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Hemorrhoids

What is hemorrhoids?

Hemorrhoids, also known as Piles, is a common anorectal condition where – there are swollen veins in the lower part of the rectum, which are affecting millions of people, both men and women at any age around the world, and represent a major medical and socioeconomic problem, where-in symptomatic enlargement and distal displacement of the normal anal cushions is observed.

What are the causes of hemorrhoids / piles?

Various causes of hemorrhoids / piles are as follows:

Chronic constipation
Chronic diarrhea
Lifting heavy weights
Pregnancy
Straining when passing a stool
Genetics

Signs & Symptoms

Internal hemorrhoids signs and symptoms include:

Usually painless - not richly supplied by nerves (above dentate line)

Bleeding (splash in pan)

Prolapse

Perianal itching & irritation – due to mucoid discharge

External hemorrhoids signs and symptoms include:

Pain or discomfort- area is richly supplied by nerves

Itching or irritation in the anal region

Swelling around the anus

Bleeding

What are the complications that hemorrhoids / piles will lead to?

Hemorrhoids piles complications include:

Anal Fissures: Straining during bowel movements due to Hemorrhoids / piles can lead to small tears in the lining of the anus.

Strangulation: Internal hemorrhoids have the potential to prolapse and may get trapped outside the anal opening causing cut off of blood supply, which is an emergency condition.

Anemia: Iron-deficiency may eventually result from chronic bleeding of Hemorrhoids.

How to diagnose hemorrhoids / piles?

Your healthcare provider will examine you, ask about your symptoms and evaluate you.
External hemorrhoids / piles can be diagnosed by checking the area around the anus.
To diagnose internal hemorrhoids / piles, your doctor will perform a digital rectal examination. During this, your doctor inserts a gloved and lubricated finger into your rectum and may perform procedures like anoscopy, sigmoidoscopy, or colonoscopy to look inside the anus and the rectum. Each of these tests involves using a small camera to diagnose any abnormalities in your anus, rectum, or colon.
An anoscopy examines the inside of the anus, a sigmoidoscopy examines the last 2 feet of the colon, and a colonoscopy explores the entire colon.

How to treat hemorrhoids / piles?

Conservative Management of hemorrhoids / piles:

Sitz bath: - Soak the anal area in warm water for 10 to 15 minutes, at-least two or three times a day.
Eating plenty of fibre (for example, fruit, vegetables, cereals, wholegrain bread, oats etc.)
Drink lots of fluid, except alcohol and caffeine should be avoided.
Avoid medicines that cause constipation.
Go to the toilet as soon as possible after feeling the need to defecate.
Do not strain on the toilet.
Regular exercise.

Medical Management of hemorrhoids / piles:

Several medicinal options are available along with conservative measures like:

Medications include painkillers, ointments, creams, and pads, and can help soothe redness and swelling around the anus.
Flavonoids: Help to reduce the symptoms of piles like bleeding, pain, swelling, itching and irritation.
Corticosteroids: These can reduce inflammation and pain.
Laxatives: Laxatives may be used if a person with piles suffers from constipation, which will help to pass the stools more easily with reduced pressure on the lower colon.

Surgical Management of hemorrhoids / piles:

When all the other managements fail to control piles or hemorrhoids then various surgical options are available which your doctor might suggest depending on the type and severity of hemorrhoids / piles:

Rubber band ligation: - Is a procedure in which the hemorrhoids is tied off at its base with rubber bands, cutting off the blood flow to the piles, i.e. hemorrhoids. After a few days, the hemorrhoids falls off.
Sclerotherapy: Involves an injection of a solution (generally a salt solution) directly into the vein causing piles i.e. hemorrhoids to collapse and shrink. This is effective for grade II and III hemorrhoids.
Infrared coagulation: Infrared light coagulation is a device i.e. used as a heat source to quickly coagulate, or clot, vessels supplying blood to the hemorrhoids
Hemorrhoidectomy: In grade III & IV the hemorrhoidal tissue that is prolapsed and causing bleeding is surgically removed by various ways under anaesthesia.
Stapled Hemorrhoidectomy: Hemorrhoidal tissue is lifted into a ring of tissues with sutures and a stapler removes the hemorrhoids, effectively cutting off blood flow to the tissue