What is Hemorrhoids or Piles?
The rectal and anal blood vessels mostly veins are dilated and swollen because of prolonged straining while passing stool and bowel movement. Increase pressure within vein is also observed during pregnancy. Swollen painful vein of rectum and anus is known as hemorrhoids or piles. Swollen veins may form internal or external hemorrhoid.
Is Hemorrhoids or Piles a Serious Disease?
No, hemorrhoid is a benign disease of veins of rectum and anus. Hemorrhoid is also known as piles. Hemorrhoids or Piles is inflammatory disease of anal and rectal veins. Hemorrhoid causes severe bleeding during defecation. Straining while passing solid stool causes tear in hemorrhoid veins resulting in bleeding. The hemorrhoid disease is very painful condition.
What is Internal Hemorrhoids?
Internal hemorrhoid is not seen during examination. The enlarged veins are felt during examinations. The enlarged dilated veins lie within rectal and anal passage along the mucosal wall. Internal hemorrhoids are described in 4 grades
What are the 4 Grades of Internal Hemorrhoids?
- Grade 1-The dilated veins are within the wall of the anus and rectum.
- Grade 2- Veins prolapses during bowel movement and retracts at rest.
- Grade 3- Blood vessels prolapse during bowel function, straining and sneezing. The dilated and engorged blood vessels often prolapse through anal sphincter. The prolapse veins do not retract to normal position.
- Grade 4- The prolapsed veins cannot be reduced manually and remains prolapsed out of anal sphincter.
What is External Hemorrhoids?
The anal veins when hypertrophied, swollen and enlarged in size then protrudes out of anal canal. The swollen veins are felt and seen during examination. The disease is recognized as external non-inflamed or inflamed hemorrhoids. Dilated vein outside anus is known as external hemorrhoids. External hemorrhoids often are thrombosed and extremely painful.
What Causes Pain?
Solid stool when passes through narrow anal sphincter causes laceration of the vein. The lacerated vein is exposed to atmosphere and eventually gets infected. The infected veins show signs of inflammation. Inflammation causes severe pain at rest and during bowel movement.
What Causes Bleeding?
The dilated vein occupies the anal opening. Solid stool when passes through the anal opening causes laceration and tear of the anal and rectal veins. The tear causes bleeding.
What is a Thrombosed Hemorrhoids?
External hemorrhoids are dilated and enlarged veins. The blood flow in veins are obstructed and stagnated because of strangulation created by anal sphincter. The venous drainage is compromised and results in slow blood flow. The obstruction of blood flow results in clotting of the blood within the veins. When hemorrhoid gets infected the thrombus inside the vein also gets infected. The infected thrombus causes severe pain.
Describe the Causes of Hemorrhoids or Piles?
Following Are the Causes-
- Straining during bowel movements
- Continuous and prolonged cough seen in upper respiratory tract disease
- Constipation results in straining during bowel movements.
- Narcotic medication causes constipation.
- Ascites results in difficulties in defecations and results in straining.
What Are The Other Symptoms And Signs Of External Hemorrhoids?
External Hemorrhoids Symptoms and Signs Are As Follows-
- Discomfort at rest
- Moderate to severe pain during bowel movements
- Bleeding during bowel movements.
- Lump is felt around anus.
What Are The Other Symptoms And Signs Of Internal Hemorrhoids?
Internal Hemorrhoids Lie inside the Rectum. Symptoms are as follows-
- Moderate to severe pain during bowel movements
- Bleeding during defecation
- Lump is not felt around anal opening,
- Rectal dilated veins are felt during rectal palpation (rectal examination with fingers).
- Severe straining during bowel movement can cause protrusion of engorged and swollen veins through anal sphincter.
When Should I See The Doctor For Hemorrhoids or Piles?
You should see a doctor when you experience above symptoms. You could see primary care physician or specialist. Specialists who are experienced in treating hemorrhoid are General Surgeon or Proctologist Surgeon.
How Can One Avoid Getting Hemorrhoids or Piles?
You should know risk factors to avoid formation of Hemorrhoids or Piles.
Hemorrhoids or Piles Risk Factors Are As Follows-
- Anal Manipulation and Stretching
- Low Fiber Diet
- Narcotic Medications Causes Constipation
What Is The Treatment For Hemorrhoids or Piles?
Hemorrhoids or Piles treatment options are conservative, medication or surgery.
Conservative Treatment1 for Hemorrhoids or Piles Are As Follows-
- High fiber diet
- Clean the skin around the anus with clean water and soap once or twice a day. Wipe the skin clean following bowel function.1
- Drink lots of water.
What Are The Medications Used To Treat Hemorrhoids or Piles?
- Constipation- Laxative
- Pain- NSAIDs
- Topical Agents and Suppositories1- Ingredients are as follows
- Petroleum Jelly
- Zinc Oxide
- Steroid Ointment- Should be used for itching and pain for 7 to 10 days only.
What Are The Surgical Procedures To Treat Hemorrhoids or Piles?
Surgery For Hemorrhoids or Piles Include:
- Rubber Band Ligation2- Most of the protruded veins are isolated and ligated with rubber band.
- Sclerotherapy- Phenol is a sclerosing agent. Phenol is injected in vein to cause inflammation and collapse of the vein.
- Cauterization- Infrared cauterization of enlarged strangulated vein results in shrinkage of hemorrhoids.
- Excision- Veins are isolated and surgically excised. Open end of the veins are sutures and ligated.
- Ligation of Artery- Artery supplying the rectal and anal venous plexus is dissected and ligated. The result is lack of blood flow into hemorrhoid veins that results in collapse of the vein.
- Radiofrequency Hemorrhoidectomy- The renal vein plication and radiofrequency ablation of hemorrhoid veins is effective treatment and prevents need for hospitalization.4
What Are The Complications Of Hemorrhoids or Piles?
How to Prevent Hemorrhoids or Piles?
Following Are the Guidelines to Prevent Formation of Hemorrhoids or Piles-
- Avoid constipation and diarrhea
- Eat fiber diet
- Drink lots of water daily
- Take laxative with narcotics
- Daily exercise
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Dis Colon Rectum. 2000 Apr;43(4):561-3.
2. Pharmacological treatment of hemorrhoids: a narrative review.
Altomare DF1, Giannini I.
Expert Opin Pharmacother. 2013 Dec;14(17):2343-9.
Mounsey AL1, Halladay J, Sadiq TS.
Am Fam Physician. 2011 Jul 15;84(2):204-10.
4. Radiofrequency ablation and plication of hemorrhoids.
Tech Coloproctol. 2003 Apr;7(1):45-50; discussion 50.