General Surgery

Haemorroids / Piles

Hemorrhoids, also called piles, are swollen and inflamed veins in your anus and lower rectum. Piles, may result from straining during bowel movements or from the increased pressure on these veins during pregnancy, among other causes. These may be located inside the rectum, or they may develop under the skin around the anus. Piles are common ailments. By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes.

Signs and symptoms of hemorrhoids may include:

• Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
• Itching or irritation in your anal region
• Pain or discomfort
• Swelling around your anus
• A lump near your anus, which may be sensitive or painful
• Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside the rectum. You usually can’t see or feel these hemorrhoids, and they usually don’t cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid’s delicate surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation. External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation.

See a doctor?

Bleeding during bowel movements is the most common sign of PILES. But rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

Your doctor can do a physical examination and perform other tests to diagnose hemorrhoids and rule out more-serious conditions or diseases. Also consider seeking medical advice if your Piles cause pain, bleed frequently or excessively, or don’t improve with home remedies.

Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness or faintness. The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins (hemorrhoids) can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:

• Straining during bowel movements
• Sitting for long periods of time on the toilet
• Chronic diarrhea or constipation
• Obesity
• Pregnancy
• Anal intercourse
• Low-fiber diet

Hemorrhoids are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.

Most of the time, treatment for hemorrhoids involves steps that you can take on your own, such as lifestyle modifications. But sometimes medications or surgical procedures are necessary.

Medications

If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel or hydrocortisone, that can relieve pain and itching, at least temporarily.

Don’t use an over-the-counter cream or other product for more than a week unless directed by your doctor. These products can cause side effects, such as skin rash, inflammation and skin thinning.

Minimally invasive procedures

If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief. For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor’s office or other outpatient setting.

• Rubber band ligation: Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week. This procedure called rubber band ligation is effective for many people.
• Injection (sclerotherapy), Coagulation (infrared, laser or bipolar): are other forms of outpatient treatment for Piles.

Surgical procedures

If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

• Hemorrhoid removal: During a hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used.
• Hemorrhoid stapling: This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to regular activities.

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. Anal fissures are very common in young infants but can affect people of any age. An anal fissure usually heals on its own within four to six weeks. If it doesn’t, medical treatment or surgery usually can relieve discomfort.

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus). Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland. Surgery is usually needed to treat anal fistula.A General Surgery can be carrried out.