Piles or Hemorrhoids
Hemorrhoids or piles are swellings containing enlarged blood vessels that are found inside or around the rectum and anus. Hemorrhoids result from increased pressure on the anus.
Risk factors for developing hemorrhoids
The exact cause of hemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause the blood vessels in the rectum and anus to become swollen and inflamed.
Factors predisposing to the development of hemorrhoids include:
- irregular bowel habits (constipation or diarrhoea)
- increased intra-abdominal pressure (prolonged straining)
- a low-fiber diet
- pregnancy: the increased intra-abdominal pressure and the effect of straining at delivery can predispose to the development of piles
- the absence of valves within the haemorrhoidal veins
- aging: as we grow older the body’s supporting tissues get weaker
- being overweight or obese
The pressure causes the normal anal veins and tissue to swell. This tissue can bleed, often during bowel movements.
What are the symptoms?
You may notice the following symptoms:
- Blood in stools
- Pain while defecating
- Painful hard lump in the anus
- Mucus discharge while defecating
- Itching sensation around the anus
- Feeling of fullness in the bowels even after passing a stool
The severity of symptoms vary in patients and depends upon the grading of the piles and the type of piles:
- Internal Hemorrhoids usually present with painless rectal bleeding. If they are large they may emerge outside the anus (prolapse). Most prolapsed hemorrhoids shrink back inside the rectum on their own. Severely prolapsed hemorrhoids may protrude permanently and require treatment.
- External hemorrhoids present with pain in the area of the anus. If a blood clot forms in an external hemorrhoid, it can be very painful (thrombosed external hemorrhoid)
What are the Implications of Piles?
If untreated, hemorrhoids may cause complications such as anemia with resultant generalized weakness from the chronic blood loss during defecation. There is a risk of developing strangulated haemorrhoids where the blood supply of a prolapsed pile gets occluded by the constriction of the anal sphincter.
What are the treatment options?
Lifestyle changes to reduce the strain on the blood vessels in and around your anus is recommended to reduce the risk of hemorrhoids developing or recurring:
- Increase the amount of fibre in your diet through foods like fruit, vegetables, wholegrains, pulses and beans, nuts and oats
- Drink plenty of fluid especially water
- Do not delay going to the toilet as this may make your stools harder and drier, which can lead to straining when you do go to the toilet.
- Avoid medication that causes constipation – such as painkillers that contain codeine
- Lose weight if overweight
- Exercise regularly –it can help prevent constipation and help you lose weight.
Non- surgical procedures
Banding is a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The hemorrhoid should fall off after about a week.
Sclerotherapy: A chemical is injected into the haemorrhoid to shrink it
Coagulation techniques: Laser or heat energy is used to coagulate blood in the internal hemorrhoids and harden them.
Surgery
Surgery may be recommended if other treatments for hemorrhoids don’t work. Surgery carried out under general regional anaesthesia is sometimes used to remove or shrink large or external hemorrhoids.
Hemorrhoidectomy: Hemorrhoidectomy is the surgery to remove hemorrhoids. Conventional hemorrhoidectomy involves gently opening the anus so the hemorrhoids can be cut out. Hemorrhoidal artery ligation: Hemorrhoidal artery ligation is an operation to reduce the blood flow to your hemorrhoids. It involves inserting a small ultrasound probe into your anus that locates the vessels supplying blood to the hemorrhoid. Each blood vessel is stitched closed to block the blood supply to the hemorrhoid, which causes the hemorrhoid to shrink over the following days and weeks. The stitches can also be used to reduce prolapsing hemorrhoids (hemorrhoids that hang down from the anus).
Stapling
Stapling, also known as stapled hemorrhoidopexy, is an alternative to a conventional hemorrhoidectomy. It’s sometimes used to treat prolapsed hemorrhoids.
Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but rather, removes the abnormally lax and expanded hemorrhoidal supporting tissue that causes the hemorrhoids to prolapse downward.
In stapled hemorrhoidectomy, the surgery is done through the anal canal. A circular, hollow tube is inserted into the anal canal. The procedure is done through this tube.
During stapled hemorrhoidectomy, the arterial blood vessels that travel within the expanded hemorrhoidal tissue and feed the hemorrhoidal vessels are cut. This reduces the blood flow to the hemorrhoidal vessels and reduces the size of the hemorrhoids.
The staples are needed only until the tissue heals. They then fall off and pass in the stool unnoticed after several weeks. Stapled hemorrhoidectomy is designed primarily to treat internal hemorrhoids, but if external hemorrhoids are present, they may be reduced as well.
Stapling has a shorter recovery time than a traditional hemorrhoidectomy, and you can probably return to work about a week afterwards. It also tends to be a less painful procedure.
What is the post-surgery care that should be taken?
- You should take the medications and pain killers as prescribed
- Drink plenty of water to avoid dehydration and constipation.
- Have a diet that is high in fibre.
- Use ice packs to relieve the pain and swelling.
- A Sitz bath several times a day will help relieve discomfort.
- You should avoid lifting heavy weights for at least 5 to 7 days.
