Hemorrhoids or piles refers to dilated veins occurring in relation to the anus ,A common problem approximately 50% of the people above 50 years of age tend to develop haemorrhoids. Common in both men and women. Tendency to run in families Uncommon below the age of 20 years.
Increased intra abdominal pressure (as due chronic constipation, pregnancy, obesity etc.) leads to dilated veins in rectal area, Which might bleed or felt as rectal mass particularly during defecation or straining.
The factors, which may be responsible in increasing abdominal pressure resulting into formation of hemorrhoids, include:
• Constant straining due to constipation.
• Diet high in processed food and low in fiber (noodles, cold drinks, fried food, etc.)
• Laxative abuse and frequent enemas.
• Sedentary lifestyle
• Lifting heavy objects
• Repeated coughing and sneezing
Frequently seen in the members of the same family presumably due to weakness of vein walls since birth.
Pressure of the fetus in the abdomen cause the blood vessels around the anus to enlarge. Some diseases/ conditions such as enlarged prostate, urethral stricture (narrowing of the urinary opening) and cancer of rectum. '
Lot of traveling (e.g. marketing and sales professionals) and prolonged standing (e.g. traffic police, waiters, etc.)
• Symptoms of Hemorrhoids Manifestations of hemorrhoids may vary depending upon the type of hemorrhoids.
They may be quite painful as they lie under the skin that has rich supply of nerves. May appear as a tender blue swelling at the anal margin (due to thrombosis). Since the blood clot usually lies at the level of external sphincter muscles, anal spasm often occurs. Bleeding and itching in and around anus may also occur in some cases (due to co-existence of internal hemorrhoids, passage of hard stools or poor anal hygiene).
A mucoid (slimy) anal discharge and fecal leakage usually accompanies prolapsed hemorrhoids. Itching in and around the anal area follows mucoid discharge from the prolapsed hemorrhoids. Pain is not a common feature unless complicated by thrombosis (formation of blood clot), infection or erosion of the inner lining of the anal canal (mucosa).
Types of Hemorrhoids Depending upon the site of origin, hemorrhoids can be divided into two types.
External Hemorrhoids Develops at the margins of the anal opening Usually painful because richly supplied by nerves Can be seen outside as a small, tender lump (due to thrombosis)
Internal Hemorrhoids Develops inside the anus Usually painless because not richly supplied by nerves Tendency to bulge out of the anal opening in various degrees When both the external and internal varieties are associated, the condition is called interoexternal hemorrhoids.
Diagnosis of hemorrhoids is made on the basis of history of complaints, inspection, digital examination and direct visualization History of complaints suggestive of hemorrhoids includes:
• Chronic constipation
• Fresh bleeding per rectum (splash in the pan)
• Anal discomfort
• Anal discharge
• Perianal itching
• Direct visualization of the Rectum and Anal Canal is done using:
• Proctoscope is an instrument used to visualize the interior of the anal canal and the rectum. Internal hemorrhoids, anal fissure and any growth can be seen.
Hemorrhoids has to be differentiated from the following conditions:
A longitudinal tear in anal mucosa Associated with streaks of blood with the passage of stool Highly painful and causes spasm of the anal sphincters.
An abnormal communication between the anal canal or rectum and skin around the anus May cause swelling, pain, discomfort & discharge in perianal region intermittently.
May manifest as painless bleeding per rectum Tendency to empty the rectum several times a day often with passage of blood and mucus Sudden change in bowel habits, weight loss & anemia are also common Complications of Hemorrhoids.
This usually common in the early stages of second-degree hemorrhoids.
Sometimes the prolapsed hemorrhoids may get caught at the external sphincter. This causes collection of blood at the anal opening resulting in further swelling of the hemorrhoids and this condition is very painful.
Thrombosis (clot formation)
If the internal hemorrhoids continue to remain in a strangulated state, blood starts clotting in the veins and hemorrhoids may appear purple or black in color and are tender.
Classification of Internal Hemorrhoids Depending upon the degree of protrusion, the internal hemorrhoids can be divided into.
First degree hemorrhoids
The dilated veins remains entirely within the anal canal and do not bulge out of the anal opening.
Second degree hemorrhoids
Piles protrudes during the passage of stool but recede back on its own.
Third degree hemorrhoids
The protrusion does not recede back on its own and has to be replaced by hand.
Fourth degree hemorrhoids
Piles may protrude anytime of the day and remains permanently protruded.
• Eat more vegetables and fruits (fiber)
• Drink a lot of water
• Avoid constipation
• Avoid straining while passing motion
• Medication for constipation
• Stool softeners
1st and 2nd Degree for Piles Treatment
• Diet and medication as suggested by doctor
• Develop good bowel habits
• Injecting a chemical solution into pile mass
• Banding tiny rubber bands around pile mass and cutting off blood supply
• IRC (Infra-Red Coagulation)
3rd and 4th Degree for Piles Treatment
"Surgery is the only option"
Conventional Surgery for Piles
Pile mass is cut surgically, sutured and removed Two-Three open wounds in the prenatal area Slow healing require regular dressing
Minimally Invasive Procedure for Piles/ MIPH
1. Your surgeon will decide if you require MIPH
2. Pile mass is lifted and fixed back where it belongs
3. Surgery is at "no-pain" area
4. No open wounds after surgery
5. Minimal pain and faster recovery