Hemorrhoids are blood vessels surrounding the smooth muscles. Pathologically, “Hemorrhoids” are termed as coagulated blood lumps formed due to swelling and inflammation. This happens as a result of pressure being exerted on these blood vessels.
The exact reasons behind the occurrence of piles remain unknown. In case of piles, the blood vessels become thin and stretched, which leads to bleeding. This happens due to forceful activity of blood vessels against gravity for getting the blood back to the heart which is also known as venous return. Due to intra-abdominal pressure, blood vessels are displaced below and formation of hemorrhoids takes place.
The risk factors associated with the occurrence of Piles are discussed below.Aging:
Piles consists of different parts, such as mucosa lining, vein and smooth muscle cluster and supporting connective tissue. With aging, deterioration of the supporting tissues takes place. This results in prolapse of piles. Mucosal lining becomes more sensitive with age, to the pressure from straining and may lead to complications.Chronic constipation and diarrhea:
Constipation is a condition where straining is needed for bowel movements to pass hard stools. Inward pressure is generated on the hemorrhoids due to the hard stools and leads to troubles in the process of venous return. While outward pressure from abdomen and pelvic muscles causes formation of swollen hemorrhoids. Excessive use of laxative for constipation and Irritable Bowel Syndrome treatment may lead to hemorrhoid disease.Obesity:
Obesity is another risk factor in the formation of piles. Sitting for longer period of time, lack of physical activities, can lead to obesity and further piles. The risk of piles is prevented with the physical activity, since it promotes strengthening of abdominal muscles as well as colon walls. Exercises such as aerobics help improving blood flow to the gastrointestinal tract which ultimately helps in venous return improvement.Pregnancy:
Piles get formed during pregnancy as a result of hormonal changes making the veins relax. Piles can be itchy and painful. It has been reported that piles may disappear within few weeks after childbirth.Diet and lifestyle:
Diet and lifestyle can also be reasons behind generation of piles. Low-fiber diet, alcohol consumption, excessive spicy food consumption, can contribute formation of piles. Low-fiber diet can lead to constipation while spicy food and alcohol may cause diarrhea. In both cases piles get formed.
Piles get formed inside or outside the anus. Internal Piles or hemorrhoids are those which originate above the dentate line while external hemorrhoids are the ones which originate below the dentate line.
Types of Piles or hemorrhoids are given below.
Piles occur more commonly in young or middle-aged adults. Symptoms of Piles are listed below.
Piles are usually diagnosed by a physician based on the symptoms told by the patients. The physical examination usually involves back passage examination. With the use of lubricant by wearing gloves, physician examines the back passage for signs of piles.
When piles are not obvious after physical examination, further examination called Proctoscopy is recommended. In proctoscopic examination, a proctoscope is used, which involves a short hollow tube with a light at one end. Proctoscope helps in examining the back passage lining more clearly for confirming presence of piles.Differential diagnosis
In most of the cases, piles may resolve on their own. Timely treatments can help in reducing the discomfort significantly. Dietary and lifestyle changes can help in reducing pain and irritation. Straining on the toilet needs to be avoided to reduce the piles pain. Methods for treating the piles are described below.Treating piles with medicaments:
Over-the-counter topical medications, such as ointments, creams as well as suppositories are recommended for piles pain relief. These are no-prescription drugs. Self medication is not recommended in severe cases of piles where further treatments are required.
Corticosteroid creams which contain steroid can be used for treating inflammation around the anus area. Since these creams contain steroids, prolong use is not recommended as it can enhance the irritation. Painkillers such as acetaminophen are used for pain-relief.
In case of excessive bleeding in piles, use of Non-steroidal anti-inflammatory drugs (NSAIDS) need to be avoided as they may worsen bleeding. Laxatives are recommended to get relief from the constipation which is a root cause of piles most of the times. They help in emptying of bowels.Banding:
The process of banding involves tightening the piles or hemorrhoids with the help of elastic band to cut off blood supply. It is expected that hemorrhoids fall off after this process within a week. This is a day's process and no anesthetic is required. Patients can get back to work the next day after the banding process. Some pain and discomfort can be felt after the process which can be reduced with use of painkillers.
