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What are Piles? and Piles Treatment | Treatment of Piles
"Hemorrhoids" are like Cushions, composed of arterio- venus channels & Connective tissues, in anal canal, which helps in regulation or control of stools. Due to excessive stress sometimes they become pathological or "Piles “with symptoms of Swelling & inflammation. Condition is known as "Varicose Veins inflammation" in ano-rectal region.
Piles can be internal & external & initially can be characterized by slight pain & itching sensation while defecation, later on it becomes worse with daily bleeding & pain along with external or internal lumps or lobules like structures.
Piles can come at any age, but they’re most common in age groups of 45 to 65. It’s difficult to exactly know the number of people getting piles, but in UK, between four and thirty people in every 100 are thought to get piles or hemorrhoids in their life span
Piles are very common during pre & post pregnancy. They may develop due to hormonal changes (chemicals) in your body and the increased pressure in your abdomen, although doctors aren't sure. However condition improves & gets better once your baby is born.
Types of Piles
Depending on the origin & morphology Piles or Hemorrhoids are broadly classified as :-
☛ Internal Piles (Hemorrhoids): Occurs in Anal Canal & Rectum.
☛ External Piles (Hemorrhoids): Outside Anal Canal near anal opening.
Internal Piles are further classified as :-
☛ Grade-I :- Hemorrhoids (Piles) are still in the interior anal canal & there is no protrusion or prolapsed. However there is minor itching or pain.
☛ Grade-II :- Hemorrhoids (Piles) are similar to grade-I however bleeding is also observed at this stage. Additionally some small protrusion will come outside during bowels & reverts back to its original position.
☛ Grade-III :- When hemorrhoids reaches at stage-III, they have all the symptoms of earlier stages only the prolapsed or protrusion will not return to its original position on its own & must be manipulated back into the anal canal manually.
☛ Grade-IV :- This is a final stage and haves all symptoms of earlier stage except haemorrhoids can no longer be manipulated back into place in the rectum.
SYMPTOMPS OF PILES :-
Piles don’t always cause pain or other symptoms. Other symptoms are -
☛ Bleeding along with bowel movement – you may see blood on toilet paper or on your faeces.
☛ A lump in or around your anus.
☛ A feeling that your bowels haven’t emptied completely.
☛ Watery discharge or mucous from anus, or leaking faeces.
☛ Itchy or sore skin around your anus.
☛ Pain and discomfort during or after a bowel movement.
Above symptoms can be caused by problems other than piles, such as inflammatory bowel disease, anal cancer, bowel cancer & anal fissure (tear) so always consult your Doctor in such conditions.
Treatment of Piles :-
Piles are common & often mild and get better with some simple lifestyle improvements. There are numerous things that you can do for effective treatment of piles.
Self-help or self treatment of piles patient :-
By making diet and lifestyle changes, you can often help to relieve symptoms of piles. For example, eating a high-fibre diet like raw fruit and vegetables, cereals and fibre supplements will make your stools softer and ease bowels. This is important for reducing the pressure on the veins in your anus caused by straining when you have a bowel movement. Drink enough fluid to keep hydrated, and don’t have too much caffeine or alcohol.
Try not to strain when you’re passing a bowels. Afterwards, gently clean around your anus with water or moist wipes and pat it dry. Regular warm sitz baths twice or thrice a day may relieve some of your symptoms. Some experts think there isn't enough evidences that sitz baths help to treat piles though.
☛ If you’re passing hard faeces, a fibre supplement such as psyllium husk (isabgol) or mild laxative such as lactulose will soften your faeces. Don’t use laxatives that stimulate your bowel, unless your doctor or pharmacist recommends it you.
☛ Over-the-counter painkillers, such as paracetamol, diclofenac etc. may help to get relief from any pain you have.
☛ Soothing creams, ointments and suppositories may ease any pain and itchiness. There are many different products available over the counter. Some contain a local anaesthetic such as lidocaine.
