What are Piles?

Piles (haemorrhoids) are swollen veins that may occur either inside or outside the anal opening. Piles occur in the lowermost part of the anus and can cause a considerable amount of pain and discomfort. When the blood vessels of the anal region get enlarged, it leads to stretching of the skin and pain. Piles that can be felt bulging out near the anal opening are termed external haemorrhoids. On the other hand, piles that occur on the inner part of the anus cannot be felt and are termed internal haemorrhoids.

Piles can affect people of any age, regardless of their gender. However, haemorrhoids generally do not affect children. This condition can cause a lot of stress and difficulty in your life, but the good news is it can be treated very effectively with a simple piles surgery.

Piles Symptoms

Listed below are some of the symptoms of piles you should keep an eye out for:

• Anal itching

Haemorrhoids can cause excessive itching around the anus, especially if they occur externally.

• Swelling

Swelling (one or more small balloon-like swellings that can be felt in the anal region) is an indicator of haemorrhoids, and it causes the anus to feel very tender.

• Anal pain

External piles cause pain in the anal region and make it very difficult for a person to pass stool or even sit.

• Bleeding

Blood being passed along with stools can be an indicator of internal piles.

• Lumps near the anus

Lumps on the anal surface that may seem hard or tender are major piles symptoms.

• Slimy anal discharge

A slimy discharge from the anus may stain your underwear or even be passed along with stool.

• Sore skin on the anus

Sore skin on the surface of the anus or skin sticking out after bowel movement is generally a symptom of haemorrhoids.

When to consult a doctor?

You should visit your healthcare provider/doctor if:

• The symptoms of piles persist for more than 2-3 days.
• If you notice bleeding from your rectum.

While haemorrhoids are a frequent cause of rectal bleeding, there are other underlying conditions such as Crohn’s disease, ulcerative colitis, colorectal cancer, and anal cancer that may be responsible. Therefore, it is essential to consult your healthcare provider to determine the root cause of the bleeding and receive appropriate treatment.

Prevention

Following these steps may help reduce the risk of piles:

• Incorporate fibre-rich foods into your diet.
• Drink about 2-3 litres of water each day.
• Avoid straining during bowel movements.
• Avoid prolonged sitting on the toilet.
• Steer clear of regular heavy lifting.
• Treat persistent cough.
• Avoid sitting or standing for many hours.

By implementing these habits, you can take proactive steps to maintain optimal bowel function and reduce the occurrence of piles.

 Piles Causes

• Constipation

Strained bowel movements due to constipation may put pressure on the blood vessels in the region of the anus and cause piles.

• A low-fibre diet

A diet low in fibre causes strain on the movement of bowels due to harder and smaller stools.

• Prolonged Diarrhoea

Passage of loose stool for a prolonged period causes strain on the anus, which may cause haemorrhoids.   

• Pregnancy

Pregnancy causes an enlarged uterus that may put pressure on the colon, which is connected to the anus. Pressure on the anus can lead to internal piles.

• Heavy weight lifting

Heavy weight lifting or excessive strain during exercise can also be a cause of piles.

Types of Piles

Piles are swollen veins inside or outside your anal opening that may cause a lot of pain if left without care for a prolonged time. Essentially, there are two types of piles. They are:

• Internal piles: As the name suggests, piles that occur internally and cannot be seen on the body surface are internal piles. They are more like protrusions inside your anus, on the walls of your anal canal. Sometimes, less serious cases of internal piles are tiny lumps inside the anal area.

Internal piles can also form in the upper part of the anal canal or in the lower rectum area. Internal piles are usually not painful unless they are prolapsed in nature. If you are suffering from internal piles, you may experience bleeding from your rectum in the form of bright red blood on your stools, on the toilet paper or on the toilet sheet after passing stools.

• External piles:  External piles are lumps on the outer region of the anal area. External piles can be felt by the patient or visible to the patient or a doctor. You may also feel these as water-filled swellings around the anal opening. External piles start off near the external surface of the anus and can extend below a few centimeters inside the back passage. With external piles, you may experience symptoms like anal itching, one or more hard and tender lumps near your anus and pain near the anal area, especially when sitting.

Too much straining while passing bowel movements, rubbing the affected area or cleaning too much of your anus with agents that are not gentle on the skin may aggravate your symptoms and make them worse. For many people, the symptoms of external piles may go away within a few days with proper care. However, diagnosis and treatment by a doctor are very important for piles.

Piles Diagnosis & Treatment Options

A doctor will diagnose your condition based on your symptoms and clinical examination before suggesting piles treatment. If you have the symptoms of external piles, a doctor will visually examine the affected area. If your symptoms indicate internal piles, you will need to get a digital rectal exam.

A piles surgery can help in quick recovery from the ailment (when indicated). It can also be a very effective and permanent solution for this condition.

