Problem of ‘PILES’ or a pile of problems?

Dr. Varun Dogra

The word “Haemorrhoids” (aka piles) is derived from the Greek word “haema” meaning blood, and “rhoos” meaning flowing. It was in 460 BC when Hippocrates first applied thisterm. The burden of this disease is around 10 -12% in Indian population.
What isPiles?
Piles, also known as Haemorrhoid (Bawasir), is a condition in which a personhas swollen and inflamed blood vessels in the rectum & anal canal that leads to discomfort and bleeding. This disease carries a social stigma along with it, and hence, patients often hesitate to seek timely medical help. The disease causes a lot of discomfort and hampers productivity in professional life. It is thus very important to break the silence and seek medical help for the problem. Excessive straining during defecation (passing stools), obesity or pregnancy are a few of the risk factors.

What are the signs and symptoms of Haemorrhoids?
Haemorrhoids can present with symptoms depending upon their location. When they are present inside the rectum, they are called Internal Haemorrhoids. Patients with internal Haemorrhoids may complain of painless, bright red bleeding from the anus, usually accompanied with straining or difficulty during defecation. Sometimes with persistent straining, haemorrhoids may prolapse out while defecating, which can cause pain. Haemorrhoids developing under the skin around the anus are known as external haemorrhoids. Patients often feel something protruding out of the anal canal. They may also complain of bleeding from the anal canal. There are instances where there is just discomfort, itching and mucus discharge around the anal region accompanied by repeated episodes of constipation.
What should be done if a patient has such symptoms?
If the patient has such symptoms, he should immediately seek medical help by consulting a surgeon. A surgeon will evaluate for the cause of haemorrhoids and may do a rectal examination. If needed, an inspection through a proctoscope (Instrument used to visualize the interior of the anal canal) may be done. Patients above 50 years may also be advised to undergo a Colonoscopy before the institution of any treatment.
What are the various treatment options in cases of Haemorrhoids?
Most of the patients can be treated without any surgery with the help of a few medicines. Patients are advised to take a sitz bath and a high-fibre diet. Stool softeners are also advised to avoid any straining and bleeding. In addition, analgesics are prescribed to avoid pain.
Then there are certain day-care procedures such as haemorrhoid banding, infrared photocoagulation, cryotherapy, electrocoagulation and sclerosant injection therapy, which can be employed for early grades of haemorrhoids in case conservative therapy fails. Surgical options are also available, but they should be used only in advanced stages of diseases. Surgical options include Open Surgery, Haemorrhoid stapling and Laser Haemorrhoidoplasty.
What is Sitz Bath?
Sitz bath has a pivotal role in the treatment of haemorrhoids. A patient needs to sit in a tub of lukewarm water with two to three teaspoons of antiseptic solution added to it. Generally, sitting in the water for ten to fifteen minutes two times a day will suffice. The anal region should be fully submerged in the water while taking a sitz bath. The idea is to relax your anal sphincter and increase blood flow through the tissues, which in turn promotes healing and reduces pain, itching and irritation.
What can be done to prevent haemorrhoids?
Prevention is always better than cure. Few changes in lifestyle and diet can help us to prevent this problem.

  1. A fibre-rich diet (Salads, fruits, etc.) goes a long way in the prevention of haemorrhoids.
  2. Keep ourselves adequately hydrated. At least 6-8 glasses of fluid should be taken daily.
  3. Avoid food that leads to constipation, such as excessive red meat.
  4. Excessive and prolonged straining during defecation is to be avoided. It causes greater pressure in the veins of the lower rectum, leading to Haemorrhoids.
  5. Avoid prolonged periods of sitting on the toilet seat. Carrying Mobile phones into the toilet is an upcoming cause of poor bowel habits!
    Busting Myths about Haemorrhoids!
    * All cases of bleeding from the anal canal are not haemorrhoids. They can be anything from a fissure to a cancer. Hence, asurgeon’sadvice is of paramount value.
    * All cases of haemorrhoids don’t cause pain. It’s usually the external haemorrhoids that are painful.
    * All cases of haemorrhoids do not require surgery. In fact, most of the cases can be treated with medicines, and very few people require surgery.
    * Haemorrhoids can recur after surgery if due precautions are not taken. Surgery doesn’t mean you won’t have it again.
    * OPD Procedures like banding and sclerosant injection therapy are not meant for external haemorrhoids. Once such a procedure is done in external haemorrhoids, it can lead to excruciating pain in the patient.
    * Colonoscopy is very important in elderly patients complaining of bleeding from the anal canal, and advice for colonoscopy should not be taken lightly.
    (The writor is Assistant Professor, Department of General Surgery, AIIMS Vijaypur, Jammu).
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