18:49
Dr. Ajay Srivastava
Hemorrhoids or haemorrhoidsare vascular structures in the anal canal which help with stool control. They becomepathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of stool. The symptoms of pathological hemorrhoids depend on the type present. Internal hemorrhoids usually present with painless rectal bleeding while external hemorrhoids present with pain in the area of the anus.
Recommended treatment consists of increasing fiber intake, oral fluids to maintain hydration, NSAID analgesics, sitz baths, and rest. Surgery is reserved for those who fail to improve following these measures.
CAUSES AND TYPES:-Piles and their symptoms, which are one of the most common afflictions in the Western world, are also seen commonly in India. Not many people like to talk about it hence true statistics in India are not available. In the west over half the population over the age of 50 suffer from it. However they can occur at any age and can affect both women and men.
Because the presence of pile tissue is normal, it acts as a compressible lining which allows the anus to close completely. Disease should be thought of as pile tissue that causes significant symptoms. Unfortunately, piles tend to get worse over time, and disease should be treated as soon as it occurs.
An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include:
Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened veins protrude
Piles may be caused by more than one factor. Piles can be either internal or external, and patients may have both types. External piles occur below the dentate line and are generally painful. When inflamed they become red and painful, and if they become clotted, they can cause severe pain and be felt as a painful mass in the anal area. Internal piles are located above the dentate line and are usually painless. Dentate line is a line seen in the anal canal that demarcates the area with pain sensation from that without it.
Piles that protrude into but do not prolapse out of the anal canal they are classed as grade I; if they prolapse on defecation but spontaneously reduce they are grade II; piles that requiremanual reduction are grade III; and if they cannot be reduced they are grade IV. Piles that remain prolapsed may develop thrombosis and gangrene
SYMPTOM:-
- Bleeding,
- Faecal soiling,
- Itching, and
- Very occasionally pain.
Internal hemorrhoids cannot cause cutaneous pain, but they can bleed and prolapse. Prolapsing internal hemorrhoids can cause perianal pain by causing a spasm of the sphincter complex. This spasm results in discomfort while the prolapsed hemorrhoids are exposed. The discomfort is relieved with reduction. Internal hemorrhoids can also cause acute pain when incarcerated and strangulated. Again, the pain is related to the sphincter complex spasm. Strangulation with necrosis may cause more deep discomfort. When these catastrophic events occur, the sphincter spasm often causes concomitant external thrombosis. External thrombosis causes acute cutaneous pain.
Internal hemorrhoids can deposit mucus onto the perianal tissue with prolapse. This mucus with microscopic stool contents can cause a localized dermatitis, which is called pruritus ani. Generally, hemorrhoids are merely the vehicle by which the offending elements reach the perianal tissue. Hemorrhoids are not the primary offenders.
DIGNOSEING THE PILES:-The diagnosis is made by examining the anus and anal canal, and it is important to exclude more serious causes of bleeding, such as cancer. No relation between piles and cancer has been found. A simple look inside is done by a procedure called proctoscopy where a 3 inch long hollow instrument with a diameter of about 1 inch is introduced in the rectum and with the help of a torch, the inside is looked at by the doctor. The procedure is painless but uncomfortable and lasts about 1 minute and is done in the OPD. A more detailed look can be done by a procedure called sigmoidoscopy that is done under sedation or anesthesia and a look upto 25 cm can be done to rule out any sinister disease that may be associated.
Occasionally, a barium examination or colonoscopic examination of the large intestine may be required if other diseases are suspected
TREATMENT OPTIONS:-Symptoms are due to prolapse, thrombosis, and vascular bleeding; therefore, creams and salves have a small role in treating hemorrhoidal complaints. Suppositories, except for providing lubrication, have a small role in the treatment of hemorrhoidal symptoms.
Bathing in tubs with warm water universally eases painful perianal conditions. Relaxation of the sphincter mechanism and spasm is probably the etiology. Ice can relieve the pain of acute thrombosis.
Many patients see improvement or complete resolution of their symptoms with the above conservative measures. Aggressive therapy is reserved for patients who have persistent symptoms after one month of conservative therapy. Treatment is directed solely at symptoms and not at the hemorrhoids’ appearance. Many patients have been referred for surgery because they have severely swollen prolapsed hemorrhoids or very large external skin tags. When questioned, the patients are asymptomatic. It has been said, "You can’t make an asymptomatic patient feel better." Treat hemorrhoids only if they cause the patient problems. Similarly, patients often ask when they should have surgery. Remind them that their hemorrhoids do not bother anyone else, and they should opt for aggressive treatment only when symptoms become bothersome.
The treatment choices for piles include :
- Injection sclerotherapy,
- Cryosurgery (cold probe),
- Rubber band ligation,
- Infrared coagulation (photocoagulation),
- Radiofrequency coagulation,
- Direct current/ bipolar coagulation,
- Hemorrhoidal arterial ligation (HAL),
- Hemorrhoidolysis,
- Anal stretch
,
- Scalpel (standard) surgery,
- Laser surgery and
- Stapled surgery.
Homeopathic treatment for Piles
Homeopathy greatly helps in curing piles specially the 1st 2nd and 3rd degree piles and no surgery should be thought of till homeopathy has been tried. Some of the most commonly used medicines in treating piles are:
Hamamelis –Q –very very useful in controlling bleeding caused due to piles
Aesculus hip-piles with acute pain in the back
Collinsonia..chronic painful bleeding piles with pain as if sticks were placed in the rectum.
Graphitis-for piles and fissures with hard stools
Ratanhia-pain as if splinters of glass were sticking in the rectum
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