Understanding Piles (Haemorrhoids)

Causes and Treatments Explained

Discover the underlying causes of Piles (Haemorrhoids) and explore effective treatment methods to manage and prevent it.

Understanding Piles (Haemorrhoids)

Piles (haemorrhoids) are a common condition worldwide. They affect people of all ages but are more prevalent in adults aged 45 to 65 years. The exact prevalence varies across regions and populations.

What is Piles (Haemorrhoids)?

Piles, also known as haemorrhoids, are a prevalent condition affecting both men and women of all ages. They result from prolonged pressure on the veins, often due to factors like constipation, straining during bowel movements, or persistent diarrhea. Genetic predisposition and pregnancy-related pressures on the pelvis can also contribute to their development in women. Lifestyle choices play a significant role as well. For comprehensive information on piles treatment options and various surgical procedures, continue reading this article.

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Symptoms of Piles (Haemorrhoids)

The symptoms of piles, or haemorrhoids, can vary depending on the type and severity of the condition. Common symptoms include:

  • Painless Bleeding: One of the most common symptoms is bright red blood on the toilet paper or in the toilet bowl after a bowel movement.
  • Pain or Discomfort: External haemorrhoids may cause pain, especially during bowel movements or when sitting. They can also itch or become irritated.
  • Swelling and Lump: A painful swelling or lump around the anus may indicate external haemorrhoids. Internal haemorrhoids can also protrude through the anus and cause discomfort.
  • Itching or Irritation: Haemorrhoids can cause itching and irritation in the anal region, particularly with external haemorrhoids.
  • Discomfort or Pain during Bowel Movements: Straining during bowel movements can worsen symptoms of haemorrhoids, leading to pain or discomfort.
  • Mucous Discharge: In some cases, internal haemorrhoids may cause a mucous discharge from the anus.
  • Feeling of Incomplete Bowel Movements: You may feel like your bowel movements are incomplete, even after using the toilet.
  • Prolapse: Severe cases of internal haemorrhoids may result in their protrusion or prolapse through the anus, which may require manual reduction.
  • It’s important to consult a healthcare provider if you experience persistent bleeding, pain, or other symptoms suggestive of haemorrhoids, as they can provide appropriate diagnosis and treatment recommendations.

Causes of Piles (Haemorrhoids)

Piles, also known as haemorrhoids, develop when the veins around the anus or lower rectum become swollen and inflamed. The exact cause of piles is not always clear, but several factors contribute to their development.

The primary causes of piles (haemorrhoids) include:

  • Straining during Bowel Movements: Putting excessive pressure on the veins in the rectal area during bowel movements can lead to swelling and inflammation.
  • Chronic Constipation: Difficulty passing hard, dry stools due to constipation can cause straining, further increasing pressure on the rectal veins.
  • Prolonged Sitting or Standing: Long periods of sitting or standing can elevate pressure on the veins around the anus and rectum, contributing to the development of piles.
  • Pregnancy: Increased abdominal pressure during pregnancy, along with hormonal changes, can predispose women to developing piles.
  • Obesity: Being overweight or obese can exacerbate pressure on the veins in the lower rectum and anus, increasing the likelihood of piles.
  • Age: The incidence of piles tends to rise with age, possibly due to weakened tissues supporting rectal veins.
  • Family History: A genetic predisposition may increase the likelihood of developing piles if there is a family history of the condition.
  • Chronic Diarrhoea: Persistent diarrhoea can irritate the rectal area, potentially leading to the formation of haemorrhoids.
  • Lifestyle Factors: Lack of physical activity, a low-fibre diet, and inadequate fluid intake can contribute to constipation, which in turn increases the risk of developing piles.

It’s important to note that while these factors can increase the likelihood of developing piles, not everyone with these risk factors will necessarily develop the condition. Taking preventive measures such as maintaining a healthy diet, staying hydrated, exercising regularly, and avoiding prolonged sitting or straining during bowel movements can help reduce the risk of developing piles.

Understanding Piles (Haemorrhoids) Health

It’s essential for individuals experiencing symptoms of piles to seek medical advice for appropriate diagnosis and management to prevent these complications.

Risk & Complications of Pile (Haemorrhoids)

  • Bleeding: One of the common complications of piles is bleeding. This can occur during bowel movements when the swollen veins in the rectum or anus are strained or irritated. Blood may appear on toilet paper or in the toilet bowl.

  • Pain and Discomfort: Piles can cause varying degrees of pain and discomfort, especially during bowel movements or when sitting for extended periods. External piles, in particular, can be painful if blood clots form within them (thrombosed piles).

  • Prolapse: In severe cases, internal piles may protrude outside the anus (prolapse) during bowel movements or while sitting. This can lead to difficulty pushing them back in and may require medical intervention.

  • Itching and Irritation: Piles can cause itching and irritation around the anus due to the mucus discharge associated with them.

