Piles (or hemorrhoids) are enlarged clusters of veins located just beneath the innermost lining of the anus. They develop when these veins become swollen and distended, similar to varicose veins in the legs.

There are two types of piles:

1. Internal piles – These occur within the anal canal and are not visible.

2. External piles – These develop on the external skin around the anus and are usually more uncomfortable because the overlying skin often becomes irritated.

If a blood clot forms inside an external pile, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot typically dissolves over time, but it may leave behind excess skin (known as a skin tag), which can cause itching.

Internal piles are usually painless, even when they bleed. For example, you might notice bright red blood on toilet paper or dripping into the toilet bowl. However, internal piles can prolapse or extend beyond the anus, which may lead to additional problems.

When a pile protrudes, it can collect small amounts of mucus and stool particles, causing irritation around the anus. Excessive wiping to relieve the itching may worsen the problem.

What Causes Piles?

Piles are often associated with:

• Chronic constipation or diarrhea.

• Straining during bowel movements.

• Prolonged sitting on the toilet.

These actions increase blood flow to the anal area, causing the veins to swell and enlarge. Piles are also common during pregnancy when the enlarging uterus presses on the veins.

Additional risk factors include:

• Prolonged sitting or sedentary lifestyles.

• Heavy lifting.

• Obesity.

• Weakening of connective tissues with age, which can cause piles to bulge and prolapse.

Diagnosing Piles

Piles can be diagnosed during a clinic visit and physical examination. External piles are generally visible, especially if a blood clot has formed.

A digital rectal exam may be conducted to check for blood in the stool. The anal canal can also be examined with an anoscope — a short, illuminated plastic tube inserted into the rectum.

If there is evidence of rectal bleeding, a flexible colonoscopy may be required to rule out other causes of bleeding, such as colorectal polyps or cancer, particularly in individuals over 45.

Treatment of Piles

Medications

Not all piles require surgery. Treatment depends on the size of the piles and the severity of symptoms. Conservative approaches often work for small or internal piles:

• Regular exercise.

• Good bowel habits.

• A high-fibre diet.

Medications, such as ointments and oral treatments, can also provide relief.

While small piles may resolve on their own, there is a 10-50% chance they will recur over five years. Seek medical advice if you experience:

• Prolonged rectal bleeding, especially fresh blood without stool.

• Sustained pain from strangulated piles (when blood supply to prolapsed piles is blocked).

• Symptoms of infection, such as increasing anal lump size, worsening pain without bowel movements, or fever.

Non-Surgical Options: 

Non-Surgical Options

For suitable-sized piles, non-surgical treatments include:

1. Rubber Band Ligation: An outpatient procedure where an elastic band is placed on the pile's apex to cut off its blood supply. The pile shrinks, and the band falls off within a few days. This procedure is less painful with shorter recovery times and has a 60-80% success rate. Repeated ligation may be performed if piles recur.

2. Electrocoagulation: A low electric current creates scar tissue that cuts off blood supply, causing the pile to shrink.

3. Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL): This technique, sometimes combined with anolift, is an option for selected internal piles.

Surgical Options

Surgical procedures are recommended for external piles or prolapsed internal piles. These include:

1. Hemorrhoidectomy:

   • Conventional surgery: Removal of piles using a scalpel.

   • Ligasure Hemorrhoidectomy: Minimises blood loss and post-surgical pain.

2. Stapled Hemorrhoidectomy: The prolapsed piles are stapled back into place inside the anus. This method is associated with less post-operative pain but has a higher recurrence rate compared to conventional hemorrhoidectomy.

3. Plastic Surgery: Used for larger treatment areas, involving removal of the sinus and reconstruction of the surrounding skin.

After Your Operation

Do:

• Keep the surgical area clean.

• Wear loose-fitting cotton underwear.

• Eat fibre-rich foods to ease bowel movements and avoid straining.

Don't:

• Lift heavy objects.

• Engage in strenuous exercise while the area is healing.