Hemorrhoids
Everything you need to know about piles
Written by Adam Felman
Medically reviewed by Daniel Murrell,
M.D.
Piles is
another term for hemorrhoids.
Hemorrhoids
are collections of inflamed tissue in the anal canal. They contain blood
vessels, support tissue, muscle, and elastic fibers.
Many people
have piles, but the symptoms are not always obvious.
Hemorrhoids
cause noticeable symptoms for at least 50 percent of people in the United
States (U.S.) before the age of 50 years.
This article
will explore piles, their causes, how to diagnose, grade, and treat them, and
what effects they might have on the body.
Fast facts on piles:
o Piles are collections of tissue
and vein that become inflamed and swollen.
o The size of piles can vary, and
they are found inside or outside the anus.
o Piles occur due to chronic
constipation, chronic diarrhea, lifting heavy weights, pregnancy, or straining
when passing a stool.
o A doctor can usually diagnose
piles on examination.
o Hemorrhoids are graded on a scale
from I to IV. At grades III or IV, surgery may be necessary.
What are piles?
A person with
piles may experience swollen collections of tissue in the anal area.
Piles are
inflamed and swollen collections of tissue in the anal area.
They can have
a range of sizes, and they may be internal or external.
Internal
piles are normally located between 2 and 4 centimeters (cm) above the opening
of the anus, and they are the more common type. External piles occur on the
outside edge of the anus.
Symptoms
In most
cases, the symptoms of piles are not serious. They normally resolve on their
own after a few days.
An individual
with piles may experience the following symptoms:
o A hard, possibly painful lump may
be felt around the anus. It may contain coagulated blood. Piles that contain
blood are called thrombosed external hemorrhoids.
o After passing a stool, a person
with piles may experience the feeling that the bowels are still full.
o Bright red blood is visible after
a bowel movement.
o The area around the anus is itchy,
red, and sore.
o Pain occurs during the passing of
a stool.
Piles can
escalate into a more severe condition. This can include:
o excessive anal bleeding, also
possibly leading to anemia
o infection
o fecal incontinence, or an
inability to control bowel movements
o anal fistula, in which a new
channel is created between the surface of the skin near the anus and the inside
of the anus
o a strangulated hemorrhoid, in
which the blood supply to the hemorrhoid is cut off, causing complications
including infection or a blood clot
Piles is
classified into four grades:
o Grade I: There are small
inflammations, usually inside the lining of the anus. They are not visible.
o Grade II: Grade II piles are
larger than grade I piles, but also remain inside the anus. They may get pushed
out during the passing of stool, but they will return unaided.
o Grade III: These are also known as
prolapsed hemorrhoids, and appear outside the anus. The individual may feel
them hanging from the rectum, but they can be easily re-inserted.
o Grade IV: These cannot be pushed
back in and need treatment. They are large and remain outside of the anus.
External
piles form small lumps on the outside edge of the anus. They are very itchy and
can become painful if a blood clot develops, as the blood clot can block the
flow of blood.
Thrombosed
external piles, or hemorrhoids that have clotted, require immediate medical
treatment.
Causes
Pregnancy may
increase the risk of developing piles.
Piles are
caused by increased pressure in the lower rectum.
The blood
vessels around the anus and in the rectum will stretch under pressure and may
swell or bulge, forming piles. This may be due to:
o chronic constipation
o chronic diarrhea
o lifting heavy weights
o pregnancy
o straining when passing a stool
The tendency
to develop piles may also be inherited and increases with age.
Diagnosis
A doctor can
usually diagnose piles after carrying out a physical examination. They will
examine the anus of the person with suspected piles.
The doctor
may ask the following questions:
o Do any close relatives have piles?
o Has there been any blood or mucus
in the stools?
o Has there been any recent weight
loss?
o Have bowel movements changed
recently?
o What color are the stools?
For internal
piles, the doctor may perform a digital rectal examination (DRE) or use a
proctoscope.
A proctoscope
is a hollow tube fitted with a light. It allows the doctor to see the anal
canal up close. They can take a small tissue sample from inside the rectum.
