Hemorrhoids - Symptom, Treatment And Causes

Piles or haemorrhoids refer to swollen blood vessels inside and around the rectum and anus. Depending on where they are located, they can be classified as internal and external haemorrhoids. Small haemorrhoids can be treated with medication, but surgery may be recommended for larger Hemorrhoids. This is known as a “Hemorrhoidectomy” and involves cutting out the enlarged veins. This surgery may be performed in many different ways.

Preparing for a Hemorrhoidectomy
A Hemorrhoidectomy is typically a one day procedure and does not require hospitalization. The patient will be given instructions that need to be strictly followed before the procedure. These include:

1. No food should be eaten after midnight on the night before surgery. If any medication is to be taken, it should be accompanied by only a small sip of water.
2. All makeup and jewellery must be removed before surgery.
3. The patient may be asked to take a mild laxative or enema on the night prior to surgery.
4. Talk to the doctor about any medication currently being taken for diabetes, blood pressure, asthma, heart conditions etc. In some cases, the medication may need to be stopped for a few days prior to surgery.

When the patient comes to the hospital for surgery, he or she should wear loose, comfortable clothes with an elastic waistband. Any medication being taken should be brought along. While the patient will be discharged the same day, he or she will not be allowed to drive back home. Hence, the patient must also make arrangements for someone to drive them home.

Surgery Procedure
This surgery can take anywhere from half-an-hour to one hour. After consulting the doctor, the patient will be given a hospital gown and medication through the intravenous route to help them relax. Various devices are attached to the body to track the patient’s heart rate, pulse etc. The patient is then put under general anaesthesia for the surgery. After the surgery, the patient will be kept in the recovery room for an hour. They are then transferred to another room and given something to eat and drink.

Hemorrhoidectomy Risks
This procedure has a high success rate and is considered relatively safe. However, as with any other procedure, there are a few risks involved. Before undergoing this surgery, the patient must be well aware of these risks. They include:

• Reaction to anaesthesia
• Bleeding
• Infection

Some patients may also experience trouble passing urine. This is because the pain caused by surgery makes it difficult for the patient to relax. However, there is nothing to worry as these risks can be effectively managed by the doctor.

What is hemorrhoid?

Hemorrhoid (piles) is a condition where the veins in the lowest part of rectum and anus get swollen.

How to deal with it?

Following are the most effective measures to reduce the suffering from the piles:

1. Placing a towel soaked in cold water on the piles relieves the pain, irritation, and burning around the anus.
2. Protruded hemorrhoids can be pushed back into the rectum, using a lubricating jelly, while bathing.
3. A fiber supplement, which includes Metamucil, Citrucel, or Fiber Con, and a fiber-rich food, such as broccoli, beans, wheat, oat bran, whole-grain foods, and fresh fruits, should be included in the diet. Fibrous food softens the stool and makes it easier to pass, thereby reducing pressure on hemorrhoids.
4. Exercise will help by stimulating the bowel function and by improving constipation. Aerobic exercises, such as brisk walking, jogging, cycling, skipping for 20-30 minutes a day, at least for 5 days per week, should be included.
5. Do not strain. Straining for the stool leads to pressure on the hemorrhoids and causes worsening of the symptom.
6. Don’t wait for a convenient time. Immediately pass the stool when there is urging. This stool can back up, leading to increased pressure and will require straining to pass in future. Keep a fixed time for passing stool, such as after a meal, or after waking up, and sit on the toilet seat for a few minutes. This will help to establish a regular bowel habit.
7. Take a regular sitz bath. A sitz bath is a warm water bath for the buttocks and hips. It helps to reduce itching, irritation, and spasms of the sphincter muscle. A 20-minute sitz bath after each bowel movement, two or three times a day, will help reduce burning and itching after passing stool.
8. Topical medication, such as creams containing a local anesthetic agent, can be used to relieve the pain. They are applied before passing the stools. Anti-inflammatory home remedies, such as Witch hazel, aloe vera, and a warm bath with Epsom salt helps reduce symptoms of piles.
9. Using a toilet paper after a bowel movement can aggravate existing hemorrhoids, as wipes which have alcohol, perfume, or irritants cause more irritation and worsens symptom. Use wipes which are medicated, such as wipes with aloe vera or witch hazel.
10. Stool softeners or fiber supplements help reduce constipation, make the stool softer, and make it easier to have quick, painless bowel movements. Oral painkillers can be used to relieve the pain, such as aspirin and ibuprofen.
11. When an external hemorrhoid is very painful due to a blood clot, surgery is usually indicated in order to relieve the symptoms.

