TO AVOID PILES KNOW IT WELL
Piles are another term for hemorrhoids. Hemorrhoids are collections of inflamed veins in
the anal canal. Hemorrhoids are masses, clumps, cushions of tissue full of blood vessels,
support tissue, muscle and elastic fibers in the anal canal.
Everyone has hemorrhoids venues cushions. However, when there venues cushions
guarding the anal passage become too big due to inflammation, so that the vein walls become
stretched, thin, and irritated by passing bowel movements, that is when piles develops.
Piles can be broadly classified into two categories: Internal Piles - are located far within
the rectum, and can’t be seen or felt. The only symptom is usually bleeding. External Piles -
are located around the anus right under the skin, where there are many pain-sensing nerves.
They, therefore, hurt as well as bleed.
Piles & Pain
Piles are not much painful; patient develops pain once the piles mass get infected or
thrombosed (Blood clots in the piles mass).
Peri-anal pain and pain post defecation associated with constipation is a feature of
fissure in anus. Fissure in anus can also present as post defecation minimal bleeding
associated with pain.
Other conditions of perianal region with pain are :- perianal abscess, Fistula in Anus (
with infection )
Symptoms
Initially piles does not have any symptoms but depending upon its chronicity. It can
present as a small swelling in the anus detected after defecation to florid bleeding from the pile
mass.
Symptoms depend up on the severing of the disease.
A hard, possibly painful lump may be felt around the anus. It may contain coagulated
blood. Piles that contain blood are called thrombosed external hemorrhoids.
After passing a stool, a person with piles may experience the feeling that the bowels are
still full.
Bright red blood is visible after a bowel movement.
The area around the anus is itchy, red, and sore.
Pain occurs during the passing of a stool.
Mucous discharge from the anus.
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As per the severity of symptoms piles are classified into
a. Grade I: There are small inflammations, usually inside the lining of the anus.
They are not visible.
b. Grade II: Grade II piles are larger than grade I piles, but also remain inside the
anus. They may get pushed out during the passing of stool, but they will return
unaided.
c. Grade III: These are also known as prolapsed hemorrhoids, and appear outside
the anus. The individual may feel them hanging from the rectum, but they can be
easily re-inserted.
d. Grade IV: These cannot be pushed back in and need treatment. They are large
and remain outside of the anus.
Causes
The veins around your anus tend to stretch under pressure and may bulge or swell.
Hemorrhoids can develop from increased pressure in the lower rectum due to:
Straining during bowel movements
Sitting for long periods of time on the toilet
chronic diarrhea or constipation
Obesity
Being pregnant
Having anal intercourse
Eating a low-fiber diet
heavy lifting
Anal intercourse
Aging
Treatments
Piles often clear up on their own .Treatments depends on the severity & degree of pile mas
1 st degree piles
A recent meta-analysis confirmed that fiber supplements moderately improve overall
symptoms and bleeding and should be recommended at an early stage. Other lifestyle
modifications such as improving anal hygiene, taking sitz baths, increasing fluid intake, relieving
constipation, and avoiding straining are used in primary care and may help in the treatment and
prevention of hemorrhoids.
2 nd &3 rd degree piles
Grade two &three of hemorrhoids, needs some kind of surgical intervention sooner or later.
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4 th degree piles
Treatment of grade four internal piles requires prompt surgical intervention especially if
gangrenous tissue is found.
Surgical Interventions
Banding: The doctor places an elastic band around the base of the pile, cutting off its blood
supply. After a few days, the hemorrhoid falls off. This is effective for treating all hemorrhoids of
less than grade IV status.
Sclerotherapy: Medicine is injected to make the hemorrhoid shrink. The hemorrhoid eventually
shrivels up. This is effective for grade II and III hemorrhoids and is an alternative to banding.
Infrared coagulation: Also referred to as infrared light coagulation, a device is used to burn the
hemorrhoid tissue. This technique is used to treat grade I and II hemorrhoids.
Hemorrhoidectomy: The excess tissue that is causing the bleeding is surgically removed. This
can be done in various ways and may involve a combination of a local anesthetic and sedation,
a spinal anesthetic, or a general anesthetic. This type of surgery is effective for completely
removing piles, but there is a risk of complications, including difficulties with passing stools, as
well as urinary tract infections.
Hemorrhoid stapling: Also know as circular stapled rectal mucosectomy. The aim of the
procedure is to reduced the size of internal hemorrhoids by interrupting their blood supply. The
procedure is associated with less post operative pain as there is no perianal wound and retinal
wall above the dentate line is insensitive where mucosal stapling is done. This is simple and
effective methods that result in reduced post operative pain, early recovery and hospital stay.
Doppler guided haemorrhoidal artery ligation: t is performed using a specially designed
proctoscope with an inbuilt Doppler probe that can locate feeding arteries; these vessels are
then ligated using absorbable sutures. Disrupting the inflow to the vascular cushion is thought to
reduce the size of the haemorrhoid. The technique is relatively painless, with minimal morbidity.
Complications
Complications of hemorrhoids are rare but include:
Anemia. Rarely, chronic blood loss from hemorrhoids may cause anemia, in which you
don't have enough healthy red blood cells to carry oxygen to your cells.
Perianal Thrombosis: Incarcerated prolapsed internal hemorrhoid and subsequent
thrombosis characterized by severe pain and bleeding.
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Blood clot. Occasionally, a clot can form in a hemorrhoid (thrombosed hemorrhoid).
Although not dangerous, it can be extremely painful and sometimes needs to be lanced
and drained.
Prevention is better than cure
Eat high-fiber foods. Eat more fruits, vegetables and whole grains.. Add fiber to your
diet slowly to avoid problems with gas.
Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol)
each day to help keep stools soft.
Don't strain. Straining and holding your breath when trying to pass a stool creates
greater pressure in the veins in the lower rectum. Go as soon as you feel the urge. If you
wait to pass a bowel movement and the urge goes away, your stool could dry out and be
harder to pass.
Exercise. Stay active to help prevent constipation and to reduce pressure on veins,
which can occur with long periods of standing or sitting. Exercise can also help you lose
excess weight that might be contributing to your hemorrhoids.
Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase
the pressure on the veins in the anus.
