Article by Dr. Qazi Arif (currently doing research on treatments of piles)
Piles may not be anybody’s favorite topic of discussion, It is not something most people want to talk about. Even so, they are very common,its difficult to say how many people suffer because most people do not have the correct conception about piles and any pain or bleeding in stool passage is considered by them as piles. It’s only when the pain becomes unbearable and blood loss is more, a person tells to his family members or close friends and approaching to a doctor for proper treatment is probably the last option for them.
Let’s know basics of piles which are also called haemorrhoids.
■What are piles or haemorrhoids?
Hemorrhoids are clumps of swollen veins in the end part of stool passage (anus).
There is a network of blood vessels within the wall of the anal canal. Veins in that network sometimes become engorged and swollen. The engorged veins and the overlying stool passage wall may then form into one or more small swellings, which are actually piles.
The anal canal is the last part of the large intestine and is about 4 cm long. Anus from where faeces come out is connected with the rectum.
The exact cause of piles is unknown but many conditions are there, which help in piles formation.
1. Constipation and Straining at the toilet
It is the most common cause as pressure increases in anus causing the veins to swell.
During pregnancy pressure effects of the baby lying above the rectum and anus, and hormones level change can play a role in piles formation.
The tissues in the wall of the anus may become less supportive with growing age and hence increase the risk of piles.
In some people, there is hereditary weakness of the wall of the veins in the anal region.
People who are obese are likely to develop piles as are those who are constipated, since extra strain is being placed on the veins.
6. Sitting too long at one place.
7. Lifting heavy weights
8. Chronic cough
9. Accumulation of fluid in the abdominal cavity (ascites )
10. Diarrhea has the same effect as constipation.
There are two types of piles.
• Internal piles
• External piles
Internal piles form in the upper part of back passage (anus).They are usually painless because the upper anal canal has no pain nerve fibres. Whereas External piles form in the lower part of the anal canal which may be painful because the lower part of the anal canal has lots of pain nerve fibres, which are very sensitive to pain.
Some people develop internal and external piles at the same time.
■Internal piles can be classified as.
Grade 1 are small swellings and cannot be seen or felt from outside the anus.
Grade 2 are larger. They may be partly pushed out from the anus during defecation, but quickly go back inside again.
Grade 3 hangs out from the anus and needs to be pushed back inside the anus with a finger.
Grade 4 permanently hangs down from within the anus, and cannot be pushed back inside.
■Symptoms of piles
Symptoms are variable. Sometimes there are no symptoms and a person may not realize that he/she has piles.
Painless bleeding through the anus after defecation is the most common symptom. The blood is usually bright red and described as splash in the pan.
A haemorrhoid can hang down outside the anus which can be pushed back inside.
Sticky discharge, some pain, irritation, and itch, fullness in the anus, incomplete emptying after defecation are other symptoms.
If piles get complicated it may cause intense pain.
Hemorrhoids can cause a lot of complications if they’re not treated at the right time. These include:
Excessive bleeding leading to anaemia
Skin tags can develop because of repeated haemorrhoid
■Prevention and Treatment
Success after treatment is generally good. Prevention and medication are adequate for many people. About 10% of people will eventually need surgery.
•Avoid constipation: Constipation can be avoided by increasing fluid and fibre intake. Aim for an intake of 25-30 g of insoluble fibre. If high fibre diet is not helping, then fibre supplement can be considered. Fibre helps to relieve constipation and avoid straining, which both are major risk factors for developing piles. Raw fruits, vegetables, whole-grain cereals, beans, leafy vegetables like spinach (palak), methi and citrus fruits like oranges are rich sources of dietary fibres. Try to keep the stool soft. In addition to eating a high-fiber diet, avoid foods that lead to constipation, refined or processed item can lead to constipation.
• Increase daily fluid intake
Daily water intake should be increased depending on season and location. Though urine volume will increase, but some is passed out in the gut and soften faeces.
•Eat flavonoid rich foods: Flavonoid rich foods like blackberries, blueberries, cherries and citrus fruits increase the strength in the vein hence improves circulation around the anus.
•Use natural stool softners like bananas, figs, dried fruits
•Avoid too much caffeine.
