HEMORRHOIDS (Piles)


HEMORRHOIDS
Often known as piles these are enlarged and engorged blood vessels in or around the anus. They can be internal, occurring inside the anus, or external. These may be associated with pain, bleeding, itching, swelling and an uneasy feeling after stools or anytime during the day. Hemorrhoids can occur at any age, and affect both men and women equally.

SYMPTOMS
Bleeding which may be initially painless, there may be streaks of blood during stools which would later be followed by profuse bleeding.
Pain at or around the anus and lower bowel.
Appearance of a swelling after stools or after a straining activity which would need to be pushed in again or may itself regress after sometime.
Itching.
Discomfort around the anus as if something being pinched or pressed.


CAUSES
The basic cause of occurrence of hemorrhoids is increased pressure associated with relaxed walls of the unsupported blood vessels of the anal canal. This causes the soft pads containing the blood vessels to swell and become engorged with blood. People most at risk of developing hemorrhoids include:
Those chronically straining with constipation.
Pregnancy; here the baby may actually press on the main blood vessels.
Overweight individuals
People with heavy lifting jobs
Cancer or growths in the pelvis or bowel, which may exert pressure in a way similar to a pregnancy.
Individuals having a lot of spices and chilies in their diet are at an increased risk of suffering from hemorrhoids.

Varicose veins – many people with these also develop hemorrhoids, although hemorrhoids are not varicose veins.

DIAGNOSIS
Hemorrhoids can be diagnosed by proctoscopy easily where a small telescope known as a proctoscope is passed into the anal canal.
Digital examination in the anus does not help to diagnose hemorrhoids.
Hemorrhoids are usually situated at - 3 o’clock, 7 o’clock and 11 o’clock positions in the anal canal. This is because of the presence of blood vessels in those areas.

Hemorrhoids have been classified as:
First-degree; presence of bleeding without any prolapse of vessels or skin, they remain inside the rectum or anal canal.
Second-degree; they protrude from the anus on straining, as in during stools and return inside on their own.
Third-degree; they are similar to second degree, but only return inside when pushed back.Fourth-degree;they hang permanently outside the anus and cannot be pushed back.

TREATMENT
Before visiting the doctor - The most important element in encouraging existing hemorrhoids to clear up is to avoid constipation. By having regular bowel movements, and avoiding straining, stools pass easily and do not put pressure on the blood vessels in the anal area.

After you have passed the stool, don't strain to finish. People with hemorrhoids often think there is more to come, but this is a false sensation caused by the swollen spongy pads in the hemorrhoids themselves. Avoiding activities like reading in the toilets may help reduce the extent of time spent within the toilets. The basic aim is to reduce the pressure being exerted thus preventing the occurrence of hemorrhoids

To stop hemorrhoids returning, continue the high fiber diet to keep your stools soft and do not put off opening your bowels. Treatment for hemorrhoids should begin as early as possible so that the condition does not worsen.

Surgery should be the last resort if everything else fails, as even after surgery it cannot be guaranteed that hemorrhoids would not re-occur.

People usually believe that hemorrhoids are like varicose veins of the legs (i.e. a single vein that has become swollen) this is not the case. A hemorrhoid is one of the soft pads that have slipped downwards slightly, because the surrounding tissue is not holding it in place properly. When this happens, the small blood vessels within the cushion become engorged with blood, so the cushion swells up. When forces are applied, the hemorrhoid may be pushed further down the anal canal to the outside, and this is called a prolapsed hemorrhoid.

COMPLICATIONS OF HEMORRHOIDS
A prolapsed hemorrhoid may swell considerably and the blood flowing would then not return to the body. This gradually becomes very painful and can lead to thrombosis

Thrombosis:
This is when the blood in the swollen hemorrhoid clots. A thrombosed hemorrhoid may be less painful than a strangulated hemorrhoid and looks different, being dark purple or black in color.

Gangrene:
Lack of blood supply to a hemorrhoid may lead to severe pain and gangrene (tissue death). This is a dangerous and a rare complication needing immediate surgery.

Infection:
This also remains a rare but serious complication. An abscess may form around the rectum and anus causing pain and swelling. Rarely, the infection may spread, particularly to the liver. This is because the blood draining away from the anal area passes through the liver.

Anemia:
Severe loss of blood from hemorrhoids. Bleeding over a long period of time can cause anemia, when there are not enough blood cells to supply the body with oxygen.

Dos & Don’ts
People with hemorrhoids are usually constipated and as a result apply too much pressure during defecation, which may lead to hemorrhoids. Thus straining should be strictly avoided.
Avoid lifting heavy weights.
Spicy and oily food should be avoided.