Hemorrhoids|Piles.

Piles also called hemorrhoids is a condition where the blood vessels in the anal canal and the lower rectum become swollen and inflamed and at times rupturing giving rise to presence of blood in the stool.  Basically, this is a varicose condition of the veins of the rectum and the anal canal.  Piles is seen in about 4% of  the  population  commonly between the age of 45 to 65 years.

External Piles|External Hemorrhoids.

External hemorrhoids or external piles are the piles that occur outside the anus. Here the symptom is more of pain and itching than bleeding. This occurs in the veins that drain the area supplied by the inferior rectal artery. Sometimes, the vein ruptures and a blood clot forms. Such a hemorrhoid is called a Thrombosed Hemorrhoid.

Internal Piles or Internal Hemorrhoids.

Internal hemorrhoids are those which occur inside the rectum. These occur in the veins that drain the area of the superior rectal artery. They are painless as there are no pain sensors in this area.  You may not know that you are having internal hemorrhoids till you see blood in the stools.

Prolapsed hemorrhoids.

If untreated, the internal hemorrhoids  may prolapse outside the rectum, in which case they are called prolapsed hemorrhoids.

Strangulated hemorrhoids.

Sometimes, the anal sphincter may go into spasm and the blood supply to the prolapsed hemorrhoids may get cut off.  This condition is called strangulated hemorrhoids.

According to the severity, the Internal Hemorrhoids  have been graded in the following way.

Grade 1 Hemorrhoids.

This is the initial stage, where the swollen and the inflamed blood vessels are inside the rectum.

Grade 2 Hemorrhoids.

In this stage, the hemorrhoids or piles protrude outside the anus during passing of the stools. They however, retract on their own.

Grade 3 Hemorrhoids.

In this stage the piles that have protruded outside the anus and do not go back on their own after passing the stools. They have to be pushed back manually.

Grade 4 Hemorrhoids.

Here the piles stay prolapsed and cannot be pushed back manually.

Picture  showing internal and external Piles

Causes of Hemorrhoids|Causes of Piles.

• Low fiber diet.
• Chronic constipation  which forces one to strain during passing of stools.
• Hereditary trend.
• Increase in abdominal pressure due to some pathology.
• Pregnancy and Hemorrhoids. In Pregnancy, there may be pressure on the returning veins. This causes the rectal veins to become engorged. After the delivery, the piles may recede.
• Advancing age.
• Obesity and Hemorrhoids. The excess fat and the increased weight causes additional pressure on the anal muscles causing them to weaken and sag.
• Prolonged sitting hours.

Symptoms and Signs of  Hemorrhoids|Symptoms of Piles.

• Itching around the anus.
• Rectal Pain more so in external hemorrhoids or strangulated internal hemorrhoids.
• Bleeding Hemorrhoids.  There is bleeding during passing of the stools. The stools may be lined with blood or there may be passing of stream of frank red blood.
• A feeling of incomplete evacuation.
• In external hemorrhoids, a lump may be felt around the anus.
• Anemia results due loss of blood.
• There is generalized weakness as a result of anemia.

Hemorrhoids Treatments.

Your attending doctor will know what to do best. Here are a few options for treatments for hemorrhoids.

1) Dos and Dont’s for Hemorrhoids.

• What to eat when you have hemorrhoids. High fiber diet consisting of  green vegetables, fruits, whole grains and cereals. High fiber diet prevents constipation and facilitates easy evacuation of the bowels.
• Drink plenty of water – 4 to 5 liters per day if there no contraindications. Read Benefits of Drinking Water to understand its importance
• Sit on the toilet seat only till necessary.
• If chronic constipation is present, mild laxatives are advised till necessary.
• If anemia has developed due  to blood loss, iron medication is advised.
• Avoid alcohol.
• Avoid fried and spicy foods.
• Avoid tea, coffee and carbonated drinks.

2) Conservative  Treatment for hemorrhoids or Piles.

• Hemorrhoids creams or suppositories that contain phenylephrine or steroids are available. Phenylephrine  constricts the blood vessels. Steroids reduce that inflammation. The role of such topical creams is limited.
• Sitting in a tub of warm water gives relief by relaxation of the anal sphincter.

3) Surgery  for Hemorrhoids or Piles.

Surgery for hemorrhoids is resorted to when the conservative treatment has not given  relief even after one month and in 3^rd and 4^th degree hemorrhoids.

• Rubber band ligation for hemorrhoids: In this procedure, elastic bands are applied,  at the right area above the inflamed hemorrhoids. The blood supply to hemorrhoids is cut off. The inflamed blood vessels wither and fall off.
• Sclerotherapy for Piles: Here sclerosing agents such as phenol are injected into the hemorrhoid, which causes the blood vessels to collapse and shrivel up.
• Cauterisation of the hemorrhoids with electro cautery or radiation is also an effective method.
• Hemorroidectomy is a surgical operation in which the affected hemorrhoids are excised. Recovery normally takes 2 to 3 weeks.
• Stapled  hemorrhoidectomy is generally less painful and the patient recovers faster. It  involves removal of soft tissue above the dentate line thereby stopping the blood supply to the hemorrhoids.

Next: How to Prevent Piles.

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