☛ Corticosteroids may reduce swelling and pain. Don’t use these for more than a week as it can damage the skin around your anus.
It may take few weeks for your symptoms to improve with self-help measures and medicines. If the symptoms still persist with self help measures and medicines, take advice from your Doctor.
Non-surgical treatment of piles :-
There are certain treatments that you’ll need to go into hospital for as an outpatient. You won’t usually have to stay overnight. These include the following :-
☛ Banding. This treatment of piles involves placing a small elastic band around the pile, which cuts off the blood supply. This causes it to die and fall off after a few days. The area left behind will heal up naturally.
☛ Sclerotherapy. In this treatment of piles oily phenols are injected into the base of the pile masses (lumps) .This shrinks the piles & clots the blood inside piles.
☛ Infra-red coagulation or laser treatment of piles. This treatment of piles uses infra-red light to seal the veins above the pile, which causes it to shrink.
☛ Bipolar diathermy and direct current electrotherapy treatment of piles - This treatment of piles uses an electrical current to destroy the pile.
☛ Ksahrasutra (Thread Therapy)- Special Ayurvedic medicine for piles are coated on threads which are tied on hemorrhoids to shrink it.
☛ Doppler-guided haemorrhoidal artery ligation. This treatment of piles uses an ultrasound probe to find an artery in your anal canal that can be stitched up to limit the blood supply to your piles.
However your doctor will advise you the benefits and risks of the procedure recommended for you.
Surgical Treatment of Piles :-
Most piles don’t need surgery for piles treatment. Surgical treatment of piles is required in case of severe or older piles when all other treatments haven’t worked or your piles keep bleeding. There are different types of surgery, including the ones below.
☛ Haemorrhoidectomy- In this technique any pile masses, causing problems are carefully removed.
☛ Stapled Haemorrhoidopexy- the area of tissue with piles is stitched higher up your anal canal. This means your piles or hemorrhoids won’t come out your anus anymore and will shrink gradually.
The type of surgery that your doctor recommends for you will depend on the size and number of piles you have. Stapled haemorrhoidopexy is often recommended because people usually have less pain and faster healing than with haemorrhoidectomy.
Your doctor will explain the risks of the procedure to you, and the symptom relief you can expect.
CAUSES OF PILES
Modern Lifestyle, Junk food,Stress,improper eating habits accounted for a majority of Ano-rectal complications like Piles, Fissures & Fistula. In all Ano-rectal diseases major contribution is of a Varicose veins inflammation which in normal terms are swollen veins. There can be a lot of reasons for these ailments however the basic reasons are:-
☛ Improper eating habits,Junk food.
☛ Straining to empty your bowels, for example if you have constipation.
☛ Indigestion & Prolonged Constipation.
☛ Ageing – as you get older you may be more likely to get piles because your anal canal weakens.
☛ Diarrhoea lasting a long time.
☛ Long-term coughing.
☛ Having a family history of piles.
☛ Excessive Oily, Spicy, fatty & Non-Veg food.
☛ Lack Of High Fiber Diet.
☛ Long sitting working hours.
☛ Prolong use of Antibiotics & Allopathic drugs.
☛ Pregnancy & Overweight.
☛ Excessive Heavy weight lifting .
PREVENTION OF PILES
Small changes in lifestyle can make your bowels regular & faeces soft, thus preventing constipation and piles.
☛ Eat plenty of fibre-rich foods such as fruit, vegetables, wholegrain cereal, wholegrain rice and pasta, nuts, beans and pulses. Aim to eat 20 to 30g of fibre a day. As a guide, half a cup of bran cereal contains nearly 10g of fibre and a medium-sized apple has about 3.5g.
☛ Drink plenty of fluids & have lite but regular exercise.
☛ Avoid caffeinated drinks & Alcohol.
☛ Avoid sitting for long time in same place.
☛ Don’t fight the urge, when you have to go, go. This is one of the simplest ways to prevent Piles. “Ignoring Nature's Call has its own risks, and hemorrhoids are one of them”.
