Piles, better known as hemorrhoids, are located within the anal canal. There are typically two classes of piles: external and internal. Each indicates the location of the hemorrhoids. Once swollen or inflamed, they become pathological. Piles are one of today’s most common ailments, affecting several people.
Piles, or hemorrhoids, is classed as a varicose and is an inflamed condition of the anal veins, either within or just outside the anus. In the case of external piles, there will be a great deal of pain but not much bleeding present. When internal piles are present, there is a common discharge of a dark blood that is secreted. In the event that the veins burst, there will be a condition called bleeding piles.
Piles are seen as round swellings that are located within the anal canal, in the area termed as the anal cushions. Since there are many people that never seek treatment or consult a physician for piles, it isn’t known just how many cases there are. There are several different types of piles categorized in different degrees, based on symptoms and severity.
- First degree: Swellings located on inside lining of anal canal. Occasional bleeding but aren’t seen on the outside.
- Second degree: Large and protrude from anus during bowel movement, returning afterwards.
- Third degree: Same as second degree however do not return until pushed in.
- Fourth degree: Hang down permanently, not able to be pushed back inside the anus. Blood within can become clotted causing extreme swelling and pain.
- External: Swollen veins that develops below the anal cushions and are typically more painful than other types.
- Sentinel: Lumps that develops from anal fissure that heals and creates a painless skin tag.
There are other types as well, presenting different characteristics and locations. The pain typically increases towards the higher degrees and the more outer anal cushion piles.
Initial Symptoms & Causes
The symptoms can vary depending on the type, as well as the treatment. Fiber, oral fluids, NSAIDs, rest, and sitz bathing has been shown to be the most commonly recommended treatment. Rest is especially important as there are many complications associated with overexertion and overstress.
There are surgical measures that are taken when the piles does not respond to other treatment options. Many home remedies and herbal remedies are available, as well as over-the-counter medications that can be applied. A physician can also prescribe various medications to aid in the relief of the symptoms and the treatment of the piles for more severe cases.
There are several causes of piles, typically dependent upon the type and severity. Many of the causes are associated with functions of the anal canal, typically from some sort of irritation or strain that causes the veins to enlarge and many times protrude. Typically any over exerted activity can risk the development of piles, and should be avoided. Though some cases bleed, there are some that do not. However, treatment should be sought out to avoid progression of the affliction for any case. Worsening will continue through time causing them to get larger and more severe, especially if there is no change in stress or inexertion of the area.
There are a great many symptoms associated with Piles, each characteristic of the condition. The most common piles cases can show the least symptoms, sometimes going unnoticed for a bit of time until the inflammation and swelling increases. Many times, these cases will even often times resolve on their own in a few days. Typically, hemorrhoids are benign and are simply enlarged and swollen veins protruding the anal cavity below the anal cushion.
The external piles cases tend to be more painful and itchy, while the internal piles can be painless. Most commonly, the symptom of internal hemorrhoids is noticed during a bowel movement in which the stool will be covered by bright red blood.
This is a condition that is called hematochezia, and can be noticed in the toilet bowl or the toilet paper. Sometimes the internal piles will protrude through the anus, while many times they won’t. External hemorrhoids can be seen as a swollen lump around the anus, which will inflict a great deal of pain when inflamed.
The most common symptoms of hemorrhoids are:
- Itching of the anus
- Aching or pain around the anus, especially when sitting
- Bright red blood in the stool
- Painful bowel movements
- One or more painful, hard, and sore lumps around the anus
There are some cases when there can be a slimy mucus discharge of the anus as well, indicating there is a case of piles or even that the bowels haven’t been emptied entirely. These cases are typically dependent on the severity and type of piles that is present.
The actual cause for piles isn’t completely understood or known. However, there are theories that concern the cause, one being that there is a weakness of the anal tissue connecting the anal cushions too the muscle layers located underneath. When there is a straining during bowel movement, this anal cushions can slide out of place and down into the rectum. This presents itself as one or more hemorrhoids and can also be associated or complicated with diet.
Eating a low fiber diet can assist in causing the piles as the bowels will be much harder and more difficult to pass without strain. This strain passing these bowels could result in one or more piles developing. Constipation for this reason, is another thought to be cause of piles, which highly increases chances of developing the affliction.
Who Piles Effects
Piles are thought to afflict the elderly more so than the younger adults as the rectum structures aren’t supported as well. Pregnancy has a strong influence in the development and many women who are pregnant are at a high risk of developing the hemorrhoids. As the fetus bears down on the lower half of the woman’s body and as she strains to walk comfortably, these piles will erupt in mild to severe cases, sometimes resolving shortly after child birth. There are also some children born with a weak rectum structure, or have a family history of piles, which increases the risk of development.
Other causes are extended periods of sitting or standing, extremely strenuous working conditions, obesity, mental tension, and various bowel disorders.
