Piles

Piles

Piles, medically known as haemorrhoids, refer to round swellings, which are dilated blood vessels, located inside the anal canal - the short, muscular tube connecting the rectum (back passage) to the anus. These swellings develop in regions termed anal cushions, often due to straining during bowel movements.

Piles can affect individuals of any age, but they are more prevalent among those over 65 years old. Up to three in four people experience piles at some point in their lives. Being overweight increases the likelihood of developing piles. Importantly, piles are non-cancerous and are not contagious.

Types of Piles

Although piles originate within the anal canal, they can protrude from the anus. They are classified into the following grades:

- First-degree piles: These are swellings on the inner lining of the anal canal. While they may bleed, they are not visible from outside the anus.
- Second-degree piles: Larger than first-degree piles, these protrude from the anus during bowel movements but retract on their own afterward.
- Third-degree piles: These hang down from the anus and retract only with manual manipulation.
- Fourth-degree piles: These permanently hang down from the anus and cannot be pushed back in. They may become swollen and painful if blood clots form inside them.

External piles are swellings that develop on the outer edge of the anus and can be more painful than internal piles.

Symptoms

Typical symptoms of piles include:

- Bleeding from the anus
- A lump around the anus
- Mucus discharge
- Sensation of incomplete bowel emptying
- Itchy skin around the anus
- Swelling and discomfort, particularly after bowel movements (in cases of external piles)

These symptoms may result from conditions other than piles. If experiencing any of these symptoms, it's advisable to consult a GP for evaluation.

Causes

The precise causes of piles remain unclear. However, increased pressure within the blood vessels of the rectum and anus is believed to contribute to their development. Factors that elevate the risk of piles include:

- Low-fibre diet
- Straining during bowel movements (e.g., due to constipation)
- Pregnancy
- Heavy lifting
- Congenital rectal weakness or family history of piles
- Age-related weakening of rectal support structures

Diagnosis

A GP will inquire about symptoms and conduct a physical examination, which may include rectal examination using a gloved finger. Additionally, a proctoscope, a narrow tube with a camera, may be used to visualize the rectum. Further investigations such as flexible sigmoidoscopy or colonoscopy may be recommended to rule out other conditions.

Treatment

While most cases of piles resolve on their own within a few days, various treatments can alleviate symptoms:

Self-help measures involve dietary and lifestyle modifications, such as consuming a high-fibre diet, staying hydrated, and avoiding excessive caffeine. Warm baths can provide relief and maintain anal hygiene. If symptoms persist despite these measures, medication or medical consultation may be necessary.

Medications such as fibre supplements or mild laxatives can soften stools, while topical creams or suppositories containing anaesthetics or corticosteroids can alleviate pain and inflammation. Non-surgical treatments include banding, sclerotherapy, infrared coagulation, and bipolar diathermy or electrotherapy. Surgery, known as haemorrhoidectomy, is considered for severe cases resistant to other treatments.

Prevention

Maintaining soft, regular bowel movements can help prevent piles. This can be achieved by consuming a fibre-rich diet, staying hydrated, and avoiding straining during bowel movements.