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What Are Hemorrhoids(Piles)?

Haemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions.
The word “Haemorrhoids” is derived from Greek word Haima(bleed) + Rhoia(Flow), which means blood flow. The word “Pile” is derived from Latin word “Pila” meaning Ball. They can be described as masses or clumps (“cushions”) of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.
Many people are ashamed of having enlarged hemorrhoids. They don’t like to talk about their symptoms, and might be reluctant to go to the doctor. Many more suffer needlessly. Some might be afraid of having a physical examination or finding out that they have a serious illness.
Don’t be too embarrassed to talk to us about your symptoms. If hemorrhoids cause pain or discomfort, allow us to help you out at Brij Laser and Laparoscopy centre.

Types of Hemorrhoids (Piles)

A) Internal Haemorrhoids

If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. They are formed due to dilatation of the three haemorrhoidal veins usually situated over 3,7,11’O’ clock position in the anal and rectal region.

B) External Haemorrhoids

If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. They are formed due to dilatation blood vessels present outside the anal opening.

C) Interno-External Haemorrhoids

It is combination of both the above.

D) Prolapsed Haemorrhoids

Both internal and external hemorrhoids can prolapse, meaning they stretch and bulge outside of the anus. These hemorrhoids may bleed or cause pain.

E) Thrombosed Haemorrhoid

It occurs when a blood clot forms inside the haemorrhoidal vein, obstructing blood flow and causing a painful swelling of the anal tissues. Thrombosed haemorrhoids are not dangerous, but they can be very painful and cause rectal bleeding if they become ulcerated.

Causes and risk Factors Of Haemorrhoids

• • Inadequate intake of fiber
• • Dehydration
• • Prolonged sitting on the toilet
• • Obesity
• • Old Age The risk of enlarged hemorrhoids increases with age – probably because the tissue becomes weaker over time.
• • Chronic straining to have a bowel movement (constipation).
• • Hard stools
• • Diarrhoea
• • Pregnancy is a clear cause of enlarged hemorrhoids though, the reason is not clear.
• • Tumors in the pelvis also cause enlargement of hemorrhoids by pressing on veins draining upwards from the anal canal.
• • Diseases that make patients bed ridden eg. Paralysis

Symptoms Of Haemorrhoids (Piles)

Painless bleeding is common symptom of piles. This can happen if hard stool damages the thin walls of the blood vessels in hemorrhoids. Bleeding from hemorrhoids is usually visible as bright red or red blood, on toilet paper or in the stool. If you have blood in your stool, it’s important to see a doctor rather than try to diagnose the problem yourself. Other symptoms may include

• • Bulging of mass per anum
• • Swelling or Pain over anal region
• • Itching, mucus discharge or a burning sensation in the anus.

Feel free to consult Dr. Brijendra Singh at Brij Laser and Laparoscopy Centre if you notice any of these symptoms.

Classification of Haemorrhoids (Piles)

Hemorrhoids can be classified according to their severity
Grade 1: Slightly enlarged hemorrhoids that can’t be seen from outside the anus.
Grade 2: Larger hemorrhoids that sometimes come out of the anus, for example while passing stool or – less commonly – during other physical activities. They then go back inside again on their own.
Grade 3:Hemorrhoids that come out of the anus when you go to the toilet or do other physical activities, but don’t go back inside on their own. They can be pushed back inside, though.
Grade 4:Hemorrhoids that are always outside the anus and can no longer be pushed back inside. Usually, a small bit of the anal lining comes out of the anus too. This is also known as rectal prolapse. Sometimes hemorrhoids are confused with anal skin tags. These are small flaps of skin that grow around the anus and can cause similar symptoms.

Diagnosis of piles

How are hemorrhoids diagnosed?

Diagnosis of hemorrhoids is based on symptoms and a physical exam. When you go to see a doctor, you will probably first be asked about your symptoms and whether you have other medical conditions. The doctor will then look at your anus to see whether it is inflamed, and whether enlarged hemorrhoids come out of it when you push, or whether they are already outside.
You may also have
Digital rectal exam: The doctor inserts a gloved, lubricated finger into the rectum to feel for cushion of swollen veins.
Anoscopy: Your doctor uses an anoscope/ proctoscope (lighted tube) to view the lining of the anus and rectum.
Sigmoidoscopy: The doctor uses a sigmoidoscope (lighted tube with a camera) to view inside the lower (sigmoid) part of the colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy.
These tests may be slight uncomfortable but aren’t painful. They typically take place in a doctor’s office or outpatient center without anesthesia. You go home just after examination. Rarely colonoscopy is performed to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.

