What is Hemorrhoids?
Hemorrhoids are masses, clumps, cushions of tissue containing blood vessels, support tissue, muscle and elastic fibers in the anal canal.
Each and everyone has hemorrhoids. However, when the hemorrhoids surrounding the anal passage become big in size because of inflammation, then the vein walls become stretched, thin, and irritated by passing bowel movements, that is when piles occur.
Piles have various causes, although often the cause is unknown. It may result from straining during the bowel movements or from the increased pressure on these veins while pregnancy.
Piles can be located inside the rectum called internal hemorrhoids, or they can develop under the skin around the anus called external hemorrhoids.
Piles are very common. Nearly 3 out of 4 adults will have Piles from time to time. Sometimes they don’t cause any symptoms but at other times they can cause itching, discomfort and bleeding too.
Sometimes, a clot may form in hemorrhoid called thrombosed hemorrhoid. Piles are not dangerous but can be very painful and sometimes required to be lanced and drained.
Fortunately, Numbers of effective options are there to treat Piles. Many people can get relief from symptoms with some home remedy and lifestyle changes. In most cases, hemorrhoid goes away on its own.
Classification of Hemorrhoids?
Hemorrhoids can be broadly classified into two categories:
Internal Piles are located far within the rectum, and usually can’t be seen or felt having the only symptom is bleeding.
Further, Internal hemorrhoids can be classified into 4 grades:
Grade1: These are very small hemorrhoids within the lining of the anus.
Grade 2: These hemorrhoids too lie within the anus and are quite larger than grade 1 Piles. These Piles may get pushed out during passing the stool but return to the original position on their own.
Grade 3: These are also known as ‘prolapsed hemorrhoids’ appearing outside the anus. A person with this type of piles can push them back in by pressing them with his fingers.
Grade 4: These type of Piles cannot be pushed back and stay outside the anus at all times. They required to be treated by a doctor who typically suggests a surgery.
External Piles are located surrounding the anus right under the skin, where there are numbers of pain-sensing nerves. So it can be hurt as well as bleed.
Sometimes blood may pool in external hemorrhoid and form a clot (i.e. thrombus) which can result in severe pain, swelling, inflammation and a hard lump near the anus.
Anyone at any age can be affected by hemorrhoids. However, it has been observed that people above 45 to 50 years of age typically get affected by piles.
Nearby 50% of people experience Piles at some time in their entire life. Pregnant Women too can experience it. Though it is not properly known that what causes Piles, researchers think this can be an inherited condition of weak veins similar to varicose veins leading to Piles.
How do Hemorrhoids occur?
Piles are masses, clumps, cushions of tissue containing blood vessels, support tissue, muscle and elastic fibers in the anal canal. Piles are hemorrhoids which become inflamed.
Internal Piles occurs when blood vessels inside the rectum become swollen and engorged.
External Piles can occur because of increased pressure due to obesity, pregnancy, sitting or standing for long hours at a stretch, straining on the toilet, coughing, vomiting, sneezing, and holding breath while straining to do strenuous physical labor.
Causes of Hemorrhoids/Piles
The primary causes of hemorrhoids include:
- Genetic predisposition to hemorrhoids
- Lack of fiber in the food
- Inadequate fluid intake
- Sedentary lifestyle
- Straining during passing stool
- Constipation – Read the full article
- Diarrhea- Read the full article
- Constant sitting and standing for long hours at a stretch
- Sitting for prolonged periods of time on the toilet
- Anal intercourse
- Constant heavy lifting
- Being obese
- Previous surgery of bowel
- Constriction of intestine after surgery
- Spinal cord injury which leads to the bladder and rectal dysfunction
- Dysfunction of the floor of the pelvis
What are the symptoms of Hemorrhoids/Piles?
The symptoms of hemorrhoids include:
- Bright red bleeding from the anus while bowel movement
- Pain while bowel movements
- Painful swelling or a lump near the patient’s anus
- Anal itching
- Mucous discharge from the anus
- Hard lump around the anus
- The area surrounded the anus becomes red and sore
Symptoms of Piles during more severe condition can include:
- Excessive anal bleeding can be leading to anemia
- Inability to control bowel movements
- Anal fistula, in which a new channel is developed between the surface of the skin near the anus and the inside of the anus
- Strangulated Piles, in which the blood supply to the hemorrhoid is shut off, leading to complications including infection or a blood clot.
Who is at higher risk to Hemorrhoids/Piles?
Few individuals are at higher risk of developing piles than the others. There can be various reasons for it:
- Genetic predisposition to hemorrhoids, meaning weak veins can be genetically leading to weak rectal vein walls or week venous valves.
- Less fiber in the diet can cause constipation which can result in the formation of hemorrhoids.
