Haemorrhoids (Piles)

Sliding downwards of abnormally of anal cushions due to straining or other causes.

Haemorrhoidal veins located in the lowest part of rectum and anus. Sometimes they swell so that the veins wall become stretched, thin and irritated by passing stools.

Haemorrhoid are classified in to general categories

INTERNAL HAEMORRHOIDS

Internal haemorrhoids are placed enough inside rectum which can not be seen or felt, usually painless and bleeding may be the only symptoms at presentation. Sometimes internal haemorrhoid become enlarged enough to protrude outside the anus which can be seen or felt as moist pads of skin, pinker then surrounding area and may be painful because they become irritated by rubbing from clothing and sitting.

EXTERNAL HAEMORRHOID

External haemorrhoids lie within the anus and may prolapse out side and may be thrombosed. Thrombosed haemrrhoids purple or blue and despite their appearance are usually not serious and will resolve themselves in about a week.

CAUSES

Any one at any age but common in elderly people and during pregnancy

  • Inherited (weak veins leading to haemorrhoids and other varicose veins)
  • Extreme abdominal pressure caused by obesity, pregnancy, standing or sitting for long period, straining during defecation, over purgation, coughing, sneezing, vomiting, diarrhea and constipation.
  • Low fibers diet, inadequate fluid intake and diet high in processed foods.

SYMPTOMPS

Bright red bleeding from anus- 1st symptom, occur during defecation and blood may streak stool or toilet paper.

Pain during dffecation- may be due to prolapse, infection or spasm.

Painful swelling or a lump near the anus in case of prolapsed haemorroids.

  • Anal itching
  • Mucus discharge from anus.
  • Anaemia- secondary

COMPLICATIONS

  • Profuse haemorrhage
  • Strangulation
  • Thrombosis
  • Ulceration
  • Gangrene
  • Fibrosis
  • Stenosis
  • Suppuration
  • Pylephlebitis

DIAGNOSIS

On inspection- prolapsed piles may be seen.

On per rectal examination- thrombosed piles may be felt.

Anoscope/ Proctoscope- It is inserted into anus/rectum to look the anal area or rectum. Exact position of piles can be made out as a bulge into proctoscope.

Other investigation (colonoscopy, barium enema) to rule out other cause of anal bleeding (anal fissure, colitis, chronic disease, colorectal cancer)

TREATMENT

(1) Conservative:-

  • Local applications of creams, ointments or suppositories to reduce pain and swelling. Corticosteroids cream is used for severe swelling and inflammation.
  • Warm (but not hot) sitz bath –sit in 8 cm warm water for 15 minutes, 2-3 times per day.
  • Antibiotics
  • Analgesics to reduce the pain
  • Laxative to relive constipation

(2) Anal dilatation- Manual stretching of the anal canal sphincter for inflamed, permanently prolapsed and oedematous piles.

(3) Injectable sclerotherapy- Injection sclerocent (3-5 ml of 5% phenol in almond oil) is used for 1st degree and early 2nd degree internal hemorrhoid that creates a scar and closes of hemorrhoids

(4) Banding –Usually it is used in 2nd degree hemorrhoids

(5) Coagulation- It is done by using either electric probe, a laser beam or infrared lights which seal the end of the haemorrhoid causing it to close off and shrink.

(6) Surgery- Success rate approaches 95% but without dietary and life style changes haemorrhoids may recur. There are many different surgical procedures. The main types of operation are followings:-

  • Haemorrhoidectomy- It is indicated for following cases- - Large internal haemorrhoids (3rd degree or 4th degree ) - Faliur of nonoperative method - Fibrosed piles - Extremely uncomfortable haemorrhoids (thrombosed)
  • Transanal haemorrhoidal deartelialisation (THD) or Haemorrhoidal artery ligation (HA20)
  • Stapled haemorrhoidopexy- It is done only for plolapsed piles. In this technique circumferential excision of mucosa and submucosa 4 cm above dentate line is done by using circular haemorrhoidal stapler passed per anally (MIPH) Advantages of this technique are less painful procedure, less blood loos, shorter recovery time (1 week), short hospital stay and equally efficacious as compare to conventional haemorrhoidectomy.

All kind of surgical procedures are available at Devasya Superspeciality Kidney & Multispeciality Hospital.