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Piles : Types Symptoms and Treatments

Saturday, September 23rd 2017. | Piles

Piles are a very common condition. Normally there are small clumps of blood vessels, tissues and fibres in the anal canal. These are called haemorrhoids. When these haemorrhoids get inflamed for any reason they enlarge, bleed while passing stool or get painful. They are then called piles.

Piles are caused when the blood vessels in the anus swell up and get inflamed under increased pressure in the rectum and anus. This can be due to chronic constipation, chronic diarrhoea, exertion during passing stools, pregnancy or large tumour in the abdomen, lifting of heavy weights or a sedentary lifestyle.

Piles can form both inside the anus, known as internal piles or outside on the rim of the anal opening, known as external piles. Piles are often not a serious condition and can resolve on their own or with medications. More severe piles require surgery. Piles

A person with piles may feel a hard lump around the anus. It may be itchy and even painful if the pile is thrombosed. There may be pain during passing stools or the passage of some mucus or blood. The sight of the blood can be alarming as it is usually fresh and bright red in colour. There may be itching and heaviness around the anus. The area around the anus may be inflamed and painful.

Internal piles are graded according to visibility. When small piles exist but are not seen they are grade 1 piles. Grade 2 piles are bigger piles which come out of the anal opening on passing stools but go back inside on their own. Piles which hang outside the anus and need to be pushed back with a finger are grade 3 piles. Grade 4 piles hang outside all the time and cannot be pushed back inside by the patient.

External piles appear as small lumps on the edge of the anus. They can be very itchy and if they get thrombosed they can be very painful too. These would need urgent treatment.

Piles are usually easy to diagnose on the history alone. The doctor will enquire about any family history of piles, whether bowel movements have changed recently and whether you have lost weight to rule out any other pathology.

A rectal examination digitally or with the help of a proctoscope will help clinch the diagnosis. If the doctor suspects some other pathology you may be asked to have a colonoscopy. Rubber Band Ligation

In the majority of cases, piles are effectively treated with medications and a change in lifestyle. The medications may include local corticosteroids to reduce inflammation and pain, painkillers such as acetaminophen and laxatives for any ongoing constipation along with stool softeners. Some local creams can help reduce itching, redness and inflammation.

The doctor will also advise a more active life style, a good fluid intake, and a change in diet to keep the stools soft. This will include eating more fiber, such as fruit and vegetables, or switching cereal breakfast to bran.

In grade 2 or 3 piles a procedure called banding can be done. The doctor places an elastic band around the neck of the piles which causes the piles to wither and fall off because of lack of blood supply. The piles may be injected with a sclerosing agent which causes them to shrivel up. Infrared light can also be used to burn up the haemorrhoids. These are all out patient procedures.

In severe cases, the piles may have to be surgically removed under general anaesthesia. This is called haemorrhoidectomy. About 10% of patients with piles eventually require surgical intervention.

Dr. Neera Sanotra

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