When hemorrhoids fall off, patients may not realize it as they are supposed to pass out of the body after going to the toilet. Presence of mucus discharge within one week period after the banding process indicates that the piles or hemorrhoid have fallen off.Sclerotherapy:
Sclerothearpy is an alternative treatment used to cure hemorrhoids. A chemical solution is injected into the blood vessels during this process in the back passage of the patient. This aids in relieving pain by making the nerves numb from the site of action, i.e., back passage. The size of piles gets reduced after about four to six weeks from this treatment. Heavy exercise is not recommended post treatment. One can return back to routine activities soon after the treatment.Electrotherapy:
This method is used to treat smaller sized piles and is also known as electrocoagulation. A device called proctoscope is used during Electrotherapy. A proctoscope is inserted inside the anus for confirming the location of piles or hemorrhoids. An electric current is passed by the specialist to the piles using proper procedure with the aid of controls attached to a metal probe placed at the base of piles. This treatment can be carried out on an outpatient basis with low electric current. A higher dose is given when anesthesia or spinal anesthesia is used. Electrocoagulation process can be somewhat painful but the pain does not last for long time. Rectal bleeding may occur as a side effect of this method for short period. Sometimes it can be used as an alternative to surgical methods.Stapled hemorrhoidopexy:
This method involves cutting a circular section of the anal lining canal above the piles with the aid of a circular stapling gun. This helps in pulling the piles back up the anal canal. This process also reduces blood supply to the piles which results in their shrinkage. Since the cutting process takes place above the piles, it is less painful.Surgical treatments:
Piles are treated with surgical methods when their severity is high. Surgery is recommended for piles formed below the dentate line. Different types of surgeries are carried out which involve removal of piles and can help the patient get rid of pain and discomfort.
Piles can be made less severe during pregnancy by making some dietary and lifestyle changes. These changes can help ease the piles pain and irritations. Given below are the changes to be made to ease piles.
Most of the times, patients feel embarrassed to seek medical treatment for piles. It is recommended to consult doctors when symptoms of piles are noted.
Following complications may occur due to untreated piles:
It is rare to observe loss of bowel control post piles or hemorrhoid surgery. Loss of bowel control occurs only when there is a sphincter damage.
In piles surgery, the extra tissue causing piles bleeding is removed with surgical treatment. Stapling process can also be used to block the blood flow so as to get rid of hemorrhoid as a consequence of it. Sphincter fibers are muscles that control the opening of anal movements. If this sphincter gets damaged, patients may need to replace it with artificial anal sphincters. In such cases, patient can lose bowel control.
Once diagnosis of piles is confirmed, some home remedies are used for reducing the symptoms of piles.
Squatting involves bending of knees towards the chest similar to yoga position where pressure can be felt on the abdomen. This helps normal defecation process without need of strain. Since legs are bent at the hips and knees are touching the chest during squatting process, most of the work is done by gravity. This further stimulates the body to initiate process of moving the waste matter towards colon, rectum and to the anus finally.
For treatment of constipation, laxatives are used. There are different types of laxatives, such as stimulant laxatives, saline laxatives and osmotic laxatives
Stimulant laxatives are those which induce bowel movements by enhancing the contraction rate of muscles in the intestines, and are effective only for a short term. Example of these laxatives include Bisacodyl, Senna compounds, Cascara and Aloe.Points to be considered while using stimulant laxatives are listed below.
Magnesium, citrate, sulfate and phosphate ions are the commonly used active ingredients in saline laxatives. These ions are responsible for drawing water into the intestines. This additional water helps in softening the stools and ultimately increase the intestinal contractions which leads to easier defecation process.
Saline laxatives should not be used in some patients due to absorption of active ingredients from the intestines into blood circulation. Saline laxatives in small doses are sometimes advised for the treatment of constipation, since larger doses may lead to complete evacuation of the intestine. The active ingredient in osmotic-type laxatives, such as GoLYTELY, MiraLax and GlycoLax are the active ingredients in osmotic laxatives.
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