Overview

What is Piles?

Commonly referred Piles or medically referred to as Haemorrhoids or Bawaseer in Hindi is a condition that affects the anal or rectal region i.e. where we pass stools from. Piles is a mass that is around the anal region and when the blood vessels mainly veins, dilate i.e. become larger or more open due to downward sliding, they get irritated and bleed.

What are the symptoms that can be easily identified by the individual themselves?

• Bleeding (Blood colour bright red like a splash in a pan) is the most common symptom.
• Itchiness in the anal area.
• Sticky discharge
• Painful mass protruding outside the anus

Pain occurs if there is associated infection, anal spasm or in cases of prolapsed piles.

What can cause piles?

• Chronic constipation
• Low fibre diet
• Straining while passing stools
• Lifting heavyweights
• Increasing age
• Increased anal tone

Constipation is the major risk factor associated with piles. 

Why should you not delay treatment?

Delaying treatment for piles may cause problems that are not severe but can create a lot of discomforts. Haemorrhoids can lead to the following problems such as,

• Anaemia (Loss of blood, leading to decrease in oxygen-carrying capacity)
• Masses of tissue hang out on the skin
• Infection
• Progression of disease from Grade 1 to Grade 4
• Thrombosis of piles
• Persistent pressure while passing of stool may lead to prolapse of the rectum

Can problems in piles be prevented?

Yes, generally problems in piles go away on their own as constipation is a major cause that can be naturally treated. When diagnosed early then the disease progression can be slowed by following simple home remedies and by undergoing nonsurgical treatments. 

How can it be confirmed if you have piles?

Generally, piles can cause bleeding after passing stools. Hence, the doctor would do a physical check. Based on history, physical examination and anoscopy, the doctor can diagnose piles.

During a digital rectal examination, a gloved and lubricated finger is inserted to get a feel inside the anus. Then a small camera (anoscope/proctoscope) is inserted and the anal/rectal area is examined to check for any abnormalities. 

What is the treatment?

Home remedies

• Have a diet rich in fibres (legumes, green vegetables, whole grains, cucumbers, apples, Triphala). This helps in the generation of a good amount of poop which gets excreted comfortably without much pressure or strain.
• Drink plenty of water.
• Do not hold stools for a longer time or postpone it. You must attend your nature calls whenever you feel the urge to go to the toilet!
• Avoid sitting on the toilet seat (Asian or western type) for a long time beyond necessary. Nowadays use of mobile phones or reading something while sitting is common because of which you could lose track of time and also focus on defecating thereby putting continuous or more excessive pressure while pooping. A step stool to elevate feet while sitting on the toilet is recommended.
• An individual can use an ice pack or take a warm bath to ease pain and keep the anal region clean and dry.
• Avoid low-fibre foods such as:
•         Dairy products, 
•         White flour
•         Fried foods
•         Salty foods
•         Red meat
•         Spicy foods
•         Caffeinated beverages
•         Alcohol etc.

Medications 

If one does not get any relief from the home remedies, then there are several medicines a doctor can prescribe,

• Local applications such as ointments or creams relieve itching and swelling.
• Laxatives to ease constipation.
• Sitz bath which is a warm therapeutic bath for the delicate genitals cleanses the anal region and fastens the healing process by increasing the blood flow in the area.
• Take pain relief medicines like paracetamol (one should not use medicines that contain codeine as it can increase constipation). One should avoid pain relief medicines like ibuprofen if they have bleeding due to piles.

Several ayurvedic preparations are also available for managing piles, such as Vijaya Churna or Pathyadi Kwatha.

Procedure / Intervention / Nonsurgical options

If piles do not improve by home remedies and prescription medicines, then they can be treated by non-surgical / surgical options
1. Nonsurgical /Procedure/Intervention
Recommended when home remedies and prescription medicines did not work

• Rubber band ligation
• Sclerotherapy
• Cryotherapy
• Infrared Coagulation (IRC)
• Doppler-guided Haemorrhoidal artery ligation (DGHAL)
• Laser Therapy

2.  Surgical
Treated surgically if none of the therapies mentioned worked. Your treating Doctor decides the intervention based on the  severity of your condition

• Open Haemorrhoidectomy
• Laser Haemorrhoidectomy
• Stapler Haemorrhoidectomy

Surgical treatment is one of the best options to achieve long-term success from piles. Nowadays, surgery methods have advanced to be painless and minimally invasive for easy recovery and minimum to no pain.

Few research studies have shown improvement in erectile dysfunction problems if any in male haemorrhoid patients post-Haemorrhoidectomy.

Irrespective of the severity of piles, it can be easily treated and must not be ignored. Many Doctors have confessed that patients do not approach them in the initial stages due to unwarranted attention or shame, they consult only when the problem is unbearable.