Piles (Hemorrhoids)

A phenomenon where the blood vessels in the anus become swollen and the bulge is known as piles. 

The swelling is created due to strenuous bowel movement which irritates the vein walls of the anus. Laser Hemorrhoidoplasty (LHP) is an approach used for the treatment of advanced hemorrhoids under local, general or spinal anesthesia. 

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What are piles (Hemorrhoids)?

Piles or Hemorrhoids are swollen veins in the anus or lower rectum. The condition is similar to varicose veins. 

The symptoms of hemorrhoids are experienced by 50 percent of adults, by the age of 50. It has been difficult to identify the exact cause of hemorrhoids. 

Hemorrhoids may develop inside the rectum (internal hemorrhoids) or around the anus (external hemorrhoids). 

However, there are plenty of efficient treatment alternatives, allowing people suffering from them to get relief with home remedies and lifestyle modification.

What are the causes of piles?

Hemorrhoids are caused by increased pressure in the lower part of the rectum. Under pressure the veins around the anus bulge or swell leading to the formation of hemorrhoids. Factors contributing to increased pressure in the lower rectum are as listed below:

  • Diet with low fiber.
  • Obesity
  • Pregnancy, once the uterus increases in size to accommodate the baby, putting pressure on the veins in the colon.
  • Constipation 
  • Chronic diarrhoea.
  • Having to put excessive pressure during bowel movements.
  • Prolonged sitting on the toilet seat.
  • Lifting heavy objects regularly.
  • Regular anal intercourse.
  • Family history: Genetically passed from parents to children.
  • Long hours of standing, without regular sitting breaks.

What are the different types of piles and what are their symptoms?

Piles or hemorrhoids can be classified into 3 main types - External piles (external hemorrhoids), Thrombosed piles (Thrombosed hemorrhoids) and Internal piles (Internal hemorrhoids).

External hemorrhoids: These are formed under the skin surrounding the anus and have the following symptoms-

  • Soreness or itchiness around the anus.​
  • Dull ache and uneasiness. 
  • Swelling on the skin around the anus.
  • Bleeding in severe cases.

Thrombosed hemorrhoids: A condition in which blood accumulates in external hemorrhoids and coagulates (thromboses); it can lead to:

  • Inflammation​
  • Swelling
  • Hard lump near the anus.
  • Severe pain

Internal hemorrhoids: These are formed inside the rectum. They can't be seen or felt and generally do not cause discomfort. However, passing stools can aggravate and cause:

  • The affected area to bleed without causing any pain. Bloodstained stools or blood on the toilet paper while cleaning the area.​
  • A prolapsed or protruding hemorrhoid forced through the anus, producing irritation and pain.

One should visit a doctor should any of the above symptoms show up. However, rectal bleeding is not exclusively because of hemorrhoids. Moreover, other causes such as other diseases, including anal cancer and colorectal cancer should be eliminated.

How is piles diagnosed?

The diagnoses begin with an evaluation of the symptoms described by the patient. This is followed by a physical examination (digital examination), where the doctor inserts a gloved and lubricated finger in the anus to feel any abnormalities in the internal structure of the rectum. 

External hemorrhoids (External piles) can be seen, evaluation is generally needed for the internal hemorrhoids (Internal Piles).
A Sigmoidoscopy may be recommended, should the doctor feel any abnormality in the structure of the rectum on physical examination. Or, sometimes the internal hemorrhoids (Internal Piles) are too soft to be sensed by digital examination. 
In such cases, a sigmoidoscope (also called the proctoscope or anoscope) is used. It is a small fiber-optic camera that fits into a small tube. 
This is inserted into the anus to the rectum to get a clear view of the rectum and colon harboring internal hemorrhoids (Internal Piles) and decide the course of treatment.

What are the treatment options for piles (hemorrhoids)?

Based on the stage and the type of piles, the doctor may recommend either medical line of treatment or surgical line of treatment. Medical line of treatment include medication that can be consumed orally or ointments to be applied around the affected area. 

Non-surgical treatment for piles:

The doctors may recommend simple home remedies such as:

  • Warm water bottle for external hemorrhoids to relieve pain.
  • Ointments, creams (hydrocortisone or hemorrhoid cream) or rectal medicated suppositories. 
  • Over-the-counter fiber supplements to soften the stools.
  • Cold-compress on the anus to aid reduce swelling.
  • Pain killers such as aspirin or acetaminophen.

Surgical treatment for piles:

Only when home remedies fail, the doctors may choose to perform surgical procedures:

Rubber band ligation: The doctor places a rubber band around the hemorrhoid to cut out blood circulation to it. As a result, it shrinks and can be removed. It is a procedure performed by doctors only, and should not be attempted at home.

Sclerotherapy: It is used as an alternative to rubber band ligation when the latter is not an option for the patient. The doctor injects a chemical into the blood vessel, resulting in the shrinking of hemorrhoids.

Hemorrhoidectomy: A minimally invasive surgery, Hemorrhoidectomy is further classified in three types:

  • Conventional Hemorrhoidectomy​
  • Stapled Hemorrhoidectomy
  • Hemorrhoidal Artery Litigation
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