Piles or Hemorrhoids is a common condition that can affect a man or woman at any stage of their life. This is not life-threatening but it can be extremely painful and uncomfortable. Therefore, seeking the proper treatment at the right time is necessary. Surgery is one of the best forms of treatment for this condition. This is known as a hemorrhoidectomy. It ensures that the problem does not recur. Recovering from a surgery to remove piles can take 2-3 weeks. Here are a few tips to ensure fast healing.

Take a sitz bath
A sitz bath can help relieve pain and discomfort after a hemorrhoidectomy. This involves filling a shallow tub with warm water and sitting in it. It is important not to add anything to this water. A sitz bath can be taken multiple times in a day in the first week following surgery. The warm water helps relax the muscles and reduces swelling and pain. Once the water cools down, you may follow a sitz bath with an ice pack. This should not be placed in direct contact with the skin and should be held in place for not longer than 5-10 minutes.

Use a handheld shower to keep the area clean
It is important to keep the surgery site clean at all times. However given the sensitivity around the area, this can be difficult especially after passing stool. Using a handheld shower or bidet attachment can make this process easier and less painful. Air dry the area or pat it dry with a soft towel. Do not rub the area as it may damage the skin.

Use medication wisely
Your doctor will probably prescribe painkillers after the surgery. This prescription must be followed strictly as overuse of opioid painkillers can result in constipation. Along with this, a laxative or stool softener may also be prescribed. The instructions given with this medication must be followed strictly. Taking excessive doses can lead to diarrhoea that may, in turn, slow down the healing process.

Eat Right
To prevent constipation and speed up the healing process, the patient must have a well-balanced diet. This should be rich in fibre to enable waste to travel smoothly through the digestive system. The patient must also drink a minimum of 8-10 glasses of water a day. This does not include soft drinks, juices, tea, coffee etc. This keeps stools soft and makes their excretion less painful.

Piles, another term for haemorrhoids, are swollen blood vessels in or around the anus and rectum. Haemorrhoid swelling occurs when there is an increase in the pressure in the small vessels. Therefore, the vein walls become stretched, thin, and irritated by passing bowel movements, and this is when piles develop.

Types of Piles: Haemorrhoids are classified into two general categories:

1. Internal haemorrhoids: Internal haemorrhoids are located far within the rectum, and cannot be seen or felt. They are normally located between 2 and 4 centimetres above the opening of the anus. The only symptom is usually bleeding.
2. External haemorrhoids: External haemorrhoids occur on the outside edge of the anus under the skin, where there are many pain-sensing nerves. Despite the name, external piles aren’t always seen outside of the opening of the back passage.

Symptoms of piles: Generally, the symptoms of piles are not serious. They normally resolve on their own after a few days. These symptoms can also vary depending on the size, position, and grade of the pile. So before discussing the symptoms, let’s take a look at the grades. Grades are nothing but the intensity by which piles occur:

Grade 1: These are small swelling

Grade 2: These are larger swellings

Grade 3: In this case, it hangs out from the anus during bowel movements

Grade 4: In this case, the hanging from within the anus is permanent

The most common symptom is bleeding after going to the toilet or to pass stools. A lump in and around the anus, a feeling that the bowels haven’t emptied completely, watery discharge from the anus, an itchy or sore skin around your anus and pain and discomfort during or after a bowel movement are some of the common symptoms.

Cause of piles: Anyone at any age can be affected by piles. However, they are usually more common in elderly people and during pregnancy. Modern lifestyle, excessive consumption of junk food, stress, and improper eating habits accounts for a majority of anorectal complications, including piles. Diet has a pivotal role in both causing and preventing piles. People who eat high fiber diet are less likely to get haemorrhoids, but people those who prefer a diet high in processed foods are at greater risk of piles. There can be a lot of reasons. However, some of the basic reasons are low fibre diet, prolonged sitting on toilet, indigestion, obesity, diarrhoea, long-term coughing, having a family history of piles, excessive heavy weight lifting, spinal cord injury and lack of erect posture.

Prevention of piles

The preventive measures include:

1. Eating plenty of fibre-rich foods such as fruits, vegetables, whole grains, nuts, beans, and pulses
2. Drinking plenty of fluids such as water helps prevent constipation
3. Avoiding sitting in the same place for long time
4. Staying active
5. Simplest one is to avoid fighting the urge

Stapler Surgery For Piles 
Stapling is used to treat prolapsed hemorrhoids. A surgical staple fixes the prolapsed hemorrhoid back into place inside your rectum and cuts off the blood supply so that the tissue will shrink and be reabsorbed. Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy.

