THIRUVANANTHAPURAM: Haemorrhoids(Piles) are swellings that develop from the inner lining of the anus and lower rectum (last parts of large intestine). Symptoms range from temporary and mild, to persistent and painful. In many cases, piles are small and settle down without any treatment. If required, there are various effective treatment options which should be decided only after proper evaluation by a surgeon. About half the people may develop one or more piles at some stage. Certain situations that increase the chance of developing piles are: Constipation, Pregnancy, Ageing and Hereditary factors
Types of piles
1. Internal piles:
These form in the anus about 2 to 4 cm above the opening. Their severity and size are classified into grades 1 to 4.Grade 1 are small swellings that cannot be seen or felt from outside the anus. They are common and may not need treatment.Grade 2 are larger and may be partly pushed out of the anus when you go to the toilet, but quickly go back in.
Grade 3 hang out from the anus. You may feel one or more small, soft lumps. However, you can push them back inside the anus with a finger.Grade 4 permanently hang down from the anus, and you cannot push them back inside. They sometimes become quite large. Symptoms can vary. Small piles are usually painless.
2. External piles (perianal haematoma) is less common and is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the piles (‘thrombosed external haemorrhoid’) it can suddenly become very painful and need urgent treatment. The pain is relieved if it ruptures but may bleed for a few days. It then gradually shrinks to become a small skin-tag.
Some people develop internal and external piles at the same time.
Prevention and treatment
- Avoid constipation and straining by keeping the motions soft.
- Eat plenty of fibre such as fruit, vegetables, cereals, wholemeal bread, etc and have lots of fluids to drink. Adults should aim to drink at least two litres (10-12 cups) per day. Most sorts of drink will do, but alcoholic drinks can be dehydrating and are not good. Also intake of spicy foods should be reduced.
- If a high fibre diet and fluids is not helping, you can take bran, or other fibre supplements (‘bulking agents’) such as ispaghula husk, which you can buy at a pharmacy. -Certain painkillers and medicines taken for other reasons are a common cause of constipation and may have to be changed or stopped.
- Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later.
How to get yourself checked?
When the general measured described above don’t work or the symptoms persist or increase you should consult a surgeon. Many times, self treatment or treatment done by ‘quacks’ who advertise magical cures, end up in disaster as they are not qualified to accurately examine you or do such tests.
Are medical treatments available?
Only a qualified doctor should prescribe medicines. Laxatives may be given to soften and quicken the motion. Ointments, creams, and suppositories are also commonly used for short periods. They do not ‘cure’ piles but may ease symptoms such as constipation, discomfort and itch. Very painful protruding piles are uncommon but can be an emergency. The pain may be eased by an ice pack pressed on for 15-30 minutes and strong painkillers may be needed.
1.Outpatient procedures: these include banding, laser, radio-frequency ablation, cryotherapy, infrared coagulation etc.
2.Haemorrhoidectomy (piles operation): An operation to cut away the piles is an option to treat grade 4 piles and sometimes for smaller grade piles not successfully treated by banding or other methods.
3.Stapled hemorrhoidopexy (Stapler surgery): This is the latest and popular procedure nowadays. In this procedure a circular stapling device is used to cut out a circular section of the lining of the anal canal above the piles.
4.Haemorrhoidal Artery Ligation (HAL procedure): In this, the small vessels that supply blood to the piles are identified using a scanner and tied. This causes them to shrink.
After surgery you should avoid driving for one to two weeks, it is advisable to sit in warm baths twice a day and you should avoid constipation by taking a high fibre diet. You may be offered a course of medicines and creams for some days to reduce the discomfort and ease the passage of motions.
Dr Shafy Ali Khan is a Consultant Surgeon at KIMS Hospital, Thiruvananthapuram.
The views expressed by the author are his own.