About Hemorrhoids / Piles

Hemorrhoids / Piles, commonly referred to as piles, are swollen or inflamed veins in the lower rectum or anal area. These enlarged blood vessels can occur inside the rectum (internal) or under the skin around the anus (external). Hemorrhoids form when pressure increases in the lower rectum, often due to constipation, excessive straining, or prolonged sitting. Though not life-threatening, they can be extremely painful and disruptive to daily comfort particularly in people over age 40 or during pregnancy.

What Are Hemorrhoids / Piles?

Piles are vascular cushions in the anal canal that become engorged due to stress or inflammation. Based on location, they are:

• Internal Piles: These develop deep within the rectum and typically cause painless bleeding during bowel movements.
• External Piles: Found under the skin around the anal opening, these are more likely to be painful and itchy.

In some cases, external hemorrhoids can clot (thrombose), leading to severe discomfort and a hard lump.

Types of Hemorrhoids / Piles

• Internal Hemorrhoids : These remain inside the rectum and are often painless but may bleed. They can bulge out during straining and retract or remain prolapsed.
• External Hemorrhoids : These appear as lumps around the anus and may hurt or itch, especially when sitting or wiping.
• Thrombosed Hemorrhoids : These occur when blood clots form in an external hemorrhoid, causing intense pain and swelling.

Hemorrhoids / Piles : Signs and Symptoms

Patients with hemorrhoids may experience:

• Fresh red bleeding during bowel movements
• Anal itching or soreness
• Pain or a burning sensation while seated
• Notable swelling or lumps near the anus
• A feeling of incomplete evacuation

Advanced or untreated piles may protrude from the anus and require manual repositioning.

Hemorrhoids / Piles Causes

Hemorrhoids are generally caused by increased pressure or strain on the veins in the rectal region, including:

• Habitual constipation or diarrhea
• Frequent straining while passing stool
• Prolonged periods on the toilet
• Pregnancy-related pressure
• Overweight and obesity
• Lack of dietary fiber

Hemorrhoids / Piles Risk Factors

Certain individuals are more likely to develop hemorrhoids due to:

• Ageing: Tissues supporting veins tend to weaken with age
• Pregnancy: Increased blood volume and pelvic pressure
• Sedentary lifestyle: Lack of activity worsens bowel health
• Low-fiber consumption: Makes stools harder to pass
• Obesity and lifting heavy objects: Heightens rectal pressure

Hemorrhoids / Piles Complications

If not addressed promptly, hemorrhoids may result in:

• Ongoing blood loss leading to anemia
• Severe clotting within the hemorrhoid (thrombosis)
• Strangulation of prolapsed hemorrhoids
• Infection or formation of painful abscesses

Hemorrhoids / Piles Diagnosis

Diagnostic steps may include:

1. Clinical History & Visual Check

• Discussion of symptoms like bleeding, discomfort, or protrusion
• Visual exam of the anal area

2. Digital Rectal Examination (DRE)

• A finger exam to feel for internal abnormalities

3. Anoscopy or Proctoscopy

• A small, lit scope is inserted to view the rectal canal

4. Colonoscopy or Sigmoidoscopy

• Advised if bleeding is persistent or to rule out other GI conditions

Hemorrhoids / Piles Treatment & Management

Management depends on the size, location, and severity.

1. Conservative Approaches:

• Increasing fiber and fluid intake
• Sitz baths to soothe irritation
• Use of anti-hemorrhoidal creams or suppositories

2. Minimally Invasive Methods:

• Rubber Band Ligation: Cuts off the blood supply to shrink the hemorrhoid
• Sclerotherapy: Injection of solution to reduce internal piles
• Infrared Therapy: Destroys tissue via heat to reduce symptoms

3. Surgical Procedures:

• Stapled Hemorrhoidopexy: Repositions prolapsed hemorrhoids and limits blood flow
• Conventional Hemorrhoidectomy: Complete removal of hemorrhoids in severe cases