star drug of the day was supposed to cure.

One particular disease that these salesmen transformed into their most excellent marketing tool was hemorrhoids also called ‘Koh Koh’ in many of our local languages in Ghana. On any such trip an unsuspecting traveler ends up buying some herbal cream, powder or liquid concoction that they claim cures ‘Koh Koh’. The real art of the sale lay in making travelers believe they or their loved ones might be suffering from this ailment. Koh Koh disease (hemorrhoids) which many physicians know to affect the blood vessels of the rectum somehow got claimed by these excellent sales men. Once claimed by these sales persons ‘Koh Koh’ ends up somehow developing limbs and crawls into almost every part of our bodies.

By the time the poor unsuspecting travelers get to Mac Carthy hill or usually the Panbros Salt Factory about 10 miles outside the city center the small traveling community has been transformed!

The middle aged person’s arthritis somehow ends up being caused by Koh Koh.

Koh Koh reluctantly accepts the blame for the unfortunate 30ish lady’s infertility and the waning erections of the many aging men gets blamed on Koh Koh.

These were the days before viagra and its lesser brothers and sisters like cialis and levitra entered the market and took away most of the sales of erection enhancers from these famous charlatans.

I almost forgot to include the all famous story of Koh Koh causing “amamai” phlegm’s, That is always a great selling point since every healthy human has phlegms. Once the salesperson manages to convince his or her audience that having phlegms anywhere was due to Koh Koh sales would shoot up like a rocket. Sooner or later the peddler having saturated the market would get off the bus and look for another unsuspecting group of gullible travelers to prey on.

Sorry for spending almost 3 minutes of your precious time on my experiences with these peddlers. Returning to the purpose of my post. With age and sedentary lifestyle hemorrhoids can easily develop. Mostly symptoms are based on the severity of the disorder. Plain hemorrhoids without any complication are usually painless. They are associated with occasional bloody stools as the dilated vessels develop thin fragile walls that occasionally rupture with bowel motions.

Hemorrhoids can get complicated and develop some clots within them at which point they would start getting painful. Uncomplicated hemorrhoids can usually be managed conservatively. They may resolve without any surgical intervention with just high fiber diets. This can be achieved by including more fruits and vegetables in the diet. Good hydration and exercise that could help reduce the pressure in the hemorrhoidal vessels from chronic constipation or prolonged siting helps. They could get inflamed and at that point your doctor could recommend a short course of steroid cream to apply daily.

Illustration showing internal and prolasped hemorrhoids; photo by WikipedianProlific

Complicated hemorrhoids which could be thrombosed or prolapsed in which case these vessels get so large they could protrude out of the anus. These ones can cause a horrible looking disorder enough to scare any prospective intimate sexual partner if one makes the mistake of undress whilst the lights are still on. These may need a surgeon to take care of. Anyway, I would like to digress here and tell my sexually adventurous readers to take the advice and make sure the light is on when the clothes come off. Many have discovered surprises that curbed their sexual appetites.

Returning to real Koh Koh or hemorrhoids the topic for my article. I would like to advise everyone to discuss any such disorder with their doctors especially for those in their 40s. Colorectal cancer and anal cancers can sometimes present with some bleeding with stools. Nobody wants these to be left unaddressed or addressed too late when treatments outcomes may not be as good.

I would end by saying it is not my plan to disparage real herbal medicine practitioners. I am making an observation of the practices of the herbal peddlers that I experienced in Ghana in the 80s and 90s. If you don’t remember anything from this essay please just remember that if you are older than 45 years please talk to your doctor about colonoscopy and if you are seeing blood in your poop or toilet bowl you need to let a doctor know.

Thank you and shalom !

By Leonard Sowah a physician in Baltimore, Maryland

Feature photo: Circle Bus Station by Joris Darlington Quarshie / CC BY-SA


A physician providing primary medical care to patients across the lifespan