This can then be sent to the lab for analysis.
The physician
may recommend a colonoscopy if the person with piles presents signs and
symptoms that suggest another digestive system diseases, or they are
demonstrating any risk factors for colorectal cancer.
Treatments
In the
majority of cases, piles resolve on their own without the need for any
treatment.
However, some
treatments can help significantly reduce the discomfort and itching that many
people experience with piles.
Lifestyle changes
Eating a high
fiber diet may help to prevent and treat the condition.
A doctor will
initially recommend some lifestyle changes to manage piles.
Diet: Piles can occur due to straining during bowel movements. Excessive
straining is the result of constipation. A change in diet can help keep the
stools regular and soft. This involves eating more fiber, such as fruit and
vegetables, or primarily eating bran-based breakfast cereals.
A doctor may
also advise the person with piles to increase their water consumption. It is
best to avoid caffeine.
Body weight: Losing weight may help reduce the incidence and severity of piles.
To prevent
piles, doctors also advise exercising and avoiding straining to pass stools.
Exercising is one of the main therapies for piles.
Medications
Several
medicinal options are available to make symptoms more manageable for an
individual with piles.
Over-the-counter (OTC) medications: These are available over-the counter
or online. Medications include painkillers, ointments, creams, and pads, and
can help soothe redness and swelling around the anus.
OTC remedies
do not cure piles but can help the symptoms. Do not use them for more than 7
days in a row, as they can cause further irritation of the area and thinning of
the skin.
Do not use
two or more medications at the same time unless advised to by a medical
professional.
Corticosteroids: These can reduce inflammation and pain.
Laxatives: The doctor may prescribe laxatives if a person with piles suffers
from constipation. These can help the person pass stools more easily and reduce
pressure on the lower colon.
Surgical options
Around 1 in
10 people with piles will end up needing surgery.
Banding: The doctor places an elastic band around the base of the pile,
cutting off its blood supply. After a few days, the hemorrhoid falls off. This
is effective for treating all hemorrhoids of less than grade IV status.
Sclerotherapy: Medicine is injected to make the hemorrhoid shrink. The hemorrhoid
eventually shrivels up. This is effective for grade II and III hemorrhoids and
is an alternative to banding.
Infrared coagulation: Also referred to as infrared light
coagulation, a device is used to burn the hemorrhoid tissue. This technique is
used to treat grade I and II hemorrhoids.
Hemorrhoidectomy: The excess tissue that is causing the bleeding is surgically removed.
This can be done in various ways and may involve a combination of a local
anesthetic and sedation, a spinal anesthetic, or a general anesthetic. This
type of surgery is the most effective for completely removing piles, but there
is a risk of complications, including difficulties with passing stools, as well
as urinary tract infections.
Hemorrhoid stapling: Blood flow is blocked to the hemorrhoid tissue. This procedure is
usually less painful than hemorrhoidectomy. However, this procedure can lead to
an increased risk of hemorrhoid recurrence and rectal prolapse, in which part
of the rectum pushes out of the anus.
Outlook
While they
can be painful and debilitating, piles do not usually pose any ongoing threat
to health and can be self-managed up to grades III or IV.
If a
complication develops, such as a fistula, this can become serious.
The surgical
options for more advanced piles are normally outpatient procedures with minimal
recovery time.
Adam
Felman is an Editor for Medical News
Today and Greatist. Outside of work, he is a hearing impaired musician,
producer, and rapper who gigs globally. Adam also owns every Nic Cage movie and
has a one-eyed hedgehog called Philip K. Prick.
Dr.
Daniel Sallis Murrell is an associate
professor specializing in internal medicine and infectious disease. He
graduated from the University of Tennessee Health and Science Center in 2014
with his degree in medicine. He recently completed his residency at the
University of Illinois at Chicago. Dr. Murrell is also an urban health program
mentor. His personal interests include brewing beer, childrearing, and
literature.
https://www.medicalnewstoday.com/articles/239454.php
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