COMPLICATIONS OF PILES
☛ Piles are very common & rarely cause any serious problems but may lead to some complications, such as:-
☛ Formation of ulcers on external piles
☛ Thrombosed piles – This is where a blood clot forms within a pile, causing severe pain.
☛ Skin tags can occur when the inside of a pile shrinks back but the skin remains.
☛ Mucus discharge from anus can cause the surrounding skin to get very sore and damaged.
☛ Severe piles (fourth degree) can sometimes get strangulated, means they lose their blood supply & becomes very painful and causes the tissue to die.
☛ Gangrene may develop from stage-IV internal Piles which can be life-threatening also.
☛ Perianal abscess/sepsis may occur. As the blood vessels are directly connected to the liver, any infection in anal region can easily spread All over the body and cause serious complications like portal pyemia, septicemia, coma & death.
☛ Untreated Piles or repeated piles surgery in long term can lead to very rare rectal cancer.
☛ piles can make you feel self-conscious (about having sex for example). If you need any advice, contact your Doctor.
FAQ’S ABOUT PILES(Hemorrhoids)
What are Piles or Hemorrhoids?
☛ Haemorrhoids, also known as piles, are enlarged veins situated in or around the back passage (anus). They occur when these blood vessels become swollen or pathological.
How Piles are caused?
☛Under pressure the blood vessels in and around the anus stretch & becomes inflamed. Chronic coughing and lots of heavy lifting are common ways that pressure in the abdomen is increased and that in turn results in increased pressure in the veins located around the anus. Pregnancy, being overweight and childbirth can also cause piles.
Will diet & lifestyle improvement solve the symptoms of piles?
☛As straining on the toilet is one of the common cause for piles to develop, avoiding constipation and having to strain is important to improve symptoms. Eating a healthy diet, having plenty of fresh fruit, vegetables and other dietary fibre, drinking plenty of water, keeping active and keeping stress levels under control & proper sleep will help in regular & proper bowels.
Ayurvedic ingredients like trifla are very common in avoiding constipation.
Are skin tags the same as piles?
☛No, skin tags aren't the same as piles, but you may have them if you get piles. Usually, you won’t need any treatment for skin tags. Taking care to clean around any skin tags after every bowel movement will reduce soreness and itching
Does sitting on cold surfaces cause Piles?
☛No. This is a very common belief but it’s a myth. Sitting on hard or cold surfaces may make haemorrhoids feel more uncomfortable for those people who already have them but will not actually cause Piles. Ignoring the urge to go to the toilet, inactivity, missing breakfast or eating on the go, however, can cause constipation, which makes straining and consequently haemorrhoids more likely.
What can I use to reduce the symptoms of Piles?
☛Ice packs help reduce swelling and sitting in a warm bath filled with plain water for 5-10 minutes three times a day will relieve symptoms too. Try not to sit for long periods of time since this may cause more irritation. You can visit your Doctor for advice on treatment to relieve pain and irritation. Stool softeners can be used to get the bowels working properly again and help to eliminate the need to strain.
What can I do to stop getting Piles again?
☛Make sure your diet contains plenty of fibre, drink lots of fluids and increase the amount of exercise you get. These measures will help prevent constipation, one of the main causes of Piles.
My job requires full day sitting in front of computer. Will this give me piles?
☛Sitting for long intervals on the same place increases the ano-rectal complications. Have regular breaks, in these breaks stand up and walk around. At lunchtime, take a walk, even just for minute or five.
What will happened if I do not take treatment for my Piles?
☛Condition can become worsen with time, eventually leading to complications. Surgery is needed only in about 10% of patients with piles. So we should not delay in getting an early diagnosis & proper treatment. Ayurvedic medicines for piles are one of the best piles treatment options.
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Reviewed by Nisha Shivhare, Sera Gurung, Vishal Dubey &, Ayushmaan Health Content Team, June-2015.
Peer reviewed by Dr D.K Sharma (Physician) & Dr.Ashok Sharma (BAMS)
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