Piles - causes, symptoms and treatments

Author: Pousali Day | January 25, 2017

Overview:

Piles are scientifically termed as hemorrhoids. These are inflammations that can occur inside and around the anus and the anal canal. The anal canal is the last part of the large intestine which connects the rectum with the anus and is almost 4 cm long. The haemorrhoidal veins are situated in the lowest part of the rectum and the anus. Piles can develop when this blood vessels or tissues becomes swollen, mainly as a result of straining on the toilet. Piles can be painful and bleed if they become ruptured.

Types of Piles

Piles are mainly classified into internal piles and external piles.

Internal Piles

Internal piles develop inside the anal canal, but they might hang down and thus come out of the anus. Internal piles are again classified according to whether they come out of the anus and how far they come out.

·First degree – They would not come out of the anus but might bleed.

·Second degree – They come out of the anus during a bowel movement, but go back inside on their own afterwards.

·Third degree – They come out of the anus and only go back inside when it is pushed inside.

·Fourth degree – They are always partly outside the anus and it cannot be pushed back. It might be very swollen and painful if the blood inside them clots.

External piles

External piles are swellings that occur further down the anal canal, near to the anus. These extremely painful in nature, especially if they have a blood clot in them.

Symptoms of Piles

Piles can be painless or asymptomatic in some cases. The most common symptoms are listed below.

·Bleeding during a bowel movement

·Growth inside or around the anus

·Slippery discharge of mucus from the anus

·Leaking faeces

·Feeling that that bowels have not emptied completely

·Itchy or painful skin around the anus

·Pain and discomfort after a bowel movement

Causesof Piles

Piles are formed when the blood vessels in the anal canal become inflammated. This can occur due to number of reasons, including:

·Increased pressure in the stomach (due to pregnancy or obesity)

·Straining to empty the bowels (in case of constipation)

·Increasing age–Because anal canal weakens along with age

·Prolonged diarrhea

·Long term coughing or sneezing

·Family history of piles

·Regular lifting of heavy objects

·Prolonged sitting or travelling

- Pregnancy and delivery

Diagnosis

The doctor will enquire about the symptoms and start examination.The rectum will be felt by gently inserting a gloved finger into the anus. A proctoscope may also be used to check inside the rectum. A proctoscope is a short, narrow, tube like device.

Treatment

Life Style Changes

Eating a fiber rich diet helps in avoiding constipation which in turn prevents formation of piles.Major sources of fiber include whole grains, cereals, fruits and vegetables. Drinking plenty of fluids and avoiding caffeine helps a lot. Avoid straining during a bowel movement, which may worsen the condition. Moist wipes or baby wipes have to be used to clean around the area. Taking warm baths regularly may relieve some of the symptoms.

Medications

Over-the-counter topical treatments

Different creams, ointments and suppositories are available from pharmacies without a prescription.

Corticosteroid cream

If the inflammation is severe, the doctor will prescribe corticosteroid cream, which contains steroids.

Painkillers

Pain killers such as paracetamol, can help to treat the pain of hemorrhoids. Local anaesthetic can be used to treat painful hemorrhoids.

Laxatives

Mild laxatives such as lactulose help in softening the stool.

Non-surgical treatments

·Banding – The doctor places a small elastic band around the piles, which cuts off the blood supply. This causes the piles to fall off after a few days.

·Sclerotherapy - A medicine is injected to make the hemorrhoid shrink. Thus the hemorrhoid gradually shrivels up.
·Infra-red coagulation or laser treatment - This uses infra-red light to cover the blood vessel above the pile, which causes it to shrink.
·Bipolar diathermy and direct current electrotherapy treatment - This method utilizes an electrical current to destroy the pile.

Most hemorrhoids can be managed using lifestyle interventions and non surgical methods, still some patients will eventually need surgery depending on the severity. There are various types of surgery that can be used to treat hemorrhoids.

Hemorrhoidectomy

A Hemorrhoidectomy is a surgical method to remove hemorrhoids. It is normally performed under general anaesthetic. The procedure involves gently opening the anus so the hemorrhoids can be cut off. Patients will require a week to get recovered from the surgery. Pain may be felt for a week after the surgery which can be controlled with painkillers. Prolonged pain should be reported to the doctor. Having a high fiber diet after surgery is advised to reduce this risk of recurrent piles.

Haemorrhoidal artery ligation

This type of surgery works by decreasing the blood flow to the hemorrhoids. It is usually performed under general anaesthetic. In this method a small ultrasound probe is inserted into the anus. The probe creates high frequency sound waves that allow the physician to locate the vessels supplying blood to the hemorrhoid.

The blood vessel is stitched to block the blood supply to the hemorrhoid, which causes it to shrink over the time. The recovery time after having haemorrhoidal artery ligation is faster compared with other surgical procedures. This is a safe and effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy.

Stapling

Stapling is also known as stapled hemorrhoidopexy. This method is used to treat prolapsed hemorrhoids and is carried out under general anaesthetic. During the operation, part of the anorectum is stapled. It reduces the blood supply to the hemorrhoids, which causes them to eventually shrink. Stapling has a shorter recovery time compared to other techniques and also reported to be a less painful procedure.

Cost of Piles surgery in India depends on the type of surgery performed. The cost ranges from INR 40,000 inclusive of pre and post surgery expenditure. Stapling is slightly costly and ranges to about INR 60,000.You can check the more information about piles surgery cost in India here.

*****