FAQ - Piles

Piles  

What is piles ?

To a layman, any trouble around anus is piles. But scientifically speaking, only painless, frank bleeding while passing motion is piles (hemorrhoids). The rectum is the last part of the intestine and it ends into the anus. The wall of the rectum, has a tissue area containing a network of small veins. One on the left, and two on the right. In some individuals, this tissue may enlarge, along with its blood vessels. This enlargement constitutes piles : internal piles. In some other individuals, there may be similar enlargement of the tissue and blood vessels beneath the anal skin. This is called external piles. It can be felt by hand, around the anus.

Why do piles occur ?

Erect posture causes stagnation of blood in the rectal veins. In some persons, these veins may be inherently defective; and they swell up with a slight increase in the pressure inside. They are more likely to develop piles. This tendency for piles runs in families. Constipation tends to produce piles. A constipated person has to strain during defecation. The rectal veins swell up due to the increase in pressure. This pressure also elongates the surrounding anal tissues. Together they form the piles. Hard stools damage the rectal veins causing bleeding during defecation. Other causes of piles include. The foetus in a pregnant woman’s womb A tumour in the abdomen. A cancerous growth in the rectum : all these exert pressure on the rectal veins. Cirrhosis also can cause piles.

What are the symptoms of piles ?

Almost anybody having piles may suffer from frank bleeding during defecation. This bleeding is like bleeding from a fresh wound. Sometimes, bleeding occurs just by straining even if there are no hard stools. Compared to other rectal diseases, bleeding in piles is painless. But if it gets complicated, it can be painful. But there may be other complaints like protrusion of the rectum, wetness and itching around anus. Due to excessive bleeding, the haemoglobin level in the blood goes down causing tiredness, weakness, breathlessness on walking, lack of appetite etc.

How is piles diagnosed ?

Any person with frank painless bleeding during defecation has to be examined rectally. A small tube like instrumentthe rectoscope- can be inserted through the anus to see the exact site, size and number of piles. If cancer of the rectum is suspected, a longer tube, sigmoidoscope, is used which will even show the upper portion of the rectum.

What is the treatment ?

If piles is caused by the pressure exerted by the foetus or an abdominal tumour, this secondary piles will reduce after delivery or after surgery for the tumour. If no such cause exists, the piles are called primary piles and require treatment. If in the initial stage, primary piles can be treated with medicines and specific (fibre-rich) diet. The main treatment to arrest piles is to prevent constipation. You have to include fibre-rich food in the diet; for example, green leafy vegetables, other vegetables, fruits etc. Drink a lot of water. Avoid food items like bread and biscuits as they contain very little fibre. Jowar or bajra roti are good to prevent constipation. Also avoid hot, spicy food as they may cause bleeding.

Which surgical operation is done for piles ?

The following surgical options are available. These Surgical procedures are simple *o perform, but the piles recur after 5 to 10 years. Hence, generally, they are done only in exceptional circumstances. Sclerotherapy An irritant, sclerosing medicine is injected at the root of the piles. This causes irritation followed by ‘sclerosis’ in the piles, making it shrink in size. Band ligation The piles is held with a forceps and a thick, strong, rubberlike band is applied at its root by a special instrument. The pile-tissue gets strangulated, dies and falls off in about 8-10 days. Cryosurgery The temperature of the piles is reduced to less than that of ice through a special instrument. This kills the piles tissues which fall off in a few days. This may cause lot of pain and the piles can recur later. Hence this therapy is generally not advised. Excision of piles This surgery is employed most frequently. In this operation, the piles inside and outside the anus are excised and a thread is tied at their bases. The remaining part of the piles along with this thread falls off in about 8-10 days. It takes about 3-4 weeks for the wound to heal. Piles do not recur after this surgery. Underrunning of the piles In this operation, instead of excising the piles, the piles are stitched with the underlying tissue with a special thread. The small veins in the piles are tied up so that the bleeding stops immediately. The piles can recur 5-10 years after this operation.

 What precautions are needed after the surgery ?

Avoid spices or chillies for a month after surgery as they may cause irritation in the surgical wound. The doctor may advise you to take paraffin oil so that stools would pass smoothly without rubbing the surgical wound. Sit in a warm water tub after passing motion. This gives comfort and keeps the wound clean. Bath can be taken from the second day of operation. The bandage is to be reapplied on the wound after the bath. As sitting can be painful for a few days after the operation, a cushion of the shape of a scooter-tube can be used to avoid pressure on the anal region and the consequent pain.

How long one has to stay in the hospital ?

Once it is clear that the surgical wound would not bleed, when surgical pain gets reduced, and meals are started, the patient can go home; generally, in about 3 to 5 days after the operation. However, the surgeon has to examine the patient by inserting his gloved finger through the anus; every week for 6 weeks. This is necessary to prevent narrowing of the anus (Stricture).

Can this operation lead to any complications ?

When a well-qualified, well-trained doctor does this operation with due care, in 95% of patients there are no complications. But despite due care, in about 5% of patients, complications like bleeding, infection in the surgical wound and narrowing of the anus can occur.

 

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