Here are some surgery options your doctor might suggest:

• Laser piles surgery

Laser surgery is the least intrusive piles surgery. The surgery targets the affected areas with a precise laser beam. The laser beam seals the blood supply to the swollen blood vessels to prevent further swelling. This treatment procedure has a very high success rate, is relatively painless, causes minimal bleeding, and the recovery time is minimal. 

• Haemorrhoidectomy

This process involves the surgical removal of haemorrhoids from the internal or external part of the anus. A precise incision is made to remove the piles, and you will also require medication before and after the procedure. 

• Haemorrhoidal artery ligation

This process treats piles by cutting off blood supply to the haemorrhoids. The procedure involves locating the haemorrhoids with a probe and stitching the blood supply channel. There is hardly any risk involved with this procedure.

• Stapled hemorrhoidopexy

Tissues around the piles are stapled in this procedure. This decreases the supply of blood to the pilesand reduces their size. There is minimal postoperative pain which subsides within a week. This procedure also reduces the risk of incontinence and the piles from prolapsing.

Comparison Table

Best Option of all

When it comes to treating haemorrhoids, the laser method procedure is generally considered to be more favourable than conventional surgeries. This is primarily because patients tend to experience less postoperative pain compared to the surgical approach. Additionally, the laser procedure may cause lesser blood loss and help in faster recovery compared to other surgeries.

Laser piles surgery, haemorrhoidectomy, haemorrhoidal artery ligation, and stapled hemorrhoidopexy are all effective treatment options for haemorrhoids, but the best option depends on individual factors. It is recommended to consult with a surgeon who can evaluate your individual case and recommend the most appropriate treatment for you.

Pre and Post Operative care instructions

Pre-Operative Care

Certain precautions should be taken to minimize the risk of complications and ensure a successful recovery, before performing haemorrhoid surgery. These precautions include:

A week before surgery:

• Tell your doctor about all ongoing medications- e.g., blood thinners. Your doctor mayask you to stop taking them a week before the surgery to reduce the risk of excessive bleeding during the procedure.
• You will need to undergo certain tests that may require a visit to the hospital. Typically, these tests will take place a week before the scheduled surgery. E.g., blood tests, cardiogram, urine tests, etc. The healthcare provider will also give you more information on the surgery you will be having.

On the day of surgery:

• While bowel preparation is not mandatory, you may be given an enema to empty the rectum.
• You will be instructed to adhere to a clear liquid diet 24 hours before the surgery. No oral intake is allowed 6 hours before the procedure.
• On the day of surgery, you will be given a consent form. By signing this form, you acknowledge that you have agreed to the treatment and possess an understanding of the procedure.

Post Operative care

It is important to understand and take note of all post-operative care instructions from your doctor. Here are some instructions that your doctor may advise you to follow after piles surgery:

Diet:

• Consume clear liquids and drink plenty of water.
• Advance to a regular diet the next day and eat healthy foods like whole grains, vegetables, and fruits.
• Avoid constipation-promoting foods like dairy, red meat, processed foods, and sugary products.

Medications:

• Take antibiotics and anti-inflammatory medicines as directed.
• Use pain killers and stool softeners as prescribed by your doctor.

Activity:

• Rest completely for 24 hours and then slowly resume normal activities as tolerated.
• Avoid lifting anything heavy or straining for at least 5-7 days.

Wound dressing:

• Keep the dressing on until the next day .
• Use soft gauze or sanitary napkins for drainage control and change pads frequently.
• Do Sitz baths thrice daily, especially after each bowel movement. (Sitz bath involves sitting for 20 minutes with your knees against your chest in 6-8 inches of clean, warm water in bathtub.)
• Bathing: Shower the next day after surgery.

Also Read: Mineral Oil for Constipation: A Viable Solution?

Piles diagnosis/How are piles diagnosed?

Self-diagnosis of piles should never be done. With signs and symptoms like if you are feeling discomfort in the anal region itching, or pain around your anus that does not go away in a few days, you should consult a General Surgeon for the diagnosis. There are several ways in which piles diagnosis can be made. Some of them are as follows:

• Self:  Check for any blood spots on the toilet paper or in the toilet bowl whenever you go to empty your bowels. You may also get moist, pink lumps around the anal opening      or sensations as if something (soft mass tissue) bulging out from your anal area. They may appear purple or blue too.
  
  
• Surgeons:  Your doctor may opt for a visual examination in case of internal hemorrhoids/piles. Internal piles can be extremely delicate and soft to be felt during a rectal examination. In that case, your doctor might examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope.

• While performing an anoscopy, your doctor will insert a device called an anoscope into your anus. This device is typically made of disposable plastic or sterilizable stainless steel. An anoscope allows your doctor to get a detailed look at the tissue within your anal-rectal areas.
  
