Piles (Hemorrhoids) Causes, Symptoms and Treatment

Piles or hemorrhoids medically, are swollen blood vessels in the lower rectum or anus. These veins are a part of one's normal anatomy and assist in supporting bowel movements. The problems arise when prolonged pressure stretches, swells and inflames these veins.

Unlike temporary anorectal irritations, piles tend to persist or worsen if the cause is not eradicated. Repeated straining at stool, bad bowel habits and life habits contribute importantly to developing piles.

Types of Piles Based on Location

The understanding of the type helps elucidate the symptoms and treatment.

Internal Piles

These develop inside the rectum and therefore do not present any visible external signs and symptoms. Due to fewer pain-sensitive nerves inside the rectum, internal piles usually never cause pain.

Common features include:

• Bleeding painlessly from the anus
• Bright red blood on toilet paper or in the toilet
• Feeling of incomplete bowel evacuation in advanced stages

Internal piles may prolapse during straining.

Grades of Internal Piles:

Internal piles are further categorized into grades based on their severity.

• Grade 1: Bleeding without prolapse
• Grade 2: Prolapse during straining but retracts on its own
• Grade 3: Prolapse that requires manual repositioning
• Grade 4: The rectum is permanently prolapsed and cannot be returned to its normal position

The higher grades often need procedural or surgical treatment.

External Piles

External piles form under the skin around the anus and are sometimes painful. Symptoms include:

• Burning or aching
• Swelling or lump near the anus
• Itching and irritation
• Difficulty sitting for extended periods of time
• Pain tends to be worse with passage of bowel

Thrombosed Piles

This is when a blood clot develops within an external pile and is known as thrombosed. These include:

• Severe pain that comes on suddenly
• A hard tender swelling near the anus
• Bluish or purplish skin discoloration

Such thrombosed piles necessitate immediate medical clearance.

Major Causes of Piles

Piles are developed as a result of increased pressure that has been exerted on the veins in the rectum over a certain period of time. Common causes include:

• Chronic constipation
• Exerting excessive strain on bowel movements
• Prolonged sitting on the toilet
• Low-fiber diet
• Inadequate intake of water
• Chronic diarrhea
• Pregnancy and childbirth
• Obesity
• Heavy lifting
• Sedentary lifestyle

Factors contributing to this include weakening of vein walls and impairment of blood flow.

Piles and Pregnancy

In pregnancy, the hormonal changes bring on relaxation of blood vessel walls and the expanding uterus increases pressure on pelvic veins. Constipation, which is common in pregnancy, further raises strain. Most piles that occur for the first time during pregnancy improve after the delivery, although some persist.

Mild piles come with occasional discomfort, but there are symptoms that need the intervention of doctors. Seek evaluation if you notice:

• Recurrent or heavy rectal bleeding
• Pain that continues to worsen
• Persistence of anal swelling
• Discharge or foul odor
• Fever with pain in the anus
• Black or tarry stools

These may be indicative of complications or other conditions such as fissures or colorectal disease.

Diagnosis of Piles

Diagnosing the problem is often quite straightforward, but should always be done by a healthcare professional since other causes of rectal bleeding must be excluded.

Diagnostic evaluation may be performed with:

• Complete medical history
• Anal physical examination
• Digital rectal examination
• Anoscopy or proctoscopy
• Colonoscopy if the source of bleeding is vague

Early diagnosis prevents unnecessary complications.

Non-Surgical Management of Piles

Most piles at an early stage do not require a surgical approach for their management.

Key components:

• Higher dietary fibre
• Fluid intake in sufficient amount
• Re-establishing normal bowel routines
• Avoid straining
• Limiting time spent in the lavatory
• Warm sitz baths to reduce pain and swelling

These measures relieve the pressure on rectal veins and assist in healing.

Dietary Recommendations for Piles

Diet is central to both treatment and prevention. Useful dietary modifications include:

• Whole grains instead of refined foods
• Fresh fruits like papaya, pears, apples
• Vegetables like spinach, carrots and broccoli
• Proper hydration throughout the day
• Fiber softens the stool and decreases strain.

Medical Treatment Options

Drug therapy is usually prescribed when lifestyle measures are not enough. These may include:

• Topical creams used for pain and inflammation
• Suppositories for the piles inside the anus
• Stool softeners
• Medications by mouth that help regulate bowel movements

The drugs alleviate the symptoms but may not cure advanced piles.

Minimally Invasive Procedures

These are effective in minimally invasive treatments for moderate piles. Common procedures include:

• Rubber band ligation: cutting blood supply to the pile
• Clerotherapy: injecting a solution to shrink the pile
• Infrared coagulation: use of heat to reduce blood flow

These procedures are usually quick and have less recovery time. Surgical treatment for piles is recommended in case of severe, recurrent or complicated piles.

Surgical options include:

• Haemorrhoidectomy: complete removal of piles
• Stapled hemorrhoidopexy: repositioning prolapsed piles

Surgery offers symptomatic long-term relief when other modes of treatment do not succeed.

Post Treatment Care and Recovery

The recovery depends on the method of treatment. General post-treatment advice includes:

• Eating enough fiber
• The avoidance of constipation
• Proper hydration
• Medications as prescribed
• Follow-up visits with the doctor regularly

Proper care reduces recurrence.

Prevention of Piles

Many cases of piles are preventable by adopting healthy habits. Preventive steps include the following:

• Prompt response to bowel stimulation
• Avoidances of prolonged sitting
• Physical activity
• Maintaining body weight
• Keeping good toilet habits

More importantly, it prevents piles, especially among those who have a history of it.

It is very easy to manage piles if the diagnosis is done early and with proper treatment and modification of lifestyles. Early institution of treatment and follow-up of preventive measures can lead to significant symptomatic relief and improvement in the quality of life in most patients.