There are several risks, most which correlate with the causes. Heredity, age, activity, and diet can play a large role in the risk for piles. Pregnant women are at an extreme risk due to the extra strain that is placed on the anal cushions. With the rapid weight gain and the disproportioned weight in the mid section, there is an increase risk for excessive strain.
The elderly are also at risk as age deteriorates muscle structure and strength. Children are typically not affected by hemorrhoids, but children can be born with weakened muscles in the rectum that will increase their risk of developing piles later in life. Constipation and other bowel disorders have a strong influence on the risk for developing the condition as this creates extreme strain and pressure.
There are 5% of Americans that are afflicted at one point of their lives with piles. Over one million people in the US are afflicted each year with hemorrhoids, yet many others don’t even report the condition, leaving many cases unaccounted for.
The best prevention method for piles is to maintain soft stool so there is no strain during bowel movement; this decreases the pressure and strain during bowel movement. It is also a necessary to prevent piles, to pass stool as soon as the urge occurs. Daily exercising, including jogging and walking, as well as a diet rich in fiber can reduce the chances of constipation and will assist in making softer stools so they are easier to pass. There should be minimal time attempting to defecate as this could create the slippage in the anal cushion that develops piles.
Test and Diagnosis Considerations
If there is bleeding occurring from the rectum, a physician should be contacted immediately in order to decrease any complications that may occur from the piles. The physician will typically diagnose according to description of the symptoms as well as an examination of the rectum and the anal canal. The exam will consist of inserting a gloved finger into the rectum gently to feel for any hemorrhoids. There will also likely be an evaluation of medical history.
Physicians also may use a proctoscope for looking inside the anal cavity. This proctoscope is a narrow, tube-like camera that will blow air through to open the bowel and see more clearly. This is a great test for ruling out the occurrence of worse complications that may be causing the bleeding and pain. There is also a sigmoidoscopy or colonoscopy test that is done within the hospital allowing the doctor to see inside the large bowel. These are tests that are typically done in order to ensure there isn’t a more serious condition causing the symptoms.
Although there are many treatment options for piles that can alleviate the symptoms and provide a great amount of relief from the swelling and pain, there is no cure for the condition. There are several home treatments that are basic and consist of relieving the symptoms through self help methods. There is also a great deal of medical treatments, and there are surgeries that can take place in the most severe cases of piles. Over-the-counter creams are great for treating the symptoms and are most commonly used.
Herbal and Home Remedies
The most common home remedy is to bath in sitz which is an antimicrobial liquid that can be poured into the bath to sooth any inflammations and prevents infections of many kinds. Other herbal and home remedies include the use of:
- Dry figs
- Mango seeds
- Jambul fruit
- Bitter Gourd
There are many other home treatments that include using onion, wheat grass, sesame seeds, and many other types of extracts. The most common remedy however is also a fiber rich diet that allows for softer and more passable stool. Exercise is also quite important to the treatment as it allows the bowels to remain strong and able to pass stool easily. There are also various laxatives that can be used to soften the stool when constipation.
There are several over-the-counter corticosteroid creams that are effective in alleviating pain and swelling. Witch hazel applied with a cotton swab can also be effective at reducing itching followed by several other steps including:
- Wear cotton underwear
- Perfumed or colored toilet tissue
- Avoid scratching as it will irritate and inflame more
Increasing fiber intake, oral fluids, and use of NSAIDs and taking advantage of rest can also be very effective at treating the condition, even decreasing the size of the hemorrhoids. Preparation H is a commonly used cream for piles, but will not cure the condition or make it go away. Many times there are flair ups that must be treated, as they occur, which could be often or seldom.
There are also various medical procedures that will be performed without surgical need, including:
- Rubber band ligation: elastic bands applied to internal hemorrhoid to eliminate blood supply, allowing it to wither and fall off. Cure rate is seen at 87%.
- Sclerotherapy: injection of sclerosing agent, including phenol, into the piles. The vein walls collapse and the hemorrhoid shrivels up and falls off. The success rate of this cure is 70%.
- Cautery: many methods such as electrocautery, infrared radiation, and cryosurgery are performed to remove piles.
If there is no response to medical treatment, there are some surgical techniques that are performed. They can cause urinary retention, or other complications associated with the surgery, as the surgery is performed so close to those organs. Types of surgery include:
- Hemorrhoidectomy: surgical excision of hemorrhoid used in severe cases. Requires 2-4 weeks for recovery.
- Doppler guided transanal hemorrhoidal dearterialization: taping off of Doppler located arteries providing blood to the piles. Minimal complications yet has high reoccurrence rate.
- Stapled hemorrhoidectomy: resection of soft tissue, disrupting blood supply to piles. Less painful than removing the hemorrhoids and has faster healing rate.
These surgical treatments are highly effective at removing the hemorrhoids; however there is no guarantee that there won’t be recurrence. The most severe cases are relieved with surgical measures, but these measures are much more costly than other non-surgical treatments.