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Introduction Piles or hemorrhoids:

Hemorrhoids or piles, are swollen and inflamed veins located in the rectum and anus. They can cause discomfort, itching, pain and bleeding, especially during bowel movements. Hemorrhoids are divided into two main types:

Internal hemorrhoids:

These are located inside the anus and are usually not visible. They usually cause painless bleeding during bowel movements. However, if the disease prolapses (falls out of the anus), it can be painful and annoying.

External hemorrhoids:

These develop under the skin around the anus and are often painful. They can cause swelling, irritation, and bleeding. If blood clots inside an external hemorrhoid, it can lead to a hard, painful lump.

Reasons:
Caused by increased downward pressure on the anus. Factors contributing to this stress include:

• Prolonged sitting on the toilet
• Chronic constipation or diarrhea
• Obesity
• Pregnancy
• Low fiber diet
• Heavy lifting

Common symptoms of hemorrhoids include:

• Bright red blood on toilet paper or stool
• Itching or burning in the rectal area
• Pain or discomfort, especially during bowel movements
• Swelling around the anus
• A lump near the anus, which may be tender or painful.

Diagnosis:

Diagnosing hemorrhoids typically involves a physical examination and a review of your symptoms and medical history. Your healthcare provider may perform:

1. Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to feel for abnormalities.
2. Visual Inspection: A doctor might use a tool called an anoscope to look at the lower part of the rectum and anus. A proctoscope or sigmoidoscope may also be used to examine the rectum and lower colon.
3. Colonoscopy: In some cases, especially if there are signs of other gastrointestinal conditions or the patient is over 50, a colonoscopy may be recommended to rule out other causes of symptoms like rectal bleeding.

Treatment:

The treatment for hemorrhoids depends on their severity and symptoms. Options range from conservative home treatments to minimally invasive procedures and, in severe cases, surgery.

Home Treatments and Lifestyle Changes:

1. High-Fiber Diet: Increasing fiber intake can soften stools and reduce straining. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Fiber supplements like psyllium husk can also be helpful.
2. Adequate Hydration: Drinking plenty of water helps keep stools soft and easier to pass.
3. Warm Sitz Baths: Soaking the anal area in warm water several times a day can relieve symptoms.
4. Over-the-Counter Medications: These include creams, ointments, and suppositories designed to reduce pain, itching, and swelling. Products containing hydrocortisone can be effective in reducing inflammation.
5. Good Hygiene: Keeping the anal area clean and dry can prevent irritation and worsening of symptoms.
6. Avoid Straining: Trying not to strain during bowel movements and avoiding prolonged sitting on the toilet can help prevent hemorrhoids.

 

Medicines:

Pain relievers, stool softeners and topical treatments to reduce inflammation and discomfort.

Effective methods:

Rubber band ligation, sclerotherapy, or infrared coagulation to shrink or remove hemorrhoids.

Minimally Invasive Procedures:

When home treatments are not effective, various minimally invasive procedures can be considered:

1. Rubber Band Ligation: A small rubber band is placed around the base of an internal hemorrhoid to cut off its blood supply. The hemorrhoid shrinks and falls off within a few days.
2. Sclerotherapy: A chemical solution is injected into the hemorrhoidal tissue to shrink it.
3. Coagulation Therapy: This involves using infrared light, laser, or heat to shrink the hemorrhoidal tissue.
4. Cryotherapy: Freezing the hemorrhoid to destroy the tissue.
5. Hemorrhoidectomy: Surgical removal of severe or large hemorrhoids.

Surgery:

For severe cases or when other treatments fail, surgery may be necessary:

1. Hemorrhoidectomy: This is the most effective and complete way to treat severe or recurrent hemorrhoids. The procedure involves removing excessive tissue causing bleeding. It’s typically done under general anesthesia and may require a hospital stay.

2. Stapled Hemorrhoidopexy (PPH): This procedure uses a circular stapling device to reposition the hemorrhoid tissue and cut off its blood supply. It is less painful than a traditional hemorrhoidectomy and has a shorter recovery time but may have a higher recurrence rate.