Haemorrhoids (or piles), are swollen blood vessels located in the anus. It can be divided into internal or external,
depending on the location where it starts.
External piles develop at the outer part of the anus. It usually manifests itself when it forms a blood clot within, resulting in a painful swelling. External piles feel like a hard, sensitive lump. Bleeding only occurs if the overlying skin ruptures. On the other hand, internal piles start from the upper part of the anal canal.
It is believed that repetitive straining causes a high pressure within and it becomes swollen. The wall of the blood vessel gets stretched and is thinned out and tends to break easily. Once this happens, bleeding occurs.
Repetitive straining also causes the supporting ligaments in the blood vessel to become overstretched and loses its elasticity. When the blood vessel loses its elastic support, it descends further down the anal canal and protrude outside of the anus.
Once it is outside, it becomes a prolapsed haemorrhoid, which differs from the external piles.
It is believed that the upright posture of humans raises the amount of pressure in the veins and can predispose humans to piles. Other postulated factors include chronic constipation, ageing, pregnancy and childbirth.
There are many people with piles without any symptoms and are not even aware that they have the condition. The symptoms also do not correspond well with the stage of the piles. Some of the symptoms such as itching, bleeding or pain may be due to other conditions. For example, bleeding may be due to colon cancer and pain may be due to anal fissure (tear) .
Piles are divided into 4 different degrees of severity. First degree is within the anal canal and there is no visible
lump on the outside. Second degree occurs when it becomes bigger and bulges out during bowel movements. However, the
bulge disappears once straining stops.
Third degree piles bulge out during bowel movements, but it stays out for a longer time before gradually going back into the anus, or the patient may push it back in after a bowel movement.
Fourth degree is the most advanced stage. The piles are out of the anus all the time and cannot be pushed back in.
This commonly occurs for the earlier degree where they become inflamed and swollen. This causes pain that may or may not be associated with bleeding.
This occurs when the blood flow is interrupted. It usually happens when the piles prolapse out of the anus. The blood is unable to return to the body and clots. This results in severe pain and swelling.
Piles that do not cause any symptoms do not require surgery.
For first- or second-degree piles, symptoms can be relieved by reducing straining during bowel movement. This could mean taking more fluids or laxatives. Oral medication or suppositories may be given by your piles surgeon to relieve the symptoms.
If this does not help, further treatment may be required for your piles . This includes the following piles surgery procedures:
For 3rd and 4th degree piles, treatment includes:
Other piles treatments include cryotherapy, BICAP coagulation and direct current to shrink the piles. None of these treatments have gained widespread acceptance.
For more information, visit our website on Piles Surgery.