Haemorrhoids (piles) : Common Questions & Answers

What are piles( Haemorrhoids)?

Piles or haemorrhoids are specialized, vascular cushions located in the anal canal.( lower end of your back passage)

How are they caused?

Some believe that activities that cause raised intra abdominal pressure are responsible for the formation of haemorrhoids. This increase may be secondary to straining, excessive time spent on the toilet, or constipation. Other factors that can cause haemorrhoidal irritation include diarrhea

and dehydration. Women in the third trimester of pregnancy commonly report hemorrhoidal swelling caused by increased intravascular volume and the oestrogen sensitivity of haemorrhoidal tissues

 Will diet improve symptoms? It is said that sitting on cold surfaces cause piles, is this true?

Diet high in Fiber sometimes tend to improve symptoms as it will alleviate constipation, inturn helping reduce the raise in intraabdominal pressure.

There is no evidence to suggest that sitting on cold surface causes piles.

 Many patients are asked to sit in warm water. How does this help?

It is true that majority of patients with problems in the perianal area including piles are sometimes asked by the physicians to sit in a tub of warm water. It enhances the comfortable/ soothing feeling and reduces the discomfort associated with perianal problems.

 How it is diagnosed and what are the treatments available?

Haemorrhoids are diagnosed by a combination of symptoms and proper clinical examination which include external and internal examination atleast by proctoscopy. Haemorrhoids can be Internal or external associated with perianal skin or a comibination of both called intero external haemorrhoids.

Haemorrhoids are usually responsible for painless fresh bleeding, which is often intermittent. Pain associated with haemorrhoids usually are external and occur due to complications which include prolapse , thrombosis & ulcerations.

Treatment usually is non-operative. The mainstay of non-operative hemorrhoidal treatment is to increase fiber and water consumption. Evidence suggests that fiber supplementation can reduce symptoms and bleeding, although this effect may take several weeks to manifest. Patients should

also be educated on lifestyle modifications, including the avoidance of prolonged sitting or straining on the toilet, perianal hygiene, and avoiding triggers of constipation or diarrhoea.

Surgical treatment options for symptomatic haemorrhoids (piles) include Office procedures ( Outpatient procedures) . These are infra red coagulation, Sclerotherapy, Cryotherapy, and Rubber band ligation. Of these Rubber band ligation is widely practised due to cost restraints associated with the rest of the procedures. All of these above procedures rely on tissue destruction and

resultant tissue fixation caused by fibrosis. Operative ( Surgical) therapy for symptomatic haemorrhoids include Excisional haemorrhoidectomy,

stapled Haemorrhoidopexy and Doppler guided transanal Haemorrhoid devascularisation ( HALO procedure)

 Which age group is it very prominent?

It can occur in later age groups but known to occur predominantly during pregnancy and in elderly

patients.

 Will it persist despite measures? How can one avoid getting piles?

Very rarely it may persist in spite of supportive measures. These group of patients should be investigated further for rare causes, which can include malignancy. Sticking to simple lifestyle changes and avoiding the risk factors responsible to increase the abdominal pressure may help in avoiding symptoms with Haemorrhoids.

 Is it seen as an social embarrassment to address the issue?

It is still percieved to be as a cause of social embrassment in some, particularly in older women. Fortunately with improved knowledgeand education, perception of late is changing.

 Why does the skin around anus get itchy when a person has piles?

Piles per se are not responsible for itching. Complications of piles which may include prolapsed, thrombosis , ulceration and ocassional tag formation can cause itching. This is often purely due to mechanical causes and improper cleaning habits.

 Are there any natural or herbal remedies that can help piles?

My knowledge in these alternative remedies are limited but natural and herbal remedies may act as a fiber supplement helping the cause of constipation.

 What treatments for piles can one get from a pharmacy?

There are several over-the-counter medications that confess to reduce hemorrhoidal symptoms. Most of these treatment are aimed at providing symptomatic relief rather than truly altering the underlying pathophysiology of the disease. These preparations include several medications include local anaesthetics, vasoactive agents, corticosteroids, antibiotics, and lubricants. Although these treatments are plentiful,

data regarding their efficacy are sparse. There also has been instances wherein topical use of these agents have been responsible to aggravate the symptoms, particularly perianal symptoms. My advice to all patients would be to avoid using topical remedies in that area. Most of the perianal

symptoms are avoided by keeping the area clean and dry.

 Does having piles affect sex life?

There is no evidence to suggest that sexual life is affected by piles.

 Why it is not talked about much?

This is not talked about much may be mainly due to poor perception and stigma attached to it.

 Diet changes that can cut the risk

High fiber content diet and plenty of water may help in cutting down the risk.

 How long does the patient have to undergo the treatment?

The treatment duration varies according to the symptoms and the treatment offered. Most of the treatment particularly office procedures and surgery are done as a day case basis.

 Is there any non-surgical procedure to treat such conditions? How effective it can be?

Mild to moderate haemorrhoids should ideally be treated non surgically. Non surgical methods can be effective in majority of patients by sticking to simple lifestyle and dietary changes.

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