HAEMORRHOIDS, PILES, BAWASEER
What are Piles
Pile is the common term used for disease called haemorihords characterized by formation of outgrowths of blood vessels (veins) of anal canal. These outgrowths may remain inside the anal canal or may protrude out. Piles in common Hindi is also called 'bawaseer.'
Understanding the medical lingo
Haemorrhoidectomy:It means the surgical removal of the haemorrhoids.
First degree haemorrhoids:These are haemorrhoids which do not protrude out of the anal opening.
Second degree haemorrhoids: These are those haemorrhoid which protrude out of the anal opening on straining or defecation but go inside once the straining is over.
Third degree haemorrhoids: These are hemorrhoids which are permanently protuding out of the anal opening.
The various presentations of Piles
Piles may present in two ways
External piles (external to the anal orifice)
Vein outgrowths are visible outside anal canal.
They are covered by skin Internal piles (internal to the anal orifice)
They remain inside anal canal (not visible outside anus)
Covered by inner lining of anus.
Factors contributing towards Piles
Hereditary: Conditions seen frequently in members of the same family, which may be due to some weakness in the vessel walls. Straining while passing stools ( constipation) Sometimes even severe diarrhea and dysentery can activate latent piles Cancer of rectum can cause piles During pregnancy piles can occur because of changes in pressure in veins, but become normal again after pregnancy is over Straining while passing urine in case of prostate enlargement
Signs and symptoms of Piles
Bleeding during passing stool. This is one of the first signs. This may initially be only during defecation and may continue in an on-and-off pattern for a long time. The pile that does not protrude out of the anal canal is calledfirst-degree haemorrhoid. Piles may protrude out of anus. This is a late symptom of piles. This protrusion may occur only during defecation and may be reduced automatically. They may also be reduced by the person's finger. As time goes on the pile does not get reduced and stays out permanently. The pile that protrudes out but gets spontaneously reduced is calledsecond-degree haemorrhoid. A feeling of heaviness in the rectum and discomfort may be a feature of a permanently prolapsed pile. Piles that are permanently protruding out are called third-degree haemorrhoid. A thick watery discharge from anus may be present which is usually associated with intense itching in the anal region. Feeling of incomplete evacuation after defecation One should remember that pain is not a regular feature of piles. If a patient complains of pain he should be evaluated for an associated condition or a complication.
Physical examination and investigations
Visual and digital examination:It is usually carried out before the other examinations. Unless the pile is protruding out it will not be seen. A local examination of anal region is done followed by examination of anus by inserting a finger (per rectum examination).
Type: Diagnostic test Method: An instrument called proctoscope is inserted into anal canal after lubricating, and the canal is viewed under light by the eye. Inference: Piles if present will bulge into the lumen of proctoscope and become visible.
Type: Diagnostic Test Method: A sigmoidoscope is inserted through the anal opening to view the terminal portion of large intestine, rectum, and anus. Inference: Piles if present are visible.
Possible complications of Piles
Heavy bleeding may occur. It should be kept in mind that the bleeding may continue after the pile has retracted into the anal canal and thus not visible to the eye. Strangulation: The piles can get caught by the anal sphincter and cause intense pain. Thrombosis: The strangulated pile will lead to formation of clot inside it. Gangrene formation: When the strangulation of the pile is so tight that the arterial supply is compromised, then gangrene sets in and has the potential to cause severe bacterial infection and abscess formation. Abscess formation: It occurs due to the infection of the thrombosed pile.
Modalities of Haemorrhoid management
This mode of treatment is recommended when the cause of piles is some other condition except for the cause being cancer. The bowels are controlled by water absorbing colloids. Various creams are available for insertion into the rectum at night and before defecation.
Active Treatment It consists of any of the following methods:
Injection treatment is recommended for those patients who have first degree piles (piles which do not protrude from the anal opening. It can also be used for patients with small second-degree piles (piles that protrude from the anal opening on strain but then are reduced automatically). The procedure is the following. Injection of 3 to 4 ml of 5% phenol in almond oil is injected into piles resulting in permanent collapse of piles. 3 sessions at 6-week interval is needed. It is a relatively painless procedure. Tight elastic bands are tied at base of each pile, resulting in their shrinking and shedding off. Procedure is painless. Cryosurgery: Painless procedure of removing piles using liquid nitrogen (temp -196°C). Photocoagulation: Painless removal of piles using infrared heat radiation.
Surgery: The surgical procedure to remove the hemorrhoids is called haemorrhoidectomy. Procedure is simple, and patient is discharged with in 2-3 days. The recommendations for the operative procedure are the following conditions:
Permanently prolapsed haemorrhoids (third-degree haemorrhoid) When the nonoperative procedures fail. When the hemorrhoids are fibrosed.
Prevention and precaution
Those with family history of piles should take care not to have chronic constipation by drinking lots of water, eating salads, and green vegetable. People having constipation can have a teaspoon of isabgol in water or milk at night before going to sleep. Eating very spicy food to be avoided by people at risk. In cases of prostate enlargement, early operation of the prostate is recommended.
Q.What is the age at which piles can occur?
A.Piles can occur at all ages. It is uncommon in children, and occurs only because of some diseases of liver or other complications. Incidence of piles increases, particularly, after age 40.
Q. What is the treatment and subsequent management?
A. Piles are removed surgically by a procedure called haemorrhoidectomy. Alternate procedures include injection of phenol & almond oil into piles, elastic banding of piles, cryosurgery, and photocoagulation. To prevent recurrence patient is advised to avoid spicy and greasy foods, take lots of water and salads, and avoid constipation. The patient should not strain during defecation.
Q. What are the factors that are associated with increased risk of getting piles?
A. Family history of piles
Prostate enlargement leading to chronic straining while passing urine
Cancer of rectum
Q. Are there any non-surgical methods of treatment?
A. The main treatment of piles is surgical. The non-surgical methods are only for temporary relief. They cannot cause the regression of the piles. They are usually used when there is a secondary cause of piles e.g. pregnancy.
Q. Can haemorrhoids be a symptom for other conditions?
A. Haemorrhoid can be a symptom of other disease. They are cancers of the rectum, straining during urination due to causes like urethral narrowing or prostate enlargement, and pregnancy