Piles (Hemorrhoids) | Dr. Chintamani Godbole | Colorectal Surgeon

Piles | Hemorrhoids

Dr. Chintamani Godbole

MS, DNB (Surgical Gastroenterology), FRCS (Edinburgh, UK)

Consultant – Colorectal Surgery & Peritoneal surface Oncology

What is a piles?

A pile, also known as hemorrhoid, is a mass of tissue that contains dilated and thin-walled veins, as well as extra growth that develops in the inner and external area of the anus. Internal piles occur when there is excessive inflammation between 2 and 4 millimeters (cm) above the orifice of the anus. Internal piles is the most common form. External piles occur when anus veins get dilated under the skin around the anus.

What are the symptoms of piles?

Internal hemorrhoids

• Painless bleeding

• Perianal irritation and itching

• Perianal pain due to prolapse

• Acute pain

External hemorrhoids

• Acute thrombosis caused by physical strain and exercise

• Swelling, pain, and redness in the affected region

• Bright red bleeding after defecation

• Skin tags are excessively redundant, hanging skin.

• Infection and abscess development

• A painful perianal mass is present.

What are the different grades of piles?

• Grade 1: These are small hemorrhoids inside the anus lining.

• Grade 2: hemorrhoids are slightly larger than grade 1 hemorrhoids and also occur inside the anus. These hemorrhoids may be pushed out when passing stool, but they will gradually return to their normal position.

• Grade 3: These are also known as ‘prolapsed hemorrhoids’. They occur on the exterior of the anus. The patient can push them back in by pressing against them with fingers.

• Grade 4: These hemorrhoids cannot be moved back and must always remain outside the anus. They must be treated by a doctor, who will likely recommend surgery.

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What are the complications of piles if left untreated?

• Bleeding during bowel movements

Anemia

• Poor cleanliness in the anal region may result in a wide range of infections.

• Itching in the anal region

• Gangrene occurs when the blood supply to an internal hemorrhoid is disrupted.

What is the diagnosis of piles?

• Digital rectal examination,  proctosigmoidoscopy, and inspection of the anoderm, including the distal anal canal.

• Hematological examinations: CBC, hematocrit tests, and coagulation investigations

• Flexible sigmoidoscopy and anoscopy: Anoscopy is a required examination for hemorrhoids, and flexible sigmoidoscopy is performed to rule out the existence of any proximal condition.

• Proctography to indicate rectal prolapse

• Colonoscopy in some cases

What is the treatment of piles?

• If there is chronic bleeding, hemorrhoids may be treated in the hospital using proctoscopy for 1st and 2nd-degree hemorrhoids.

• Outpatient techniques like banding or sclerotherapy may be used to treat 2nd-degree hemorrhoids.

• Third and fourth-degree hemorrhoids need surgery. It is preferable to get it done while it is in the third degree since LASER surgery is an option that produces better outcomes.

Surgical Approach

• An open haemorrhoidectomy is a time-tested approach, however, pain management after the treatment is a concern. One may not be able to sit comfortably for almost a month. The pain threshold varies from person to person.

• Stapled Haemorrhoidopexy: A method used to alleviate the discomfort of an open procedure. Pain is significantly less compared to open procedures.

• When you have prolapsing hemorrhoids, this procedure may be done alone or in conjunction with mucopexy.

• LASER Procedure for Haemorrhoids: LASER has recently revolutionized the treatment of hemorrhoids. The main benefit is that it combines haemorrhoidal artery ligation with LASER, resulting in a better outcome than other procedures. Pain associated is very minimal.