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Piles: Causes, Risk Factors, Symptoms, And Treatment

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“World Piles Day” is observed on November 20th every year to spread awareness about piles.

Piles, clinically termed as hemorrhoids, is a common disorder among adults in India. It is a condition that causes inflammation and swelling of the blood vessels in and around the anal and rectal region. Although it occurs frequently in the adult population, a considerable number of people with the condition do not complain about the symptoms of piles. Many patients suffer in silence for a long period before seeking medical care.

According to the 2017 research study published in The Indian Journal of Surgery [1], more than 50% of men and women aged 50 years and above will develop hemorrhoid symptoms during their lifetime. Moreover, approximately 5% population suffer from hemorrhoids at any given point of time. So to get a clear idea about the causes, symptoms, types, and treatment of piles, Dr. Parameshwar CM, Chief, SIICP (Bengaluru Smiles), explains in detail about piles.

What Are The Causes And Risk Factors Of Piles?

The actual cause of hemorrhoids remains unknown. The chances of suffering from piles increase with age. However, even children and the elderly have also been diagnosed with this condition. There are certain common factors that increase your risk of suffering from piles. These are:

-Constipation

-Sedentary lifestyle

-Inadequate fiber intake through diet

-Postponing bowel movements frequently

-Lifting heavy weights regularly

-Straining to expel stools most often

-Chronic diarrhea

-Smoking and alcohol

-Use of over the counter medication (NSAIDS)

-Familial history of hemorrhoids

-Have high BMI (body mass index) or obesity

-Being stressed

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What Are The Different Types Of Piles?

Piles are classified into internal and external piles. Internal piles are present within the rectum and usually do not hurt because there are less pain-sensing nerves in the rectum. External piles are present within the anus and are often uncomfortable. If they prolapse to the outside (usually in the course of passing a stool), it can be seen or felt.

However, the 2017 consensus committee has proposed a new classification of hemorrhoids[1], which classifies piles into four grades.

Grade 1: Piles that lead to small inflammations which remain inside the anal lining.

Grade 2: Piles that protrude when passing stool and reduce spontaneously

Grade 3: Piles that hang from the rectum but can be easily re-inserted into the rectum.

Grade 4: Piles that remain prolapsed outside and cannot be pushed back in. They are usually large and remain outside the anus (external hemorrhoids).

What Are The Signs And Symptoms Of Piles?

Usually, the signs and symptoms of piles are not serious and subside on its own after a few days. The patient might feel:

-Bowels are still full

-The area around the anus is itchy, red or sore

-Pain when he/she pass stool

-A hard and possibly painful lump that contains coagulated blood around the anus

-The appearance of blood in stools

Piles are usually self-diagnosable. Based on the symptoms, your doctor will either do a physical examination or a rectal examination (which may include colonoscopy) to diagnose the condition.

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What Are The Treatment Options For Piles?

Dr. Parameshwar says that only 10% of piles cases may require surgery, rest 90% are treatable by diet and medicine.  

The symptoms of piles can also be managed using medications which include over the counter painkillers, ointments, creams, and pads all of which can help soothe redness and swelling around the anus. It’s important to remember that over the counter medications can help manage the symptoms of piles but do not treat it. Hence, consult your doctor to get the right treatment to treat the condition. Also, some doctors may prescribe laxatives for piles caused by constipation. Laxatives help you to pass stool more easily and reduce pressure on their lower colon.

There are certain advanced treatment options for piles such as-

LASER surgery: It shrinks or removes the piles.

DG-RAR (Doppler-guided recto-anal repair) surgery: The procedure reduces the blood flow to the haemorrhoidal cushions which leads eventually to the fibrosis and shrinking of hemorrhoid.

Stapled haemorrhoidectomy: In this procedure, the doctor uses a stapler-like device to repose hemorrhoid and cut off their blood supply. In the absence of the blood supply, the hemorrhoids eventually shrivel and die.

Radio frequency ablation: It uses high-frequency radio wave energy to incise, excise, or coagulate tissues.  

IRC or infrared coagulation therapy: In this, infrared energy is used to scar the hemorrhoid tissue resulting in the reduction of its mass.

Talk to your doctor to know the right treatment option based on your condition.

Tips To Manage Piles

For the majority suffering from piles, the disease resolves itself on its own. People suffering from piles may be required to make certain lifestyle changes. This include:

Eating food rich in fiber. This is because piles can occur due to straining during bowel movement. As excessive straining is a result of constipation, people suffering from piles may benefit by including more fiber as it makes stools soft and regular.

Losing weight. Obese people are more likely to suffer from piles hence, it is advised to lose weight to alleviate the symptoms of piles. Weight loss regimens that include a balanced diet and regular exercise will help alleviate the symptoms of piles.

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Avoiding self-medication. It is always advised to consult your doctor if you feel that the symptoms are worsening or if any of the medications you are taking are not providing any relief. Consult your doctor to change the medication than trying out OTC medications to get rid of pain. Also, take home remedies only after consulting your doctor.

Staying hydrated. Make sure you drink loads of water to stay hydrated. You can even opt for fresh fruits and vegetables which are high in moisture and has good amounts of fibre such as oranges, banana, etc.

Not delaying the urge to visit a washroom. When you feel the urge to go to a washroom, go immediately. It is not a good idea to wait or delay the washroom visit as it puts off more pressure on the bowel movements and aggravate hemorrhoids.

(The article is reviewed by Dr. Lalit Kanodia, General Physician)

Recommended Reads:

9 Foods To Avoid If You Are Suffering From Piles

Piles: What else could it be?

References:

1. Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A. Executive Summary –
The Association of Colon & Rectal Surgeons of India (ACRSI) Practice Guidelines
for the Management of Haemorrhoids-2016. Indian J Surg. 2017 Feb;79(1):58-61.

2. Ali SA, Shoeb MFR. Study of risk factors and clinical features of hemorrhoids. Int Surg J 2017;4:1936-9.

3. Ravindranath GG, Rahul BG. Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre. Int Surg J 2018;5:496-9.

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