Piles Treatment , Types, Causes&Symptoms

Piles, often known as Hemorrhoids, are engorged veins that hang down and emerge from the anus. This is a fairly common disease that affects millions of people around the world. It causes excruciating pain and burning when passing feces. There may also be blood streaks in the stools. Diet and lifestyle modifications can help with piles. Your surgeon may recommend non-surgical treatment methods such as sclerotherapy, banding treatment, and coagulation, or surgical treatment options such as hemorrhoidectomy, depending on the piles' size and grade.

Hemorrhoids, or piles, are swollen veins that are formed inside and outside your anus and rectum. The veins around the anus are present to provide better sphincter control. They ensure that there is no involuntary passage of stools. With age, these veins become lax and lose their tone leading to dilatation and pooling of blood. These heavy, engorged veins hang out through the anus and are called piles. Lifestyle factors such as obesity, lack of physical activity, eating a lot of processed food, and not drinking enough water are some causes of piles. 

Piles appear as small, discolored lumpy structures. In severe cases, you can see them hanging from your anus. Piles are prominent and visible after a bowel movement. Most of the time, they can be pushed back inside. If they cannot be pushed back, you need to visit your doctor and get them treated. Piles cause extreme pain, discomfort, and burning during and after stools. Blood streaks on the stools are also a common symptom of people having piles.

Piles can be of two types External and internal.

• External piles: These are piles that develop towards the outer end of the anal canal, under the skin of your anus. They are extremely painful, especially if the blood inside them clots.
• Internal Piles: These are formed inside the anal canal, but they start hanging down, reaching all the way to the anus. They are graded based on their ability to be pushed back inside.
  • First Degree piles are just under the skin of your anus; they bleed but do not come out of the anus.
  • Second Degree piles come out of the anus when there is a bowel movement, but they go back inside on their own.
  • Third Degree piles come out when you pass stools but must be manually pushed back.

Fourth Degree piles do not recede. They always hang out of the anus and can cause complications.

Piles happen when the veins around your anus and rectum are dilated. This dilation leads to the veins hanging out from the anus. The dilation of the veins can happen due to several reasons-

• You have to strain a lot when you go to the toilet- chronic constipation and diarrhea can affect the veins in the anal canal and make them lax.
• You are aging- with age, the anal canal weakens, so piles are very commonly seen in old people.
• You have a history of piles in your family- this increases your risk of developing piles.
• You have a chronic cough that has failed to respond to treatment- this causes pressure on the anus, leading to the development of piles.
• Incorrect methods of exercising and lifting heavy objects- these can put undue pressure leading to the development of piles.
• You are pregnant- pregnancy causes constipation, which in turn can lead to piles.
• You are obese- an increase in weight puts increased pressure on the anus while standing, sitting, etc., leading to piles.
• You suffer from diseases like Polycystic ovarian syndrome (PCOS), which is associated with piles.
• You have a very unhealthy lifestyle where you eat a lot of junk food- this causes an increase in weight which causes the development of piles.
• You do not exercise - a sedentary lifestyle leads to the development of piles.
• You do not drink enough water- this causes constipation, leading to piles.

Internal piles do not cause many symptoms except when they prolapse. You might occasionally see streaks of fresh blood on the stools or the toilet paper. 

If you have external piles, you will notice the following-

• Hard lumps in the anal area 
• Difficulty and pain while sitting down
• Itchy anus
• Severe pain while passing stools
• Burning while passing stools that lasts for a long time after stools.
• Bleeding from the anus is seen as streaks of blood in the pot, on the paper, or on the stools.
• A slimy discharge from the anus that itches and wets your underpants
• Feeling that you have not emptied your bowels fully after passing stools

Piles are diagnosed based on the history you provide and the tests that your doctor performs. These include:

• Digital Rectal Examination: This is a test where the doctor inserts a finger into your anus to check for piles. A lubricating gel and a topical anesthetic will be used to reduce the pain.
• Sigmoidoscopy: A special tube fitted with a camera is used for this purpose. The doctor uses this instrument to view the lower part of your colon and rectum.
• Colonoscopy: The surgeon performs a detailed examination of your colon to rule out other conditions. Like a sigmoidoscope, a colonoscope is inserted into the anus to view the entire colon.

Blood tests: These are suggested mainly to check for anemia resulting from blood loss due to piles.

Piles can be treated at home with a few changes in diet and lifestyle. Some medicines help you with the symptoms of piles. When these methods fail, you may need to seek medical help. Piles are initially treated with non-surgical procedures. Surgery is used in severe cases of piles.

Self-help At Home: A few changes in your diet and lifestyle can help you deal with piles.

