Piles

Symptoms: Irritation and itching in the anal region, severe  pain and discomfort, anal inflammation, bleeding and pain during bowel movements, protruding haemorrhoid formation, hard lump near the anus, rectum pain after passing stool

Causes: Elevated pressure in the lower rectum, persistent constipation, straining during stool passage, chronic diarrhea, obesity, an unhealthy diet with low fibre intake

Risk Factors: Age, pregnancy, obesity, unhealthy diet, lifting heavy weights

Severity: Mild to severe (Depending on the type and position of piles)

Which doctor to consult: Gastroenterologist or General Surgeon or Proctologist or Colorectal surgeon

Overview 
Piles or haemorrhoids are enlarged blood vessels inside or around the anal region, specifically the rectum. Generally, piles are of two types : internal and external. The internal condition starts inside the upper part of the anal canal. External piles, on the other hand, occur near the rear surface.

Any inflammation in the rectum vessels leads to piles. These blood vessels cover the internal rectal region. They are responsible for absorbing the shocks to the excretory organs during defecation . In addition, they enable your anus to close after the bowel movement.

The rectal blood vessels transform into piles due to the exertion of pressure on them. This development can be due to several factors, including heavy weight lifting, pregnancy, weakened anal muscles, persistent diarrhoea or constipation.

Because of the force, the internal lining of the anus gets damaged. It leads to the inflammation and bleeding in  these blood vessels causing discomfort during the passage of  stools.

With the development of piles, these vessels appear like small, circular, discoloured lumps. They also protrude from the anal opening in some cases. Based on the protrusion, the condition is also divided into four categories, including first, second, third and fourth degree.

Usually, the condition gets better within 2-4 weeks. However, if it persists beyond this  duration, you must consult a gastroenterologist or proctologist for immediate treatment. Additionally, leaving your haemorrhoids untreated can result in rectal infection, blood loss, and severe comfort.

When to Consult a Doctor?

On Symptoms Occurrence: As soon as you observe the uncomfortable symptoms of piles, you must seek expert consultation. Observation of a lump in the anus, rectal pain or bleeding in stool must alarm you to arrange for a call with a gastroenterologist. Usually, the general medication offered by the doctor alleviates symptoms. However, your medical practitioner can refer you for surgery if pain and blood loss are extremely severe upon diagnosis.

After Home Remedies: In case,  home remedies fail to offer relief from the painful and discomforting symptoms of the condition, it's time for a consultation. Although rare, haemorrhoids can  result in severe medical emergencies, including anaemia and gangrene. So, opt for timely treatment to reduce the risk of extreme complications.

Regular Screening: Since piles are common in older people, scheduling routine anal-rectal checkups or screenings  is important. This enables doctors to detect haemorrhoids and related conditions during the initial stage itself. You should consider routine annual screening if:

• You’re aged 50 years or above
• You have a family history of colorectal conditions, including cancer

Diagnosis 

Physical Examination: It is the primary diagnostic procedure for piles. Before physical examination, the doctor will enquire about your medical history to understand the likely causes of such an occurrence. He or she might ask you questions about your dietary  habits, toilet practices, laxative usage, any previous surgeries and present medical health.

After this, the doctor will analyse the appearance and structure of the haemorrhoids if it's visible. Your doctor will also include a standard examination of the rectal area for swelling, rashes or skin tags to comprehend the impact and type of piles.

Digital Examination: A visual examination provides an understanding of piles' presence, but your doctor may require further information. To confirm the haemorrhoid dysfunction, they will conduct a digital rectal inspection. The procedure  involves inserting a lubricated and glove-protected finger inside the patient’s rectum.

Through this test, the doctor observes the softer portion of the rectum, which can't be felt with a physical exam.

In addition, if the doctor observes risk factors for gastrointestinal diseases, they may certainly recommend advanced tests.

Advanced Tests

• Anoscopy: This procedure involves the insertion of a device called an anoscope into the patient's anus. It offers your doctor detailed information about the tissue in the anal-rectal region. This test checks the possibility of several conditions like cancer, anal fissures, and rectal polyps.
• Sigmoidoscopy: This test specifically analyses the part of your body where stool is formed, i.e. sigmoid colon. It involves inserting a sigmoidoscope with a light inside the patient's rectal region to check issues with the sigmoid colon only.
• Colonoscopy: It is a comprehensive test for the entire colon. Through this process, your doctor checks the abnormalities and diseases of large intestines. It is  performed by a doctor upon the suspicion of colorectal cancer in the patients.

Treatment

• Home Remedies: The primary symptoms of piles go away with usual home remedies.

1. Fibre intake: Your gastroenterologists might suggest including additional dietary fibre in your daily intake. Eating more fibre from fruits and vegetables will help soften the stool and reduce discomfort. 
2. Topical treatments and pain relievers: To alleviate the pain, your doctor may also suggest using an over-the-counter cream with hydrocortisone. They may also prescribe pad usage to get relief from itching and swelling with numbing pads and painkillers. Additionally, your expert might also recommend stool softener to ensure easy passage during bowel movements.
3. Sitz bath: For pain relief, the experts also prescribe using a hot water bath a few times a day.  

