Piles (haemorrhoids)

About Piles

Piles also known as haemorrhoids,is a very common problem among adult population. Piles normally present as painless bleeding per rectum especially after passing motion. Anyone with passage of blood per rectum should see a surgical specialist. This is not to miss a cancer lurking in the rectum or colon. Severe degree of piles protrude from the rectum and sometimes need to be manually pushed back. Protruding pile masses will require surgical treatment. Smaller piles may get cured with injection sclerotherapy or piles banding. Piles surgery can be performed by stapler technique, harmonic scalpel, Doppler guided hemorrhoidal artery ligation etc..and all these procedures are essentially day care operations. Piles (haemorrhoids) are enlarged blood vessels that you can get inside or around your anus. They’re usually small, round, discoloured lumps. You might be able to feel them on your anus or hanging down from your anal canal. Your anal canal is the short, muscular tube with blood vessels that connects your rectum (back passage) with your anus. It’s completely normal to have blood vessels in your anus – they have an important role to play in continence. But piles are when they get enlarged, which can cause symptoms.


How does piles occur?

Haemorrhoids are masses, clumps, cushions of tissue full of blood vessels, support tissue, muscle and elastic fibers in the anal canal. Piles are haemorrhoids that have become inflamed. Internal haemorrhoids form when blood vessels inside the rectum become swollen and engorged. External haemorrhoids can occur due to increased pressure caused by obesity, pregnancy, sitting or standing for long hours at a stretch, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do strenuous physical labour.


Symptoms

  • You might notice small amounts of bright red blood in the toilet
  • Itching or irritation in your anal region
  • Swelling around your anus
  • A lump near your anus, which may be sensitive or painful

There are two types of hemorrhoids:

Types fo piles

Internal Hemorrhoids

These lie inside the rectum. You usually can't see or feel these hemorrhoids, and they rarely cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid's surface and cause it to bleed.

Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.

External Hemorrhoids

These are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed.


What causes hemorrhoids?

Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which interfere with blood flow to and from the area, causing it to pool and enlarge the vessels. This also explains why hemorrhoids are common during pregnancy, when the enlarging uterus presses on the veins. More recent studies show that patients with hemorrhoids tend to have a higher resting anal canal tone — that is, the smooth muscle of the anal canal tends to be tighter than average (even when not straining). Constipation adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter muscle. Finally, the connective tissues that support and hold hemorrhoids in place can weaken with age, causing hemorrhoids to bulge and prolapse.

Self-help for piles

Sometimes piles can be improved by making a few changes to your diet and lifestyle. There are a number of things that you can do to help.

  • Eat a high-fibre diet to help make your poo softer and easier to pass. This will help to reduce the pressure on the veins in your anus caused by straining when you have a bowel movement. Learn more about fibre and which foods to eat to up your fibre intake.
  • Drink enough fluids to keep hydrated but don’t have too much caffeinated ones like tea and coffee.
  • Try not to strain when you’re going to the toilet. Afterwards, gently clean around your anus with water and pat the area dry.
Diet changes such as increasing fibre and drinking enough fluids are known to help. Lots of people wonder if eating spicy foods makes their symptoms worse. However, there isn’t any scientific evidence to suggest this is the case, so you shouldn’t need to start cutting things out of your diet, unless your doctor advises you to. It’s good to keep active and get your recommended amount of physical activity each day. There might be some activities that may make your symptoms more noticeable such as cycling; so, you may want to switch to something else for a while if you notice this. Generally, though, physical activity is good for your health and shouldn’t make your piles worse.

Treatment of piles

It can be uncomfortable if you have piles and it’s understandable if they make you feel a bit self-conscious. They might have an effect on other areas of your life, such as your sex life if your piles hang out or you have some discharge. But try not to worry – the symptoms usually get better within a month and the piles shrink back, although they might come back. In the meantime, there are plenty of treatments that can relieve your symptoms. If you have mild intermittent bleeding from piles, changing your diet and lifestyle to prevent constipation may be all that you need for things to get better. See our Self-help section above for more information.

Medicines for treating piles

There’s a range of medicines that can help to relieve the symptoms of piles. Ask your pharmacist for advice and always read the patient information leaflet that comes with your medicine.

  • If you’re passing hard poo, a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxative such as lactulose will soften it.
  • Over-the-counter painkillers, such as paracetamol, may help to ease any pain from piles. Don’t take painkillers that have an opioid in them (like codeine), as these could make you constipated.
  • Soothing pile creams, ointments and suppositories may ease any pain and itchiness. There are lots of different products available over the counter. Some contain a local anaesthetic such as lidocaine.
  • Products that contain corticosteroids, such as Anusol HC and Proctosedyl, may reduce swelling and pain. Don’t use these for more than a week as they can damage the skin around your anus. Most are available over-the-counter and others on prescription.
  • It can sometimes take up to a month for self-help measures and medicines to work. If your symptoms don’t improve after this time, contact your GP. They may refer you to a specialist.

    Non-surgical treatments for piles

    Piles will usually go away on their own but if they don’t, you might need to have a procedure to deal with the problem. There are some treatments that you’ll need to go into hospital for as an out-patient. This means you can have the treatment and go home the same day.

    • Banding. In this procedure, your doctor will put a small elastic band around the pile, which will reduce the blood supply. This causes the pile to die and fall off after a week or two. The area left behind will heal naturally.
    • Sclerotherapy. Your doctor will inject an oily solution into your piles, which makes them shrivel up.
    • Bipolar diathermy and direct current electrotherapy treatment. In this procedure, your doctor will use an electrical current to destroy the pile.
    • Your doctor will let you know the benefits and risks of each procedure and which is the best option for you.

      Surgery for piles

      Most people don’t need an operation to treat piles. But if you still have symptoms of piles and other treatments haven’t worked, or your piles keep bleeding, it might be an appropriate option for you. There are different types of surgery for piles, which include the following.

      • Haemorrhoidectomy – this is a surgical procedure to remove piles if they’re causing problems.
      • Stapled haemorrhoidopexy – in this operation, your surgeon will attach the area of tissue with piles higher up your anal canal and staple it in place. Your piles then won’t come out your anus anymore and will shrink.
      • Haemorrhoidal artery ligation operation (known as HALO). During this procedure, arteries in your anal canal are stitched closed to limit the blood supply to your piles. Sometimes an ultrasound probe will be used to help find your arteries and guide your surgeon during the procedure. Experts aren't yet sure how well this procedure works.
      • In shyamal hospital we take care of your problems and we have best treatment for your piles problem.

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