WHAT ARE PILES?
Piles or hemorrhoids are swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).
WHY DO THEY OCCUR?
Hemorrhoids are usually seen in people who strain during bowel movements or have constipation. Other risk factors include pressure on the rectal veins that can happen due to obesity, constant lifting of heavy weights, sitting for long periods, or during pregnancy. Increasing age is a risk factor as tissue support to the dependent rectal-anal veins weakens.
WHAT ARE THE SYMPTOMS?
Discomfort in the rectal and anal area is a common symptom, which is especially felt during bowel evacuation or when sitting. Other symptoms include itching and bleeding which is painless, usually noticed as small amounts of bright red blood on your toilet tissue or in the toilet, after passing stool.
External piles can be felt with the finger. Internal piles may not cause symptoms and are not palpable unless it pushes through the anal opening (prolapsed or protruding hemorrhoid) resulting in pain and irritation.
A clot in the vein is called a thrombosed pile which can feel very painful and hard. Sometimes the blood supply may get cut off (strangulated pile) which also can be very painful. Rarely chronic blood loss from piles can cause anemia.
WHAT IS THE TREATMENT?
External hemorrhoids are usually visible, while internal ones are diagnosed through a rectal examination or visualization by a proctoscope.
Lifestyle interventions
These mainly include a high-fiber diet, plenty of water intake, and regular exercise.
Sitz baths help soak the anal area in plain warm water for 10 to 15 minutes 2-3 times/day. Pain-relieving tablets may be given in certain cases.
Medicines
Oral treatment of piles is to give bulk fiber laxatives (psyllium husk/Ispaghula) along with stool softeners (like polyethylene glycol) to help in the smooth passage of stool and prevent constipation and straining. Sometimes a course of flavonoids (90% diosmin and 10% hesperidin) may be given which protects the vein wall, and reduces the inflammation and swelling.
Local treatment mainly includes hydrocortisone (or other steroids like beclomethasone) with lidocaine anesthetic as gel/cream. Some local preparations in addition may have zinc oxide, borax, and soothers like allantoin/aloe. Some pile creams contain specific agents. Feracrylum is a hemostatic (bleeding-controlling) agent that works by activating an enzyme (thrombin) which reduces bleeding. Calcium dobesilate protects blood vessel walls to reduce capillary permeability, swelling, and bleeding. Phenylephrine as a vasoconstrictor is also part of some creams.
There are many herbal medicines (indigenous/ayurvedic) available as tablets, powders, and local creams that are also used for treating piles.
Procedures
Severe or non-responsive piles are treated by procedures like banding and ligation, coagulation, cryotherapy, or in some cases surgery (haemorrhoidectomy or stapling).
HOW CAN IT BE PREVENTED?
The 5 points of prevention are:
- Drink plenty of fluids, at least 8-10 glasses/day
- Have high-fiber foods like salads, whole grains, vegetables and fruits, including curd.
- Avoid constipation and straining while passing stool – Use husk or fiber powder supplements (psyllium, ispaghula, methylcellulose) at night, and stool softeners when stool feels hard.
- Pass stools regularly in a comfortable toilet and seat. Do not make a habit of holding, waiting, or avoiding bowel evacuation.
- Avoid sitting for long hours. Walk around for a few minutes for every 1 hour of sitting. Exercise regularly for at least 30 minutes 5 times a week. Regular exercise and a high-fiber diet with increased water intake also help in losing or maintaining weight.
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