Based on their position within the anal canal, piles are classified into different degrees:
1. First degree piles: These refer to small piles which are present within the anal canal and do not protrude out beyond the anus
2. Second degree piles: These point to the types of piles that may prolapse out of the anal canal but they could also spontaneously go back into the canal
3. Third degree piles: These piles tend to protrude out beyond the anal canal and cannot be pushed back inside. The diagnosis of such piles is commonly done by visual inspection and use of a special instrument called proctoscope. On visualizing through the proctoscope, the piles appear in three positions-3, 7 and 11 o’clock. They are purplish red and resemble bright red grapes.
Experts are divided on exactly what causes hemorrhoids, but probably several mechanisms are at work. Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which interfere with blood flow to and from the area, causing it to pool and enlarge the vessels. This also explains why hemorrhoids are common during pregnancy, when the enlarging uterus presses on the veins.
More recent studies show that patients with hemorrhoids tend to have a higher resting anal canal tone — that is, the smooth muscle of the anal canal tends to be tighter than average (even when not straining). Constipation adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter muscle. Finally, the connective tissues that support and hold hemorrhoids in place can weaken with age, causing hemorrhoids to bulge and prolapse
Unless there is rectal bleeding, most people with hemorrhoids can diagnose and treat the problem themselves. If you have rectal bleeding, it is important for you to seek care from a physician, so that more dangerous causes of bleeding can be ruled out. Here are some of the common symptoms of hemorrhoids
- Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
- Itching or irritation in your anal region
- Pain or discomfort
- Swelling around your anus
- A lump near your anus, which may be sensitive or painful
- Leakage of feces
There are two kinds of hemorrhoids: internal ones, which occur in the lower rectum, and external hemorrhoids, which develop under the skin around the anus.
1) External hemorrhoids are the most uncomfortable, because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin (a skin tag), which may itch or become irritated.
2) Internal hemorrhoidsare typically painless, even when they produce bleeding. You might, for example, see bright red blood on the toilet paper or dripping into the toilet bowl. Internal hemorrhoids may also prolapse, or extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and microscopic stool particles that may cause an irritation called pruritus ani. Wiping constantly to try to relieve the itching can worsen the problem.
Most of the hemorrhoidal symptoms can’t be managed on your own. Keep in mind that your treatment may differ depending on your symptoms and the location of the hemorrhoid.
If your symptoms continue to persist, your doctor may recommend removing the hemorrhoid. In most cases, no special preparation is needed. This is done at a surgical center. Haemorrhoids can be treated with open surgery or with the stapler. In stapler procedure there is comparatively less pain at the operative site and the recovery period is fast.
External hemorrhoids are often painless. However, recently prolapsed haemorrhoids maybe painful because the swollen hemorrhoid stretches the sensitive skin around it. To relieve the pain, your doctor may remove the blood clot if the conservative treatment doesnot work. This takes just a few minutes. You may need to rest for a few days before returning to work.
- Numbing the Hemorrhoid: You’ll be asked to lie or kneel on a table. The hemorrhoid is then injected with a local anesthetic. This may cause some discomfort for a moment. But within a short time your doctor will be able to remove the hemorrhoid without causing pain.
- Removing the Hemorrhoid: A small incision is made to remove the blood clot. The hemorrhoid may also be removed. The skin is then either closed with sutures or left open to heal on its own. The area around the incision will likely be sore for
You’ll be asked to lie or kneel on a table. Your doctor then inserts an anoscope to view the anal canal. To treat the hemorrhoid, your doctor will use one of the methods listed below. Because internal hemorrhoids do not have nerves that sense pain, you won’t have too much discomfort. You can often return to your normal routine the same day. If you have many hemorrhoids, you may need repeated treatments.
The banding method is done by placing tight elastic bands around the base of the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to fall off. This usually takes about a week. The area then heals within a few days.
Sclerotherapy is done by injecting a chemical into the tissue around the hemorrhoid. The chemical causes the hemorrhoid to shrink within a few days. Bleeding usually stops in about 24 hours.
Can be done by open method and by stapler. In the stapler method there is less pain and early return to work.
- Certain baseline investigations like urine analysis and hemoglobin is usually done.
- Depending upon the overall health condition and age factor, more tests may be required.
- The patient will be required to starve for a minimum of about six hours before the surgery.
- The patient will be given an enema to help him move his bowel and empty it.
- The skin over the anal region is shaved clean of any hair.
In order to make the bowel movements painless and easy, the patient is given suppositories and stool softeners.
Any types of external wounds are taken care of by having twice daily “sitz baths”.
Sitz baths - In this the patient is asked to sit in warm water with some medication added after they have moved their bowels for about 10 to 15 minutes. After the bath, fresh bandages can be applied.
The surgeon reviews the healing process in the form of follow-ups after regular intervals.
Dr. Harsh Garg | Alchemist Hospital, Sector-21, Panchkula | House No.1183, Sector-7, Panchkula (Haryana) | All Rights Reserved