•Avoid smoking and drinking alcohol
Alcoholic drinks can cause the fluids loss from body so may not be so good.
•Good hygiene in the area around the anus may be helpful in providing symptomatic relief and preventing skin inections.
•Straining at stool should be avoided as it can make symptoms worse. For western-style commode user elevating feet a bit with a step stool while sitting for the toilet changes the position of the rectum which may allow for easier passage of stools.
•Sitting too much often leads to piles, to avoid this take the time to get up and walk around. Avoid sitting in toilet for too long as it encourages straining. Don’t read newspaper or avoid mobile use in toilet.
•Exercise reduces the risk of hemorrhoids as it promotes regular and smooth bowel movements and fight obesity.
•Don’t postpone the toilet. Go to the toilet as soon as possible after feeling the need. Postponement will make the stool harder and encourage straining.
•Hydrotherapy or sitz bath: sitz bath can be very effective for symptomatic relief for itchy, inflamed and painful piles.
Method: In a tub with slightly warm water, containing potassium permanganate tablets/povidone iodine solution soak the anus and surrounding area for about 10-15 minutes.
The warm water and salt in it help to relieve congestion, improve circulation and reduce inflammation.
•Ice pack/cold compress: Ice is the most effective treatment for inflammation and swelling. Use ice cube or crush some ice cubes and wrap it in a plastic bag or sheet. Use a wash cloth to cover the plastic bag. Lie on your back in a comfortable position and apply on the anus for about 10 minutes.
•Apply petroleum jelly: Piles patients usually strain during defecation. A lubricating agent like petroleum jelly can help to avoid straining if it is applied over anus before defecation.The above measures will often ease symptoms such as bleeding and discomfort.
•If it is not relieved, then treatment is required.
For Pain and symptom relief simple pain-killers are given to the patients. Ice packs and stool softeners may help to relieve pain.
•Local application of Anaesthetic preparations may reduce pain, burning, and itching. They should be used for only a few days, as they may cause sensitization of the anal skin.
•Laxative medications are generally used to relieve constipation. These medicines either stimulate bowel movements and/or soften the stool. However, using them regularly can affect bowel movement pattern and may worsen constipation.
•In pregnancy women should take care while using any natural remedy for treating piles. Eat healthy, avoid spicy foods and do mild exercise regularly. Consult doctor before using any medications.Piles that occur during pregnancy often get better after delivery.
Treatment depends on the degree of piles and the severity of symptoms.
■Treatment without surgery
• Banding is a common treatment for grade 2 and 3 piles. It may also be done to treat grade 1 piles which have not settled with the measures described above.It is outpatient clinic procedure where the surgeon grasps the haemorrhoid with a grasper, and rubber band is placed at the base. After few days haemorrhoid falls off as blood supply is cut off. The base heals after few days.
Results are very good after banding procedure.
Phenol in oil is injected into the base of the piles. It causes scarring of the base and thus blood supply interrupts. Piles die and shed off.
This newer methods burns and cuts down the blood supply of piles.Other modalities use heat energy or current to destroy piles.
•Haemorrhoidectomy (the traditional operation)
This operation is done under anesthesia where piles are cut surgically. It is the best treatment for piles. Though success rate is very high, it is a painful procedure.
•Circular stapled haemorrhoidectomy
In this procedure with the help of specialized circular stapling gun excision of a doughnut of the mucosa from the upper anal canal. It cuts off the blood supply and pulls up the prolapsed mucosa. It is comparitively less painful and allows quick recovery.
•Haemorrhoidal artery ligation is another procedure where the blood vessel is tied to produce the desired effects.
■The biggest misconception is that hemorrhoid surgery cause loss of bowel control. It’s a myth. Though rarely it may occur sphincter fibres are damaged during operation but if detected earlier, it can be repaired. If at all it is irreparable artificial anal sphincter can be placed, but these are very rare in practice.
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Disclaimer: we do not guarantee any specific results as a result of the procedures mentioned here and the results may vary from person to person. The topics in these pages including text, graphics, videos and other material contained are for informational purposes only and not to be substituted for professional medical advice. Your doctor is the best person to treat you.