Piles

Piles are one or more small swellings that can occur inside and around the anus or the anal canal due to the engorged veins and the overlying tissue.

Externalpilesare painful and occur in the lowerpart of the anal canal. Internal piles are generally painless and occur above a point 2-4 cm inside the anus in the upper part of the anal canal. Internal piles can further be classified into following grades depending upon their size and severity :

⦿ Grade 1 are small swellings that cannot be seen or felt from outside the anus.
⦿ Grade 2 are larger and may partly pushout from the anus on toilet and go back inside again.
⦿ Grade 3 are one or more small, soft lumps that hang from the anus and can be pushed back inside the anus with a finger.
⦿ Grade 4 permanently hang down and cannot be pushed back inside.

In most of the cases piles are not very serious and go away on their own after a few days.An individual with piles may experience the following symptoms :

⦿ A painful swelling or hard lump may be felt around the anus
⦿ Bright red blood after a bowel movement
⦿ Feeling of full bowel even on defecation
⦿ Anal itching and irritation
⦿ Mucus discharge when emptying the bowels
⦿ Tenderness or pain while defecating
⦿ Red and sore anal area

A doctor first asks some questions and then performs physical and anal examination to diagnose piles. This will be followed by a digital rectal examination (DRE) or use a proctoscope to see the anal canal and take a small tissue sample from inside the rectum, for lab analysis.

To see further into the anal canal, a sigmoidoscopy or colonoscopy may be performed. A barium X-ray can also be performed to view the entire interior colon.

Majority of cases of piles resolve on their own without any treatment by doing some lifestyle changes like increased intake of fibre, losing weight and being physically active etc. Treatment is required to reduce the discomfort and itching in many patients. The symptomatic treatment for piles may include the following:

⦿ Laxatives to treat constipation
⦿ Ointments, creams, pads and other OTC medications to soothe the redness
⦿ swelling around the anus area.
⦿ Pain killers to reduce pain

In cases where piles affects the quality of life of a patient, following treatment options may be selected by the doctor depending upon patient requirement:

⦿ Banding The prolapsed hemorrhoids are often removed by placing a rubber-band ligation at the base of the pile inside the anus to cut off its blood supply. After few days the hemorrhoids fall off.
⦿ Sclerotherapy The hemorrhoids are shrinked by injecting a medicated solution.
⦿ Infrared coagulation The hemorrhoid tissue is burnt by a device.
⦿ Diathermy and electrotherapy The haemorrhoids are destroyed using an electrical current.
⦿ Haemorrhoidal artery ligation The haemorrhoids are shrinked by ligating the small arteries that supply blood to the piles.
⦿ Surgery It is performed particularly for large piles of grades 3 or 4 and can be
⦿ Hemorrhoidectomy is an an operation to cut away the haemorrhoid(s)
⦿ Hemorrhoid stapling is the procedure to cut out a circular section of the lining of the anal canal above the piles that will eventually shrink the piles.
⦿ Laser haemorrhoidectomy employs laser energy to heat the vein. This leads to collapse and disintegration of haemorrhoids.

More effective than open surgical haemorrhoidectomy
⦿ Relatively shorter treatment time
⦿ Relatively painless procedure
⦿ Relieves the patient discomfort
⦿ Patient can return to normalcy in a few days time
⦿ Lesser chances of infection