Seema International

What are piles

• Piles can be of various sizes and may be internal (inside the anus) or external ones (outside the anus). Typically, internal piles occur from 2 to 4cm above the opening of the anus. External piles (perianal hematoma) occur on the outside edge of the anus. The internal ones are much more common. In the majority of cases, piles are effectively treated with over-the-counter medications, a good fluid intake, and by following a diet high in fiber. In severe cases, the piles may have to be surgically removed. About 10% of patients who go and see their doctor about piles eventually require surgical intervention.

Symptoms of piles

• A hard lump may be felt around the anus. It consists of coagulated blood, called a thrombosed external hemorrhoid. This can be painful
• After going to the toilet, a feeling that the bowels are still full
• Bright red blood after a bowel movement
• Itchiness around the anus
• Mucus discharge when emptying the bowels
• Pain while defecating
• The area around the anus may be red and sore.

Internal hemorrhoids are classified into four grades:

• Grade 1 - there are small inflammations, usually inside the lining of the anus. They are not visible
• Grade 2 - larger than grade 1 hemorrhoids, but also inside the anus. When passing a stool, they may get pushed out, but return unaided
• Grade 3 - often called 'prolapsed hemorrhoids'; these appear outside the anus. The patient may feel them hanging out. They can be pushed back in if the patient presses with their finger
• Grade 4 - these cannot be pushed back in and need to be treated by a doctor. They are large and stay outside the anus all the time.

External hemorrhoids are called perianal hematoma. These are small lumps that are located on the outside edge of the anus. They are very itchy and can be painful if a blood clot forms inside (thrombosed external hemorrhoid). Thrombosed external hemorrhoid requires medical treatment straight away.

Why do piles occur?

• The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge. Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to:

Chronic constipation

• Chronic diarrhea
• Lifting heavy weights
• Pregnancy
• Straining when passing a stool