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Everything About Piles - It's Symptoms & Treatment

Piles or haemorrhoids are basically swollen veins around the anus or in the lower rectum. They occur internally (within the rectum) or more commonly; externally (outside the rectum). A fairly common disease with around fifty percent of all adults reportedly experiencing some form of symptoms before the age of fifty, India reports about twenty million cases a year. Piles can cure on their own within two weeks in most cases and are treatable through a host of options; ranging from medication (even Ayurvedic) to surgery (in case the case is severe). Piles do not pose a threat to life. 

Medical experts are divided over the exact cause of piles but fairly agree on a few causes such as over exertion during bowel movement, persistent constipation, long stints on the toilet seat and familial predisposition to piles. 

The symptoms range from extreme pain and difficulty while sitting, unrelenting itchiness around the anus, a painful and irritating lump (cyst like) near the anus, faecal leakages, painful stool and bowel movement, bloody stool. Internal piles do not cause discomfort generally and bleed painlessly during bowel movement. They become problematic in case there is heavy bleeding or if they pop out (prolapse). External piles develop blood clots (called thrombosed haemorrhoids) which can cause severe itching and pain; this can be done away with through fairly simple treatment called a “drainage and incision” procedure. 

Even though simple measures like a well-balanced, high fibre diet accompanied by consuming about four to five litres of water or taking stool softeners are enough to treat the symptoms; at times piles can cause complications. For instance, external piles can develop painful blood clots called thrombosed haemorrhoids. Internal piles may move through the anus and protrude from the anus, these are called prolapsed haemorrhoids. Both prolapsed and thrombosed haemorrhoids can develop further infections that might require surgical removal. 

There are certain factors that increase the risk of developing piles. They can be genetically passed down from one generation to the next, children whose parents have had piles are more likely to have them at some stage in their lives. Strain on the body plays a major role, for instance if there is constant lifting of heavy objects in the gym or at work; the chances of developing piles are higher. Obesity also exerts strain on the body and is known to cause piles. People who stand for long spells of time without seating themselves in the middle or those who have prolonged diarrhoea or partake in anal intercourse are at increased risk. Pregnancy also increases the risk of developing piles as the uterus is enlarged and naturally exerts more pressure on the vein in the colon, causing it to protrude. 

Diagnosis can be done simply by visually examining the area around the anus to check for any bulging cyst like formations. Thereafter, a doctor may conduct further tests to reveal any other abnormality inside the anus; this is called a Digital Rectal Exam. A lubricated and gloved finger is used to probe and seek any swelling within the anus. A Sigmoidoscopy may be conducted in case any abnormalities are discovered, this is done using a tiny fibre optic camera called a Sigmoidoscope, which is inserted via a small tube. 

Treatment for piles can be done at home and naturally at a clinic or hospital. Home remedies include using simple over the counter medicines like haemorrhoid creams and hydrocortisone which ease the itching and spin piles cause. A warm water sitz bath may be prepared to soak the anus for ten to fifteen minutes in order to bring relief and comfort. Good hygiene, ample amounts of water and a high fibre diet will also help. The swelling caused by piles can also be reduced by applying a cold compress to the area. Pain relief medicines like ibuprofen or acetaminophen can help in stemming the pain caused by piles. 

Medical procedures will be needed in case home remedies fail. A rubber band ligation, wherein a rubber band is placed around the haemorrhoid; is used to cut off circulation and in turn shrink the haemorrhoid. This is the most common and simple procedure for doing away with haemorrhoids but must be done only by a medical professional. In case ligation doesn’t work or is not an option; sclerotherapy may be used, this involves injecting a chemical into the blood vessel directly, causing it to shrink. 

Treatment options are conventional haemorrhoidectomy by open and closed methods – Stapler haemorrhoidectomy & Laser haemorrhoidectomy

In some cases, piles are recurrent and never truly get cured. Prevention is the best option naturally. Some things to keep in mind: 

- Do not strain too hard during bowel movement or sit too long on the toilet. 

- Increase fibre (oats, bran) and water intake, have loads of vegetables like carrots. 

- Regular exercise will keep constipation at bay.

- Do not wait to use the toilet if bowel pressure is developing; go as soon as possible.

Dr. Nikhil Yadav
Senior Consultant
General and Minimal Access Surgery

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