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Piles (Hemorrhoids)

Category(s): Anorectal Disorder

Overview

Synonyms :



Piles are swollen blood vessels of the rectum. The hemorrhoid veins are placed in the lowest area of the rectum and the anus. Occasionally they swell so that the vein walls become thin, stretched, and irritated when a person has bowel movements. Even though they may be very unpleasant and painful but can be easily treated and are very preventable. 

Internal piles (hemorrhoids) lie down enough inside the rectum which a person may not see or feel them. They do not generally hurt because there are only some pain-sensing nerves in the rectum. Bleeding may be the only sign if they are there.

Sometimes internal piles (hemorrhoids) prolapse, or enlarge and project outside the anal sphincter. When this happens, a person may be able to see or feel them as moist, pink pads of skin which are pinker than the surrounding area. Prolapsed piles (hemorrhoids) may hurt because the anus is dense with pain-sensing nerves. They generally go back into the rectum on their own. If they don't, they may frequently be quietly pushed back into place.

External piles (hemorrhoids) lounge within the anus. They are generally painful. If they move or prolapse to the outside (usually when a person has a bowel movement), he/she may see and feel it. Blood clots sometimes form within prolapsed external piles (hemorrhoids), leading a very painful condition known as a thrombosis. If that occurs, the piles (hemorrhoids) may turn blue or purple, and could probably bleed.

Despite its look, it is typically not serious, apart from the pain. It will go away in a couple of weeks and the doctor may remove it if the pain is unbearable.

The number one cause of anal bleeding are piles (hemorrhoids) and are rarely dangerous. About 75 percent of people will have piles (hemorrhoids) at some point in their lives. Piles (hemorrhoids) are most common among adults ages 45 to 65. Piles (hemorrhoids) are also common in pregnant women.

Cases / year in India : More than 10 million cases per year (India).

Symptoms

Symptoms of piles (hemorrhoids) include:

  • Itching or irritation in the anal area.
  • Bleeding generally painless. The patient can notice red on the toilet paper or in the toilet bowl.
  • Lumps protruding from the anal region.
  • Discomfort and pain in the anal region.
  • A lump near the anus, this may sometimes be sensitive.
  • Swelling in the anal region.
  • Feces may leak (without your wanting it to happen).
  • Internal piles (hemorrhoids) generally have no symptoms
  • External piles (hemorrhoids) are more likely to present with pain.

Causes

Causes of haemorrhoids are:            

When the veins around the anus or in the rectum are enlarged or engulf with blood, the patient has piles (hemorrhoids).

They may happen for the following reasons:

  • Aging
  • Pregnancy
  • Chronic constipation
  • Chronic diarrhea
  • Anal intercourse
  • Sitting for long periods (mainly on the toilet)
  • Genetics: Some people inherit a tendency to develop piles (hemorrhoids)
  • Obesity

Diagnosis

Doctor will observe anal area, by inserting a lubricated gloved finger or an anoscope (a hollow, lighted tube) or a proctoscope.

More test may be required to rule out internal piles (hemorrhoids) or other ailments that frequently cause anal bleeding, like colitis, Crohn's disease, anal fissure and colorectal cancer.

To see more into the anal canal following techniques are used:                                                              

  • Sigmoidoscopy may be used, or    
                                                                                                                                         

Colonoscopy: To view the entire colon.                                                                                                        

  • In both techniques, a flexible, light viewing tube is inserted into the rectum.  
                                       
  • A barium X-ray: It can also show the outline of the entire colon's interior.                                        
    In this procedure, firstly a barium enema is given, then X-rays are taken of the lower gastrointestinal tract.

Treatment

In majority of cases, simple measures will alleviate symptoms while the problem gets better on its own. However, medicines and even surgery may sometimes be needed.

Medicines:

Most piles (hemorrhoids) medicine are OTC; they include ointments, pads, or suppositories. Such active ingredients as hydrocortisone and witch hazel are known to relieve itching and pain. These medicines should not be used for more than about 7 days (unless the doctor has said otherwise).

Simple incisions:

A doctor may carry out a simple incision if a clot has formed around an external hemorrhoid. These incisions are usually effective. More continuous bleeding may require rubber band ligation, sclerotherapy (injection), or coagulation.

Hemorrhoid surgery:

  • Specialist ultrasonic device for hemorrhoid surgery.
  • Surgery to treat piles (hemorrhoids)
  • Surgery is recommended if the patient has not benefited from the simple procedures, or if the piles (hemorrhoids) are very large.
  • In some cases, the patient may go home straight after the procedure, while in others they may have to be hospitalized.
  • Surgery may involve hemorrhoidectomy (complete removal of the piles (hemorrhoids) or stapling, where part of the intestine is stapled to reduce the chance of prolapse
Home remedies for piles (hemorrhoids)

Although there are ways to relieve symptoms, they will not eliminate the piles (hemorrhoids).

Topical creams and ointments: OTC creams or suppositories which contain hydrocortisone. There are also pads which contain witch hazel, or a topical numbing agent.

Bathing the affected area: Bath gently with warm water. Do not use soap. Dry the area gently with a hair drier after bathing.

Ice packs and cold compresses: Applying these to the affected area may help with the swelling.

Sitz bath using warm water: The sitz bath is placed over the toilet. Some pharmacies sell them. These may relieve the burning or itching symptoms.

Moist towelettes: Dry toilet paper may aggravate the problem.

Analgesics: Some painkillers, such as aspirin, ibuprofen, and acetaminophen may alleviate the pain and discomfort."

Latest Treatment

Doctors most commonly prescribe analgesics, such as acetaminophen, ibuprofen, or aspirin to alleviate the pain or discomfort. Some recent advancement in the field of hemorrhoid treatment includes:

  • Fibre supplements such as psyllium and methylcellulose soften the stool.

  • Doppler guided hemorrhoid artery ligation and hemorrhoid lift are some recent techniques, used to treat hemorrhoids. Doppler guided hemorrhoid artery ligation is the only hemorrhoid surgery without cutting painful nerves.