- Poor bathroom habits
- Excessive coughing and sneezing
- Constant sitting or standing for long period at a stretch
- Excessive straining, rubbing or cleaning surrounding the anus
- Regularly holding breath during straining to perform some physical labor
- Being obese
Diagnosis of Hemorrhoids/Piles
If the doctor suspects you have hemorrhoids, he will perform a visual examination of your anus to diagnose Piles. The doctor will examine the anus of the patient with suspected piles.
The doctor may ask the following queries:
- Do you have any close relatives having piles?
- Has there been any blood or mucus in your stools?
- Do you feel recent weight loss?
- Have bowel movements changed recently?
- What is the color of stools?
For internal hemorrhoids, the doctor may perform a digital rectal examination (DRE) or use a proctoscope.
A proctoscope is a hollow tube fitted with a light that allows the doctor to see the anal canal up close. They can get a small tissue sample from inside the rectum and can be sent to the lab for analysis.
The doctor can recommend a colonoscopy if the patient with piles presents signs and symptoms that suggest other digestive system diseases, or they are demonstrating any risk factors of colorectal cancer.
The doctor can also prescribe an additional test called a sigmoidoscopy. A sigmoidoscopy (a small fiber-optic camera) in which your doctor using a small camera to diagnose internal Piles.
Complications of Hemorrhoids
The complications of hemorrhoids include:
- Bleeding while bowel movements
- Pain while bowel movements
- Piles cause complications linked with hygiene, as the anal area becomes very difficult to clean after defecation
- Poor hygiene around the anal area can result in several infections
- Itchiness around the anal area
- Gangrene, if the blood supply to an internal hemorrhoid is shut off
Treatment for Hemorrhoids/Piles
In most of the cases, hemorrhoids resolve on their own without the requirement for any treatment. However, some treatments can help to decrease the discomfort and itching that many people experience with this condition.
Hemorrhoids can develop due to straining during bowel movements. Excessive straining is the result of the condition called constipation.
A change in your diet habit can help keep the stools regular and soft. This involves intake of more fiber, like fruit and vegetables, or primarily eating bran-based breakfast cereals.
A doctor can also advise the patient with piles to increase their water intake which is best to avoid caffeine.
Losing weight can help decrease the incidence and severity of Hemorrhoids.
To prevent this condition, doctors also recommend exercising and avoiding straining to pass stools. Exercising is one of the main treatments for piles.
Exercising can easily decrease the symptoms of piles. You can go for exercises like:
- brisk walking
- deep breathing exercises
- stretching exercises
- kegel exercises three times every day – the steps for which are:
- Contracting the pelvic muscles. It is akin to the action you do while you hold the urination.
- Squeeze and hold for 3 seconds then relax for another 3 seconds.
- Repeat the exercise ten times each session, until you can do as many as around 15 repetitions.
Several medicinal options are available to make symptoms more manageable for a person with Hemorrhoids.
Over-the-counter (OTC) medications:
These are easily available in the market which includes include painkillers, ointments, creams, and pads, that can help soothe redness and swelling around the anus.
OTC medicines do not cure or remove piles but can help to reduce the symptoms. Do not use OTC remedies for more than 7 days in a sequence, as they can cause more irritation of the area and thin of the skin. Do not consume 2 or more medications at the same time unless prescribed by a medical professional.
These can decrease inflammation and pain.
The doctor can prescribe laxatives if a patient with Hemorrhoids suffers from constipation which can help the patient pass stools more easily and reduce pressure on the lower colon.
Around 1 in 10 people with Hemorrhoids will end up needing surgery.
The surgeon places an elastic band around the base of the pile and cutting off its blood supply. After a few days, the Piles fall off. This is effective for treating all piles of less than grade IV status.
In this process, medicine is injected to make hemorrhoid shrink. Hemorrhoid then shrivels up. This is effective for grade II and III Piles and is an alternative to banding.
It is also referred to as infrared light coagulation; in which a device is used to burn the hemorrhoid tissue. This technique is used to treat grade I and II Piles.
The excess tissue which is causing the bleeding is surgically removed. This can be done in many ways and may involve a combination of a local anesthetic and sedation, a spinal anesthetic, or a general anesthetic.
This type of surgery is very effective for completely removing Hemorrhoids, but there is a risk of complications, such as difficulties with passing stools, as well as urinary tract infections.
In this technique, blood flow is blocked to the hemorrhoid tissue. This procedure is generally less painful than hemorrhoidectomy. However, this procedure can result in an increased risk of hemorrhoid recurrence and rectal prolapse, in which part of the rectum pushes out of the anus.
Prevention of Hemorrhoids/Piles
- Eat high-fiber foods such as fruits, vegetables, and whole grains.
- Drink minimum of 6 to 8 glasses of water per day
- Consider fiber supplements
- Don’t strain
- Go as soon as you feel the urge
- Avoid long periods of sitting
- Keep the anal area clean
- Don’t use dry toilet paper
- Soak regularly in a warm
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