Small changes in lifestyle can make bowels regular and faeces soft, thereby preventing constipation and piles. There are several lifestyle changes that may be adopted to reduce the symptoms of piles and reduce episodes of aggravated piles in susceptible individuals.

Hemorrhoids or piles are diagnosed by swelling of veins in the lower part of anus and rectum. Due to swelling, the walls of rectum and anus are stretched and thus become irritated. Hemorrhoids are of two types: Internal and External hemorrhoids.

Internal Haemorrhoids: As the name suggests, the piles are not visible from outside. These are present deep inside the rectum, located above the pectinate line and these are covered with the cells that are present through the rest of intestines. Internal hemorrhoids are normally painless. The first sign of internal hemorrhoids is rectal bleeding. However, straining can push internalhemorrhoid and it protrudes through the anus and this can be painful.

Causes of Haemorrhoids
The swelling of hemorrhoid occurs only when the pressure in the small vessels of rectum and anus is increased and is engorged with blood. The size of the hemorrhoids is also increased. The increased pressure may be due to various factors:

• Consuming low fiber diet and pushing or straining while passing stools, thus blood vessel pressure is increased.
• Pregnancy also is a cause of swelling as there is the increased pressure of the uterus on rectum and anus.
• Sitting for long on toilet also increases pressure.
• Obesity is also a cause of hemorrhoids.
• People suffering from diarrhea, both acute and chronic.
• A person having colon cancer might have hemorrhoids.

Signs and Symptoms of Haemorrhoids:

• The most common symptoms of hemorrhoids are painless bleeding, itching in anal, swelling and feeling of the presence of lump at the anus.
• All these symptoms are associated with inflamed hemorrhoid.
• Inflamed internal hemorrhoid can cause swelling, but is painless as there are no fibers attached to veins above the pectinate line that cause pain. However, passing hard stools can scrape off the thin lining of hemorrhoid, which can cause the painless bleeding.
• Spasms of the rectum and anal muscles caused by these swollen hemorrhoidscause pain, especially when they are protruded through the anus.
• Internal hemorrhoids can form a clot or thrombose resulting in severe pain.
• The presence of has inflammation, stool,and constant moisture and these can lead to itching and burning sensation in the anus among patient of internal hemorrhoid.

Treatment of Haemorrhoids

• Diet: Haemorrhoids can be treated when individuals consume a fiber-rich diet in order to soften the stools and ease their bowel movements. Fiber-rich foods include fresh fruits, dry fruits, grains, vegetables, and cereals. About 20 to 30 grams per day of fibrous foods is recommended. Dietary fiber will help create bulk in the intestines which will help in softening of stools and ease bowel movement. Supplemental fiber available in the marketincludes psyllium husk, methylcellulose, and calcium polycarbophil. Other recommendations include increased intake of liquids and having stool softeners. Drinking enough water and liquids will prevent stool from hardening.
• Over-the-counter topical treatment: There are various products available to treat hemorrhoids, such as gels, hydrocortisone creams, ointments, foams, pads, and suppositories.
• Home remedies: Soaking anus in a warm sitz bath might also help in hemorrhoids for about 10 to 15 minutes per day. One should practice good hygiene and clean anus with warm water while showering. Avoid using soap and dry toilet paper. One can also use a cold compress on the anus.

Minimally Invasive Procedure for Hemorrhoids (MIPH)

Out of the various types of medical and surgical interventions available to treat Piles, Minimally Invasive Procedure for Hemorrhoids (MIPH) 0r painless stapler surgery is known to be very popular since it acts an alternative approach to surgical interventions made for piles.

MIPH is defined as a minimally invasive surgical technique in which a band of loose or prolapsed mucosa and sub mucosa in the rectum is excised, proximal to the piles and disrupted mucosa is fixed by ‘stapled end to end mucosal anastomosis.

This will ultimately occlude the blood supply to the superior hemorrhoidal artery above the hemorrhoidal tissue, resulting in the retraction of prolapsed mucosa back to its original anatomical position. A special circular stapler known as PPHO3 is used in the anastomosis and the whole maneuver will take around 30–45 minutes. In case you have a concern or query you can always consult an expert & get answers to your questions!