Piles (Haemorrhoids)

Factors that can cause haemorrhoids have been enumerated below.

• Increased pressure on anal and rectal veins: This is the most significant factor in haemorrhoid development. It can occur due to:
  • Straining during emptying of the bowels (often due to constipation or diarrhoea);
  • Obesity: It leads to increased intra-abdominal pressure, thereby affecting veins in the anus and rectum.
  • Pregnancy: The enlarged uterus can exert pressure on the pelvic veins, thereby increasing haemorrhoid risk.
  • Heavy lifting: Repeated heavy lifting or strenuous physical activities can increase abdominal pressure, contributing to haemorrhoid formation.
  • Old age: Ageing can weaken the tissues supporting the veins in the anus and rectum, thereby increasing haemorrhoid risk.
• Dietary Factors:
  • Low-fibre diet: Such a diet can lead to constipation, thereby increasing the risk of straining during bowel emptying, and consequently, haemorrhoids.
  • Inadequate fluid intake: Not drinking enough fluids can also contribute to constipation.
• Pregnancy-related hormonal changes: These weaken the connective tissue around the rectum, thereby increasing haemorrhoid risk.
• Genetics: Some individuals may have a genetic predisposition to develop haemorrhoids.
• Sedentary lifestyle: Sitting for prolonged periods can increase pressure on the veins around the anus.

Common symptoms of haemorrhoids include:

• Discomfort: Pain, especially when sitting or during bowel movements, is more common with external haemorrhoids. Internal haemorrhoids typically do not cause pain unless they prolapse.
• Bleeding: Blood that appears during or after a bowel movement and is not mixed with the stool is a common feature associated with internal haemorrhoids.
• Itching or Irritation: Itching or irritation around the anus that can be exacerbated by moisture, wiping, or bowel movement-related irritation is common in case of external haemorrhoids.
• Feeling of fullness: Prolapsed internal haemorrhoids may cause a feeling of fullness or discomfort.
• Lumps: Swollen, tender lumps around the anus may be felt in case of external haemorrhoids.
• Mucus discharge: Some individuals may experience a mucus discharge from the rectum, particularly those affected by internal haemorrhoids.

Haemorrhoids can be diagnosed using the following strategies:

• Physical examination: For external or prolapsed haemorrhoids the area around the anus is inspected to look for visible haemorrhoids.
• Digital rectal scan: For internal haemorrhoids, the doctor feels for internal swelling or abnormalities by inserting a gloved finger into the rectum.
• Anoscopy: In this technique, a small, lighted tube (anoscope) is inserted into the rectum to visualise internal haemorrhoids and assess their size and location.
• Sigmoidoscopy or Colonoscopy: This may be performed to exclude conditions, such as colorectal cancer, especially in individuals over 50 of age or with a history of bowel issues.
• Proctoscopy: In this technique, a proctoscope is used to examine the rectum and lower colon for any indication of internal haemorrhoids or other diseases.

Haemorrhoids can be managed using various strategies, including:

• Over-the-counter medications:
  • Hydrocortisone or witch hazel creams: These can help reduce pain, inflammation, and itching.
  • Suppositories: For internal haemorrhoids, suppositories may help relieve symptoms.
• Medical treatments:
  • Rubber band ligation: This is a common outpatient procedure for more individuals with severe internal haemorrhoids. In this procedure, the base of the haemorrhoid is bound using a rubber band to cut off the blood supply, which causes the haemorrhoid to shrink, and eventually, fall off.
  • Sclerotherapy: In this procedure, the haemorrhoid is induced to shrink by injecting a chemical solution.
  • Infrared coagulation (IRC): IRC employs heat to shrink internal haemorrhoids.
  • Electrocoagulation: In this technique, electrical current is used to shrink the haemorrhoidal tissue.
• Surgical treatment: If conservative treatments and minimally invasive procedures are not effective, or if the haemorrhoids are very large, surgical intervention may be required.
  • Haemorrhoidectomy: This surgical procedure is used to remove large or prolapsed haemorrhoids under local or general anaesthesia. It is considered the most effective treatment for severe haemorrhoids.
  • Stapled haemorrhoidopexy: This technique involves removing part of the haemorrhoidal tissue using a stapling device and repositioning the remaining tissue. Though this method is less painful than haemorrhoidectomy but is used less frequently.

The occurrence of haemorrhoids can be prevented by incorporating dietary changes; the same have been enumerated below.

• Dietary changes:
  • Increasing the fibre intake: Eating a high-fibre diet helps soften the stool and decreases straining during bowel voiding.
  • Staying hydrated: This helps prevent constipation and reduces haemorrhoid risk.