• Eat a high-fiber diet.
• Drink lots of water
• Avoid processed food and junk food.
• Opt for simple, home-cooked food with fresh veggies with high fiber content.
• Keep active. 30 minutes of some form of exercise daily is a must.
• Do not strain at stools, and also do not spend a lot of time sitting idle on the toilet.

Medications For Piles: Some medications help you deal with the symptoms of piles. These must be purchased upon a doctor’s prescription only. 
The medications for piles include.

• Fiber supplements help to bulk up the stool content so you don't have to strain a lot
• Laxative to help you with constipation.
• Soothing creams and ointments that contain anesthetic agents like lidocaine help to relieve the pain and burning due to piles.
• Corticosteroid-containing creams and suppositories that help with the swelling and pain

Non-surgical Treatment Of Piles: These are minor procedures that are done on an outpatient basis. You can go home the same day after the procedure. These include.

• Rubber Band Ligation- This procedure involves putting a rubber band around the pile. This cuts off the blood supply to the pile and falls off after a week. The area left behind heals naturally.
• Sclerotherapy Injections- This procedure involves injecting a sclerosant into the tissues at the base of the piles. This solution causes the development of scar tissue at the base of the piles. The blood is rerouted to healthy veins. The diseased vein shrivels and falls off after a week.
• Photocoagulation- In this procedure, an infrared light beam is used to cut off the blood supply to the veins. This causes the vein to shrink in size.
• Diathermy and Electrotherapy- This method uses heat to destroy the piles.

Surgical Treatment Of Piles: Surgery is recommended in fourth-degree external piles that are extremely painful. Complications like strangulation and necrosis also call for surgery.

• Hemorrhoidectomy- This is a surgical procedure done under general anesthesia. It is an outpatient procedure; you can go home the same day. The procedure involves making small incisions in the anal area to access the hemorrhoids. These veins are then cut off using scalpels or scissors. Sometimes, laser therapy may also be used. This is a painful procedure, and it takes about 4 weeks to recover fully.
• Stapled Hemorrhoidopexy- This procedure is done under general anesthesia or a spinal block. The surgeon uses a circular staple gun fixed to the tissue around the base of the pile. The staple gun and the piles are then pulled up and stapled in place. This procedure pulls the piles into the anal canal and their blood supply. As a result, they no longer protrude outside the anus and eventually shrink and fall off.
• Hemorrhoidal Artery Ligation- This is an invasive procedure done under general anesthesia. The procedure involves locating the small arteries supplying the hemorrhoids. This is done under ultrasound guidance. Once the arteries are located, they are tied up in a procedure similar to rubber band ligation. Devoid of blood supply, the piles die and fall off.

Laser Piles Surgery- This is a minimally invasive laparoscopic procedure that uses laser beams to cut off the piles. The surrounding healthy area is not affected. The procedure can be done in under 30 minutes. Surgeons and patients prefer this method as it is relatively painless and has a faster recovery time. 

Chronic piles that have been ignored and not treated can lead to the following complications-

• Skin tags- These are formed when the insides of the pile shrink, leaving behind the skin.
• Ulcers- External piles often get swollen and inflamed. The Constant friction can lead to the development of ulcers.
• Mucus discharge- The constant oozing of a sticky, foul-smelling discharge from the anus can make the skin around it very itchy and sore.
• Strangulations- When the piles hang down, they can get twisted and entangled, leading to loss of blood supply. This is a painful condition called strangulation.
• Thrombosis- The blood inside the piles can sometimes form clots. This is called thrombosis and is an extremely painful condition.

Piles can be prevented by lifestyle and dietary changes. The goal is to avoid constipation and keep the stool soft so that it is passed without pain. Here is what you can do to prevent piles-

• Eat a healthy, balanced diet.
• Avoid spicy and oily foods.
• Include a lot of green, leafy vegetables like spinach and broccoli. These vegetables contain a lot of natural fiber that bulks up your stool and ensures a smooth passage.
• Eat fruits rich in nutrients like vitamin C and fiber
• Drink adequate water. Include fresh juices, buttermilk, coconut water, and soups. 
• Avoid processed food. Any ‘ready-to-eat’ food that comes out of a packet is harmful to your health. Junk like pizza, burgers, and candies should be avoided completely.
• Exercise regularly. Obesity is one of the main causes of piles. A minimum of 30 minutes of daily exercise helps to shed extra kilos and keeps you fit. It prevents constipation, thus preventing piles too.
• Do not sit on the toilet for too long. 
• Avoid straining while passing stools.
• Go to the toilet when you feel the urge. Do not hold back the stools.
• Frequent sitz baths help to relieve the pain around the anus. Sitz bath is a procedure where you must sit in a round tub filled with warm water. 

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