Hemorrhoids are one of the most common condition to affect humans, having been mentioned many centuries ago. The first descriptions of problems associated with hemorrhoids are found in the Bible, and the occupation of proctology apparently was established then as well.

If you have hemorrhoids, you are not alone. They are a common problem. In fact, hemorrhoidal tissues are a natural part of the body. Most of the time you do not notice them as they help during bowel movements. But if these tissues become swollen or inflamed, they can cause uncomfortable symptoms.
The good news is that hemorrhoids can be treated.

Introduction

Hemorrhoids - commonly known as piles - are swollen blood vessels (veins) which develop inside and/or outside the anus. They are felt as lumps around and inside the anus . The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. If they become infected, they can cause bleeding, pain and discomfort and require medical attention.


Causes of Piles/Hemorrhoids

The exact cause of piles is not known. One theory is that it is due to weakness of the tissues that connects the anal cushions to the muscle layers underneath. Due to this weakness, the anal cushions slide out of their normal place and down the back passage.


You have an increased risk of getting piles if you:

  1. Have Constipation – this is the most common cause which leads to straining during defecation. Straining leads to pressure on blood vessels causing them to swell, elongate and slide down the anal opening.
  2. Eat a low-fibre diet- Lack of dietary fibre can cause hard stools, constipation and straining.
  3. Spend too much time in the toilet and holding the urge when you have to go.
  4. Have long-lasting (chronic) diarrhoea.
  5. Are pregnant - due to the effect of hormones on the blood vessels, plus the increasing weight of the baby within your abdomen.
  6. Are Overweight.
  7. Lift heavy weights.
  8. Have a family history of piles.
  9. Have cancer or growths in your pelvis or bowel, which may put pressure on your abdomen.
  10. Old age- Ageing reduces the efficiency of the circulation.

Types of Piles/Hemorrhoids

There are two types of hemorrhoids:

  • Internal hemorrhoids - these occur inside the anus - Usually painless
  • External hemorrhoids - these appear outside the anus - may become painful

Hemorrhoids are also classified by the Degree of prolapse (dropping outside the anus), their size & if they are infected
GRADE I hemorrhoids bleeds but do not prolapse (do not come outside the anus while passing stools)
GRADE II hemorrhoids prolapse on straining and then reduce by itself (go back inside the anus by itself)
GRADE III hemorrhoids prolapse on straining and do not reduce by itself and may require manual reduction (have to push it back inside the anus by using your fingers)
GRADE IV Prolapsed hemorrhoids are trapped outside the anus and may become strangulated, infected and painful.


Symptoms of Piles/Hemorrhoids

  1. Bright red blood spots in the toilet or on the toilet paper.
  2. Heavy bleeding during defecation (During Passing Stools)
  3. Itching and discomfort around the anus.
  4. Feeling of a lump or mass near the anus which may be painful or painless.
  5. Mucus discharge after passing a stool.
  6. Discharge around the anus and soiling of clothes.
  7. Pain while passing stools and after passing stools.
  8. Feeling of incomplete evacuation of your bowels.

The most frequent complaint in true Hemorrhoid is Painless bleeding, which usually appears early in the course of the disease See your doctor if you have blood in your stool. Hemorrhoids could be the problem, but bloody stool could also be a symptom of something far more serious, like colon cancer.


Complications of Hemorrhoids

If Hemorrhoids are ignored and no treatment is given to cure them, they can lead to-

  • Iron Deficiency Anaemia (from heavy bleeding)
  • Weakness
  • Prolapse of whole hemorrhoidal tissue outside the anus.

Diagnosis

In most cases, diagnosis is easily made by a thorough history taking and on physical examination by your doctor. In advanced cases some tests may be required like Anoscopy (Proctoscopy), Sigmoidoscopy and Colonoscopy.

It is never a good idea to diagnose the condition yourself


Treatment

Multifold approach is essential for correct treatment of existing condition and to prevent the recurrence. This includes:

  1. Lifestyle Modifications
  2. Oral medication: as prescribed by your doctor. These can be used to temporarily treat small bleeding piles.
    • Analgesics: For temporary relief, if pain is present.
    • Laxatives: to keep the bowel clear.
    • Oral medicines: to regularise digestive system and to enhance healing.
  3. Topical treatment (Creams and Ointments): as prescribed by your doctor (Avoid prolonged use)
  4. Cold pack applied to anal area
  5. Hot sitz bath in tub for 20-30 minutes twice daily
  6. Kshar Sutra Therapy:
    7. By this technique, Kshar Sutra is placed right at the root of hemorrhoidal tissue and the whole hemorrhoid is ligated with Kshar Sutra. Blood supply to the existing hemorrhoid is cut off and hemorrhoid will shed off after some days. Kshar Sutra that is placed at the root of hemorrhoid will help to prevent the recurrence of the disease.
  7. Surgery : Many kind of surgical techniques are present
    • Sclerotherapy (Injection Therapy):
    • Sclerotherapy is a popular form of hemorrhoid treatment whereby a chemical agent is injected into the hemorrhoid to cause it to shrink and go away.
    • Rubber Band Ligation- A rubber band is placed on the haemorrhoid so as to cut off the blood supply and shedding off the hemorrhoid
    • Infra Red Coagulation- Infra red rays are used to kill hemorrhoids
    • Cryosurgery – Very low temperature is used to shrink the hemorrhoids
    • Surgical Excision – Hemorrhoids are cut off using a knife.
    • Stapler surgery – Used in rectal prolapse
    • And Many more.....

Keep in mind that your treatment differ depending on your symptoms and the location of your hemorrhoid.