Piles, also known as hemorrhoids is a disease due to swelling or inflammation of the vascular structures in the anal canal. In the normal course, the vascular structures being soft tissues help in controlling the stool. But if they are swollen or inflamed it becomes a hemorrhoid. Piles or hemorrhoids are cushions which are important for continence. The piles canal comprises of blood vessels, soft support tissues, elastic fibers and muscle.
Piles or hemorrhoids are classified into internal and external hemorrhoids. In the case of internal piles blood oozes out during defecation without any pain and there is redness and inflammation of the anus. But there is both pain and swelling at the anus on account of external hemorrhoids. Internal piles is formed in about two to four centimeters of the anal canal close to the anus and external piles is formed around the anus outside and visible.
Internal piles are classified into four types, namely,
– bleeding piles where the tube does not come out of the anus (no prolapse)
– Piles come out of anus during bowel movement but gets back inside afterwards (there is prolapse but reduced spontaneously)
– Piles come out at the time of defecation but go inside only if pushed (prolapse manually reduced)
-Piles coming out of anus cannot be pushed inside and swells and are inflamed. (Prolapse that cannot be reduced even manually)
Cause of Piles
No particular cause is attributed to piles but there are many factors which increases pressure in the abdomen which are responsible for development of hemorrhoids. Consumption of food without fiber and stress during defecation on account of constipation or irregular bowel syndrome are known to be major causes of piles. Stress increases the pressure on the blood vessels and consequent inflammation and swelling.
Some of the other causes of piles are pregnancy, obesity, diarrhea, cancer in the colon, surgery of the rectum, discomfort posture, injury of the spinal cord and sitting unduly longer time while defecating.
Among other causes pregnancy is an important reason for enlargement of the uterus on the anus and rectum. Moreover, during pregnancy, hormonal changes causes weakness of the muscles supporting rectum and anus making them vulnerable to swelling and inflammation.
Key symptoms of Piles
Piles can be without pain and without any symptom. But symptoms do appear, which are:
- Discomfort or pain during and after the bowel movement
- Bleeding while defecating with or without pain
- Faces leakage or mucus discharge from the anus
- Bowels mot emptying fully
- Itch around the anus
Symptoms for piles are also the same as for inflammatory bowel syndrome, anal cancer, bowel cancer and fissures of the anal canal.
Diagnosis of piles is done by a doctor by physical observation through naked eye in the case of external piles and through digital rectal examination (DRE) in the case of internal piles.
Generally piles gets cured on its own without any treatment. No treatment is required as long as there is no symptom. But when the discomfort or itching persists or other symptoms like bleeding are noticed, treatment is required.
Treatment of piles
Treatment of internal piles can be by way of selection of food and hydrating the body sufficiently to avoid constipation and ensure easy bowel movement. The first and foremost remedy for piles is changing the diet. Consumption of food rich in fiber and fruits and vegetables reduce the strain on the bowel movement and reduce constipation. Addition of whole grains to regular food also help prevent internal piles.
Consumption of plenty of water can easily move the bowels and relieve the strain.
Obesity is known to increase the hemorrhoids. Hence obese people must adopt techniques to lose weight including diet change.
Avoiding stress during excretion and avoiding laxatives can provide relief. Regular exercise also helps to prevent piles.
External application of ointments provide relief by removing itch and swelling of the anus. Other home remedies for external piles are use of ice or ice packs, olive oil, lemon juice and aloe Vera gel. Sitz bath in warm water for about fifteen minutes can provide significant relief. Only warm water and not hot water is to be used.
Only when the prolapse is not reduced even on manual intervention and when the swelling remains, surgical procedures are adopted.
Banding, sclerotherapy and laser treatment are attempted before deciding on surgery. In most of the cases, piles can be cured by natural remedies and non-surgical treatments.
Banding is just putting a band over the piles to restrict blood flow in order to make it shrink.
Sclerotherapy is injecting oil solution into the anal canal through the anus to smoothen the tissues.
Laser treatment makes the piles shrink instantaneously.
Surgery is recommended only in the case of large internal hemorrhoids or most uncomfortable external hemorrhoids.
Piles are not very serious diseases as long as they are controlled. But when there is continuous blood loss due to piles, anemia sets in. When blood circulation is cut off to an internal hemorrhoid it causes severe pain. A strangulated hemorrhoid can even lead to gangrene. This note of caution is only to drive home the point that piles need to be watched for their severity and treated appropriately.