Piles or haemorrhoids

Piles is the common term for haemorrhoids, a condition of swollen veins in and around the anus and/or lower rectum. It generally affects men and women aged between 45-65 years. Globally, the incidence rate ranges from 50-80%.

Internal haemorrhoids
These are present inside the rectum and are difficult to spot. They usually hurt less as there are fewer pain-sensing nerves inside the rectum. The only symptom in such cases is bleeding. In case they prolapse or enlarge, they can protrude outside the anus and can be seen/felt. They are moist, pink pads of skin. Prolapsed haemorrhoids may hurt while sitting or if they are irritated.

External haemorrhoids
External haemorrhoids are present in the skin around the anus. They often cause discomfort to the patient. Blood clots can also form inside prolapsed external haemorrhoids resulting in an extremely painful condition called thrombosis. These look purple/blue and can bleed. In case of unbearable pain, surgical intervention might be required; however, in most cases, the condition resolves itself in a week.

Haemorrhoids are pillow-like clusters of veins that are present beneath the mucous membrane lining the lower part of the rectum and anus. When these veins become inflamed and distended, it results in a painful and uncomfortable condition called piles (or simply haemorrhoids).

It is caused due to additional strain on the veins which can occur as a result of constipation, prolonged sitting on the toilet, strained bowel movements and excess strain during pregnancy. The muscles supporting the haemorrhoids can also weaken with age, causing them to bulge and prolapse.

Age: Age is a significant risk factor for piles. This is possibly due to the weakening of the muscles which support haemorrhoids, causing it to prolapse.
Pregnancy: During pregnancy, the enlarged uterus can press down on the anal region resulting in piles.
Diet: Following a low fibre diet can result in constipation and difficult bowel movements which is a significant cause of piles.

Complications of piles

If left untreated, piles can cause several complications such as anaemia, blood clot and strangulated haemorrhoid (an extremely painful condition).

Diagnosis of piles
Haemorrhoids are usually diagnosed from a simple medical history and physical exam. Your doctor might perform a digital rectal exam to check for bloody stool. Your doctor might also examine the anal canal with an anoscope. In some cases, colonoscopies might be performed to confirm the diagnosis or rule out other conditions such as colorectal polyps or cancer.

Treatment of piles
Common medical treatments for piles or haemorrhoids are:

• Rubber band ligation: A constrictive band is placed around the haemorrhoids to make them fall off.
• Sclerotherapy: Your haemorrhoids would be shrunk by injecting a liquid into them.
• Infrared coagulation: The blood supply to the haemorrhoids would be cut off with the help of an infrared light
• Haemorrhoidectomy: Your haemorrhoids would be surgically removed.
• Stapled haemorrhoidopexy: The haemorrhoids are stapled back inside the anus.
• Haemorrhoidal artery ligation: The blood supply to the haemorrhoids are cut off with the help of stitches.
• LASER piles surgery: The haemorrhoids are shrunk and removed with strong infrared laser beams.