  
• In a colonoscopy, the doctor checks for abnormalities or any disease in your large intestine, particularly the colon. A colonoscope is a thin, flexible tube that has a light and camera attached.

Recovery Process

Recovery can take anywhere between one to four weeks depending on the type of surgery.

• The patient is typically kept under observation in the hospital to ensure any immediate postoperative complications such as bleeding or infection do not occur.
• On the second day or the day of discharge, you may start experiencing fatigue which will last a few days following the surgery. This is normal and can be relieved by engaging in gentle exercise, which is also beneficial for your recovery.
• Due to the lingering effects of the anaesthesia, it is strongly advised that you refrain from operating a vehicle for a minimum of 48 hours following the procedure.
• Rapid recovery occurs during the first week.
• Typically, individuals with desk jobs can resume work after approximately 2 weeks, while individuals with manual labour jobs may require up to 4 weeks to recover before returning to work.

Severity/Piles Grade

As it is known, there are essentially two broad categories of piles – internal and external. Internal piles occur within the rectum and are usually not visible during an external examination. However, in some cases, internal piles may grow and start protruding out from the anus. In such cases, piles grade has to be determined. In the medical world, professionals grade internal piles on a four-point scale.

• Grade 1: This is the first grade/stage of internal piles. The growth of the piles does not cause any symptoms, and does not prolapse and protrude out of the anus yet. In the case of grade 1 haemorrhoids, doctors will most likely recommend a medical treatment regimen of adding fibre to your diet and trying one of many new over-the-counter haemorrhoid treatments.
  
  
• Grade 2: In grade 2 piles, the haemorrhoids/piles may prolapse while straining or go back inside the anus spontaneously and independently without interference. For grade 2 hemorrhoids, doctors will often try conservative haemorrhoid treatment therapies like painless haemorrhoid treatment procedures as needed. Such painless haemorrhoid treatment therapies include injection sclerotherapy, rubber band ligation, or coagulation.
  
  
• Grade 3: In grade 3, the piles prolapse on their own, but recede or go inside only when the patient pushes them inside with one’s fingers.  
  
  
• Grade 4: The last grade of piles is grade 4 when the piles come out of the anus and cannot be pushed back in.

For the treatment of grade 3 and grade 4 hemorrhoids, doctors will often refer patients to surgeons for more haemorrhoid treatment procedures.

Complications / Risk of Piles

Hemorrhoids can be chronic and painful, and if left untreated, may cause complications.

• If left untreated – Severe health complications may arise if piles are left untreated. Piles, if left untreated can lead to anemia.

Another risk involved in piles is when the blood supply to an internal haemorrhoid is cut off and the haemorrhoid becomes strangulated. This causes extreme pain and leads to gangrene.

If you are experiencing symptoms such as discomfort or pain while passing the stool along with bleeding, try not to ignore the symptoms to avoid piles complications. Consult your doctor before the condition escalates further.

Is piles surgery covered under Insurance?

Yes, it is common for health insurance companies to offer coverage for piles surgeries, specifically for patients who are suffering from piles-related symptoms. The extent of coverage often depends on your specific insurance plan, but in general, patients can expect to pay less out-of-pocket for this type of procedure if they have insurance coverage.

Do’s and dont’s for piles

Dos:

• If you have piles, a fiber-rich or high roughage diet should be consumed. A diet that is rich in fiber duly aids in softening the stool and lessens the chances of constipation. Without constipation problems, you will have less discomfort with piles caused by hard stools.
• Increase your fluid intake. Drinking plenty of fluids and water may help in keeping your body hydrated and make stool passing easier.
• Being overweight can heavily contribute to piles. If you are overweight as compared to your height, try shredding off some kilos to lessen the chances of piles occurrence.
• Warm baths and sitz baths may help lessen piles of symptoms like itching and pain.
• Indulge in physical activities as this may help in keeping the intestines clear and make bowel passing smoother.

Don’ts:

• Avoid sitting on the toilet seat for a very long time, as this puts a strain on the anal canal.
• Lifting extremely heavy objects should be avoided.
• Do not sit in the same posture for too long. If you have a job that involves sitting on a chair while working for long hours, make sure that you get up periodically and take a walk now and then.
• Avoid factors that may lead to constipation – Passing hard stool requires a lot of pressure. If you are suffering from constipation, make sure you get diet modifications and medications for the same and avoid putting on strain while passing stool.
• Laxatives and enemas, no matter how much they help if you have constipation, should be avoided to be consumed regularly.
• Do not self-medicate and self-diagnose.

FAQs

References

1. Pneumonia – Symptoms and causes: https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204 . Published on: Mayoclinic . By: | June 13, 2020
2. 121324: 3r24r2 . Published on: Mayovvevclinic . By: vesdv | June 13, 2020