Treatment of Haemorrhoids or Piles

Diagnosis of hemorrhoids is based on symptoms and a physical exam. When you go to see a doctor, you will probably first be asked about your symptoms and whether you have other medical conditions. The doctor will then look at your anus to see whether it is inflamed, and whether enlarged hemorrhoids come out of it when you push, or whether they are already outside.
You may also have
Digital rectal exam: The doctor inserts a gloved, lubricated finger into the rectum to feel for cushion of swollen veins.
Anoscopy: Your doctor uses an anoscope/ proctoscope (lighted tube) to view the lining of the anus and rectum.
Sigmoidoscopy: The doctor uses a sigmoidoscope (lighted tube with a camera) to view inside the lower (sigmoid) part of the colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy.
These tests may be slight uncomfortable but aren’t painful. They typically take place in a doctor’s office or outpatient center without anesthesia. You go home just after examination. Rarely colonoscopy is performed to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.

INDICATIONS FOR SURGERY

• • 3rd & 4th degree haemorrhoids
• • 2nd degree haemorrhoids not cured by conservative means
• • Thrombosed haemorrhoids
• • Interno- external haemorrhoids
• • Need of manual deposition of haemorrhoids
• • Bleeding of concern with or without anaemia
• • Discharge due to mucosal prolapse
• • Soiling of cloths
• • Ulceration over perianal region
• • Gangrene

Surgical Treatments for Piles

Classical Surgery for Piles called Hemorrhoidectomy

Excision of the pile masses up to the base. It can be done by the 2 methods;
A. Milligan-Morgan method: Post surgery the wound is left open.
B. Hill- Ferguson method: Mucosal wound and skin sutured completely with a continuous absorbable suture.

COMPLICATIONS of Classical Hemorrhoidectomy:

• • Postoperative pain remains the major complication
• • Acute retention of urine
• • Reactionary hemorrhage
• • Secondary hemorrhage
• • Anal fissure
• • Anal stricture
• • Incontinence

New/ latest/ Advanced Technology for piles treatment

Stapler Haemorrhoidectomy/ Haemorrhodopexy

Stapled hemorrhoidopexy or Minimal Invasive Procedure for Haemorrhoids (MIPH) This method involves removing ring of the tissue from anal lining (loose prolapse mucosa and submucosa) above the piles with the aid of a circular stapling gun. It is a specialised instrument specially designed for the purpose of haemorrhoid treatment. This method helps in pulling the piles back up the anal canal. This process also reduces blood supply to the piles which results in their shrinkage. Since the cutting process takes place above the piles(dentate line), it is very less painful.

Advantages:

• • Most definitive treatment for prolapse piles as of today.
• • 30 minutes procedure
• • Pain is very less
• • Absolutely bloodless procedure
• • Recovery is much faster
• • Hospital stay is 24 hrs or less
• • Can resume daily activities from next day onwards
• • No need for dressing and follow up

Role of Laser treatment in Haemorrhoids (Piles)

Laser treatment for piles (Laser Haemorrhoidoplasty) is the newest technique for treating hemorrhoids, and it has rapidly become the treatment of choice for second and third-degree hemorrhoids. Laser energy delivered into the Haemorrhoidal mass. This energy cuts off the blood supply restricting growth of haemorrhoids and hence facilitate shrinkage effect.Also fixation of anal cushions to its original position occur due to fibrosis and regeneration of type 3 collagen fibres.

Advantages of laser treatment over classical Haemorrhoidectomy :

• • 30 Minutes procedure
• • Minimal invasive
• • Minimal Pain
• • Least risk of Complications
• • No Tissue Trauma
• • Heals Faster
• • Absolutely bloodless procedure
• • Short hospital stay/ Day care procedure
• • Higher patients satisfaction
• • Early Return to Work

OFFICE PROCEDURES for piles treatment

Rubber Banding: The process of banding involves tightening the piles or haemorrhoids with the help of elastic bands to cut off blood supply. It is expected that haemorrhoids fall off after this process within a week. It can be done as a day procedure. You can go to the office or do light work even on the next day. Rubber band ligation might be considered for grade 2 and grade 3 hemorrhoids.. It takes around 1-2 weeks for the piles to fall off. Only two piles can be treated at one time. Some pain and discomfort occurs which can be reduced with medicines.

Sclerotherapy: A chemical solution is injected into the blood vessels during this process. The size of piles gets reduced after about four to six weeks from this treatment. One can return back to routine activities soon after the treatment. As a standalone procedure its recurrence rates are high. Sclerotherapy might be considered for the treatment of grade 1 and grade 2 hemorrhoids.

INDICATIONS FOR OFFICE PROCEDURES:
1. Bleeding piles
2. Anaemic patients
3. Old age
4. Not fit for surgery

Advantages of office procedures:

• • Good results
• • Non invasive
• • Non expensive
• • OPD procedures