• Medications: If the initial treatment method isn’t useful, your doctor may prescribe a different course of medication for piles. These medicines comprise zinc oxide, corticosteroids, lidocaine and astringents. These ingredients, in combination, ease overall discomfort from itching, anal irritation and inflammation. 
• Advanced Treatment Methods: If your condition fails to respond to the medications and home remedies, the doctor can resort to advanced treatment methods. It comprises both surgical and minimally invasive or non-surgical procedures. 

Non-Surgical Options: These methods usually involve cutting off blood supply to the haemorrhoid or scarring the area. Doing this either shrinks the tissue or makes it fall off. The common treatment procedures in this are: 

• Rubber band placement: In this process, your doctor ties a rubber band on the lower side of the haemorrhoid to block blood flow. 
• Sclerotherapy: This method involves injecting liquid into the haemorrhoid to produce a scar. The scar leads to restricted blood flow in the haemorrhoid.
• Infrared Photocoagulation: Through infrared light, your doctor heats the affected haemorrhoid to cause scarring for size reduction.
• Electrocoagulation: The targeting of a low-intensity electric current into a haemorrhoid causes reduced blood supply and, eventually, shrinkage. 

Surgery: If the aforementioned meaures fail to offer relief , the doctors opt for a surgical procedure  to remove haemorrhoid tissue.

For entire haemorrhoid removal at the advanced stage, your medical practitioner might recommend the following: 

• Hemorrhoidectomy: After the diagnosis, your doctor will initiate the surgical removal of the excessive tissues causing bleeding. In this process, local anaesthesia is administered to the patient before the operation. This method is usually chosen to alleviate recurring external haemorrhoids in patients. 
• Hemorrhoidopexy: For internal haemorrhoids, the general surgeon blocks the blood supply to the haemorrhoid before stapling it back to its position. This process is easier on the patients as you can resume their daily activities quickly after this. 

Your doctor can also consider surgery if you're experiencing external thrombectomy in piles. Through this process, your gastroenterologist removes the painful clot of blood for relief.

Risk and Complications if Left Untreated

• Recurring Hemorrhoids: Piles treatment tackles the underlying conditions exerting  pressure on blood vessels in the anus. In the absence of a treatment, these vessels get severely damaged, leading to the recurrence of haemorrhoids. As you age, the complications will only worsen without treatment. 
• Anaemia: Due to the frequent loss of blood through stool, your body starts facing a deficiency of enough red blood cells. Chronic blood loss leads to reduced oxygen in your body which can cause fatigue and additional complications.
• Faecal Incontinence: The long-term presence of piles can cause stool incontinence in patients. The prolonged exposure leads to the inability of the anal muscle to close properly, causing stool leakage. Over time, piles can also weaken the sphincter, causing the rectum to prolapse.
• Strangulated Hemorrhoid: In the case of untreated piles at the early stage, internal haemorrhoids might get trapped. Due to such strangulation, the blood vessels lose access to the adequate blood supply, causing extreme pain and internal swelling.
• Rectal Gangrene: Due to the persistent bruising, swelling and pain in the lower rectum, the chances of developing anal infections are high. Untreated infection can turn into a life-threatening complication called gangrene. Although rare, you can suffer from rectal gangrene.  

Additional Information 

Stages of Piles 

• Stage 1: The anal canal lining consists of multiple soft tissues that help pass stool. At first, it develops swelling and drops from its position due to pressure. At this stage, the patient doesn’t feel discomfort or noticeable signs. 
• Stage 2: As the condition progresses, the inflammation of the haemorrhoid tissue amplifies. You will start experiencing pain and itching in the anal region at this stage. Additionally, because of the narrower anal passage availability for stool, the inner lining starts getting damaged. 
• This can result in bleeding and irritation during bowel movements. 
• Until this stage, it's possible to cure piles using medications and home remedies with immediate consultation. 
• Stage 3: The protrusion or prolapse out of the anal cavity occurs in this stage. If you've ignored the symptoms, your swollen haemorrhoids will stretch out of the anal opening. Such prolapse doesn't return on its own unless manually pushed inside.
• Stage 4: This is the last and advanced stage of piles. In this phase, the grown haemorrhoids completely crown out. At this stage, the pain, bleeding and irritation associated with piles are at their maximum. Moreover, the prolapsed haemorrhoids cannot be positioned back anymore without surgery.

The protruded growth can also develop small lumps and clotting on the surface, requiring urgent medical help.

• Affect of Stress on Piles

Environmental and psychological stress is connected to your gut health. In the face of stressful situations, the body’s autonomic nervous system channels the available energy to combat the triggering situation. As a result, overall digestion is impacted, leading to bloating, constipation, heartburn and stomach pain.

On top of this, the flight or fight response can speed up and slow down digestion, forming the primary factor for piles. In addition, stress also leads to indulgence in unhealthy dietary and lifestyle habits, further aggravating the condition.