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Piles

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Introduction
Piles are tissue collections in the anal and rectal region (generally 2 to 4cm inside the anus if internal and around the anal sphincter if external) that get swollen and inflamed. They come in various sizes and can affect persons immaterial of age, ethnicity, gender etc. With internal haemorrhoids, one may not experience any symptoms. But straining can push internal haemorrhoids outwards (Ex: thrombosed haemorrhoid), which gets painful, hard and inflamed, causing discomfort, bleeding, itchiness and pain.
Piles causes (In adults/ kids/pregnant women)
The causes of piles in adults can be attributed to:
●Straining/ sitting for long during bowel movements
●Obesity.
●Pregnancy.
●Chronic constipation and diarrhoea.
●Anal intercourse
●Lifting heavy weights.
●Extended periods of sitting down.
●A low-fibre diet
●Genetic factors and increase in age.
Piles are quite rare in infants. Since piles are caused due to straining and increasing pressure around the anus, the causes of piles in children are
●Constipation
●Straining during bowel movements
●Diarrhoea
●Excess weight
●Holding back the bowel urges.
Piles are known to develop frequently in pregnant women, especially during the third trimester or just after birthing. The causes may be due to:
●An increased volume of blood and more prominent anal veins during pregnancy.
●Anal pressure on veins due to the growth of the uterus and the growing baby.
●Hormonal changes
●Constipation.
●Extended straining in childbirth.
In men and adults, piles can also be caused by the increased lower rectum pressure swelling due to:
●Chronic constipation.
●Diarrhoea.
●Obesity and poor diet.
●Anal intercourse.
●Lifting weights.
●Sitting or straining on the toilet.

Symptoms and Signs
The symptoms noticed depend on the type of piles.
External haemorrhoids:
●Itching around the anus.
●Discomfort, pain and swelling around the anus.
●Bleeding.
Internal haemorrhoids:
●Small volumes of painless bleeding when passing stools.
●Pain and itching due to the haemorrhoid (Protruded or prolapsed haemorrhoid) pushing through the anus.
Thrombosed piles
These piles occur when blood clots in a swollen (thrombosed) anal vein and results in:
●Swelling, inflammation and severe pain.
●A lumpy or clotted vein near the anus.

How are piles diagnosed?
Piles may be classified as follows.
Grade I: Mostly internal, not visible and small inflammations.
Grade II: Larger but still inside the anus. At times they get pushed out and retract on their own.
Grade III: Prolapsed haemorrhoids or pushed out piles appear outside the anus and can be re-inserted.
Grade IV: These need treatment as they cannot be pushed back. They remain as small/ large protrusions outside the sphincter of the anus.
In infants and young children, piles are harder to pinpoint. However, it is better to consult a paediatrician at Midas Hospitals if your child has these symptoms:
●Hard lumps around the anus.
●Blood streaks and mucus in the stool.
●Crying to pass motions.
●Dry hard stools.

When you visit the doctor, diagnosis starts with the:
Physical Exam: The doctor generally will do a physical examination of the area, check symptoms, medical history, genetic predisposal and medications taken. Questions regarding the frequency of passing stools, the colour of the stools, relatives with piles, weight loss etc., are explored.
The internal examination of the anal region and rectum may involve inserting DRI- digital rectal instruments like the proctoscope into the anus. The proctoscope itself is a small tube with a camera that allows the doctor to study the inside area and collect a tissue sample for lab tests.
Blood tests: The doctor may order tests like urine, blood and stool tests, while women may be advised to take a pregnancy test.

Treatment
Haemorrhoids generally are not severe and disappear on their own. Piles treatment can be self-managed up to III/ IV grades. When complications arise (e.g., fistula), the best treatment for piles are surgical options done as outpatient procedures requiring minimal time to recover.
Piles treatment advice/plans depend on stages of the piles, and the triggers vary across individuals. Generally, you will be advised on how to cure piles, against smoking, alcohol consumption, and advised to reduce weight, eat a balanced diet, reduce stress-inducing situations etc.
The doctor may prescribe:
OTC /Over-the-counter medications: These consist of pads, creams, painkillers, ointments etc., to soothe the anal region. If the symptoms stretch beyond seven days, seek medical advice. Remember, the skin is very delicate and using self-medication, herbal remedies etc. may be a bad idea.
Corticosteroids: These help with reducing pain and inflammation.
Laxatives: These help with constipation and pressure reduction of the colon.

Surgical options:
About 10% of the patients may need piles treatment through surgical interventions described below.
●Sclerotherapy: Here, medicines are injected, causing the haemorrhoid to shrink and is effective for haemorrhoids of grades 1,2, 3 and is an alternative to the banding method.
●Banding: This involves an elastic band being placed at the base of the piles to cut off the blood supply and encourages the haemorrhoid to fall off. It is effective for cases less than a grade 4 haemorrhoid.
●Infrared coagulation: In this method, infrared light is used to burn/cauterise the haemorrhoid tissue and is suitable in grade 1, 2 haemorrhoids.
●Hemorrhoidectomy: The excess bleeding tissue can also be surgically removed. The operation is conducted using sedative/local anaesthesia, spinal anaesthesia or general anaesthesia.
●Stapling: This method is less painful than hemorrhoidectomy and cuts off the blood flow to the haemorrhoid. Complications like rectal prolapse, recurrence of piles, UTI etc., are known to occur due to surgery.

Preventive measures:
Piles most often resolve themselves without the need for piles treatment and medications/ surgery. However, the pain, swelling, discomfort in passing stools, constipation, etc. can be dealt with through lifestyle changes:
●Eating a diet of high-fibre, including vegetables, fruits, bran cereals etc. and drinking sufficient water.
●Avoid coffee.
●Weight management through regular exercise
●Avoiding sitting too long, riding 2-wheelers, lifting weights etc

Warning Signs
If you see bleeding when passing stools, changes in bowel habits, have pain, altered bowel habits and discomfort when passing stools, or feel dizzy, lightheaded etc., consult a doctor at Midas Hospitals immediately for a proper diagnosis and appropriate piles treatment. Also, sometimes piles lead to rectal bleeding due to anal/ colorectal cancers, anaemia and such complications.

Conclusion:
Piles are not life-threatening and generally disappear on their own or with minimum out-patient surgical aid and piles treatment. If you have the above symptoms approach the doctors in Midas Hospitals for evaluation and treatment. Piles cures are best when not self-medicated.

FAQs
Are piles genetically inherited?
There is a good chance they are. Speak to your doctor about it.
Can babies get piles?
It is rare but possible. Consult your paediatrician.
Do pregnancy haemorrhoids disappear?
Most often, they appear during pregnancy and may/ may not disappear subsequently.
What is the best way to treat piles naturally?
Have a healthy lifestyle, eat a balanced, high-fibre diet and drink plenty of water.
Does anal sex lead to haemorrhoids?
Most often, yes, when done without appropriate lubrication.

Reference:
https://docs.google.com/spreadsheets/d/1kblLjTTnmPbcJFuZQ0piYRbs3sBKCxWw/edit#gid=1586350786
https://www.medicalnewstoday.com/articles/239454#outlook
https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268