Haemorrhoids (Piles)

Hemorrhoids are dilated veins located in the wall of the lower rectum and anus. Hemorrhoids occur when the normal veins in the lower rectum or anus become enlarged. They may eventually bleed or become inflamed or develop a blood clot (thrombus). They may be of two types namely internal or external (skin tags). Both internal and external hemorrhoids may remain in the anus or protrude outside the anus.

Increased pressure in the veins of the anorectal area leads to hemorrhoids. This pressure may result from pregnancy, from frequent heavy lifting, or from repeated straining during bowel movements (defecation). Constipation may contribute to straining. Rarely hemorrhoids develop from increased blood pressure in the portal vein. A doctor can distinguish the dilated, twisted veins that occur in this condition from common hemorrhoids.

Symptoms and Diagnosis

Hemorrhoids can bleed, typically bright red blood after a bowel movement, The blood may turn water in the toilet bowl red. However, the amount of blood is usually small, and hemorrhoids rarely lead to severe blood loss or anemia.

Hemorrhoids that protrude from the anus may need to be pushed back gently with a finger, or they may go back by themselves. A hemorrhoid may swell further and become painful if its surface is rubbed raw or if a blood clot forms in it. Less commonly, hemorrhoids may discharge mucus and create a feeling that the rectum is not completely emptied after a bowel movement. Itching in the anal region is usually not a symptom of hemorrhoids, but itching may develop if hemorrhoids make proper cleaning of the anal region difficult.

A doctor can readily diagnose swollen, painful hemorrhoids by inspecting the anus and rectum. An examination with a proctoscope helps a doctor confirm the disease. Further tests may be need to be done to exclude other conditions of the bowel such as tumor.

Treatment

Usually, hemorrhoids do not require surgical treatment unless they cause symptoms. Taking stool softeners and high fiber diet relieve constipation and straining with bowel movements, which helps reduces the incidence of bleeding. Pain and swelling can sometimes be relieved by soaking the anus in warm water with some rock salt, in what is known as a sitz bath.

Bleeding hemorrhoids which dose not respond to stool softeners can be treated with an injection of a substance that causes the hemorrhoids to become obliterated with scar tissue; this procedure is called injection sclerotherapy.

Large internal hemorrhoids and those that do not respond to injection sclerotherapy can be tied off with rubber bands (a procedure called rubber band ligation). The band causes the hemorrhoid to wither and drop off painlessly. Internal hemorrhoids may also be destroyed with a laser (laser destruction), an infrared light (infrared photocoagulation), or an electrical current (electrocoagulation).

Surgery to remove the hemorrhoids is useful if other treatments fail. Surgery is the only treatment for prolapsing hemorrhoids and external skin tags. Earlier hemorrhoid surgery was associated with severe pain. Now, less painful techniques such as diathermy surgery and circumferential stapled hemorrhoidectomy are routinely performed as day care procedures

When a hemorrhoid with a blood clot (thrombus) causes pain, it is treated with warm sitz baths and local anesthetic ointments. Pain and swelling usually diminish after a short while, and clots disappear over 4 to 6 weeks. Alternatively, especially when the pain is severe, a doctor may cut the vein and remove the clot, which sometimes relieves the pain rapidly.

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Submitted By:
DR RAVINDRAN KUMERAN

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