  • Infection: External piles, especially when thrombosed (containing blood clots), can increase the risk of infection. Symptoms may include increased pain, redness, swelling, and discharge.

  • Strangulation: Occasionally, internal piles can become trapped outside the anus and lose their blood supply (strangulated piles). This is a serious condition requiring immediate medical attention as it can lead to tissue death (necrosis).

  • Anal Fissures: Chronic straining associated with piles can lead to the development of anal fissures (tears in the lining of the anus), which can cause pain and bleeding during bowel movements.

  • Incontinence: Severe cases of piles can affect the anal sphincter muscles, potentially leading to difficulty controlling bowel movements (fecal incontinence).

  • Psychological Impact: Chronic piles can affect quality of life due to pain, discomfort, and embarrassment, impacting daily activities and psychological well-being.

  • Recurrence: Without proper treatment or lifestyle changes, piles can recur or become chronic, requiring ongoing management to prevent complications.

Classification of Piles (Haemorrhoids)

Piles can be categorized as internal or external. Internal piles are further classified into grades:

  • Grade I: No protrusion from the anus.
  • Grade II: Protrusion through the anus during straining or defecation, retracting spontaneously.
  • Grade III: Protrusion through the anus with defecation or straining, requiring manual reduction.
  • Grade IV: Protrusion that cannot be manually reduced.

Getting Rid of Piles (Haemorrhoids)

How to Diagnose Piles (Haemorrhoids)

The diagnosis of piles (haemorrhoids) typically involves a combination of medical history review, physical examination, and sometimes additional tests to confirm the presence and severity of the condition. Here’s how it is diagnosed:

  • Medical History: The doctor will inquire about your symptoms, including any pain, bleeding during bowel movements, itching, or discomfort in the anal region. They may also ask about your bowel habits and any previous medical conditions related to the digestive system.
  • Physical Examination: This involves a visual inspection and a digital rectal examination (DRE). During the DRE, the doctor gently inserts a lubricated, gloved finger into the rectum to feel for any lumps or abnormalities in the anal canal and lower rectum. This helps determine the size, location, and severity of the piles.
  • Proctoscopy or Anoscopy: In some cases, the doctor may perform a proctoscopy or anoscopy to directly visualize the inside of the rectum and lower part of the colon. These procedures involve using a thin, flexible tube with a light and camera (proctoscope or anoscope) inserted into the rectum for closer inspection.
  • Sigmoidoscopy or Colonoscopy: If internal piles are suspected to be higher up in the rectum or colon, a sigmoidoscopy or colonoscopy may be recommended. These procedures use longer, flexible tubes with cameras to examine the entire colon (colonoscopy) or the lower part of the colon and rectum (sigmoidoscopy). They can help rule out other conditions and assess the extent of the piles.
  • Stool Examination: In cases where bleeding is present, a stool sample may be examined to check for the presence of blood and to rule out other gastrointestinal conditions that could cause bleeding.
  • Imaging Tests: Occasionally, imaging tests such as ultrasound or MRI may be used to evaluate the anatomy of the anal canal and surrounding tissues, particularly in complex or severe cases.

Treatment of Piles (Haemorrhoids)

The treatment of piles (haemorrhoids) depends on the severity and type of piles, as well as individual patient factors. Here are the common treatment options:

Lifestyle Modifications:

  • Dietary Changes: Increasing dietary fiber intake through fruits, vegetables, whole grains, and legumes can soften stools and reduce straining during bowel movements.
  • Hydration: Drinking an adequate amount of water helps maintain soft stools and prevents constipation.
  • Avoid Straining: Avoiding prolonged sitting on the toilet and straining during bowel movements can help reduce pressure on the veins in the rectal area.

Medications:

  • Topical Treatments: Over-the-counter creams, ointments, or suppositories containing hydrocortisone, witch hazel, or numbing agents can help relieve pain, itching, and inflammation.
  • Oral Pain Relievers: Non-prescription pain relievers such as acetaminophen or ibuprofen may be used to alleviate discomfort.

Surgical Procedures:

  • Hemorrhoidectomy: In severe cases or when other treatments fail, surgical removal of the piles may be necessary. This procedure is performed under general or regional anesthesia.
  • Stapled Hemorrhoidopexy (Procedure for Prolapse and Hemorrhoids – PPH): This procedure involves using a circular stapler device to remove excess tissue and reposition the remaining tissue to its normal position.

Minimally Invasive Procedures:

  • Transanal Hemorrhoidal Dearterialization (THD): This procedure uses an ultrasound doppler to identify and ligate the blood vessels supplying the piles, reducing their size.
  • Laser Treatment: A laser beam is used to remove or shrink the piles, reducing symptoms.

    The choice of treatment depends on the severity of symptoms, the type and size of piles, and the patient’s overall health. It’s essential to consult a healthcare provider for proper diagnosis and personalized treatment recommendations.

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