Hemorrhoids

Hemorrhoids are commonly called as piles. These are swollen blood vessels in the region of Lower Rectum and Anal canal which results in passage of blood from the back-passage or at times with act of defecation.

The exact cause of the formation of hemorrhoids is unknown but factors which results in increased pressure in these veins like -

• Straining during defecation
• Sitting in the toilet for a long period of time
• Obesity
• Pregnancy
• Anal intercourse
• Eating diet less in fiber

Hemorrhoids is a very common disease but sometimes they do not cause any symptoms. The commonly occurring symptoms of Hemorrhoids are -

• Bleeding during defecation which is often painless 
• Itching or irritation in the perianal region
• Discomfort or pain in the perianal region
• Swelling around the anus
• Painful lump near your anus (in Thrombosed piles)

Types of Hemorrhoids:

Internal Hemorrhoids - lie inside the rectum. One can not see or feel them from outside.  Patient usually presents with episodes of bleeding while passing stools especially associated with history of straining while passing stools. This straining while passing hard and well formed stools may result in the surface abrasion of the Internal Hemorrhoids resulting into bleeding which is bright red and fresh. With tile these hemorrhoids enlarge and prolapse outside the rectum which causes pain and irritation.

External Hemorrhoids - present under the skin around the anus. Digital pressure or abrasion of these hemorrhoids may cause bleeding episodes and itching at the perianal region.

Thrombosed Hemorrhoids - sometimes a blood clot may for in some external hemorrhoids which results in severe pain, swelling and inflammation around the anus.

Special precautions should be taken when bleeding episodes are associated with alteration of bowel habits a weight loss especially with patients above 40 years of age and a positive family history of colo-rectal cancers. In such cases a thorough colonoscopic examination is must to rule out other diseases like a tumor or ulcer which can cause bleeding from the back-passage.

Complications of Hemorrhoids:

Complications are rare but Anemia can occur because of long standing bleeding and delay in treatment.

Preventive measures - Increase dietary fiber intake, drink plenty of fluids, don’t strain much and don’t try to pass stools by the clock, go only when you feel the urge to pass stools, exercise regularly.

Diagnosis:

• Digital Rectal Examination (DRE)
• Proctoscopy Examination
• Sigmoidoscopy/ colonoscopy

Treatment options :

Office procedures - Rubber band ligation, Injection Sclerotherapy, Infrared/ Laser Coagulation. The advantage of office procedures is they can be done on an OPD basis and can be repeated if the symptoms recur. The disadvantage is recurrence of hemorrhoids.

Operative Procedure -

Stapler Haemorrhoidectomy - Is a minimally invasive technique of treating hemorrhoids and is having a long term and time tested results. The stapler gun resects an entire circumference of rectal tissue with haemorrhoidal roots (dilated blood vessels) and results into near permanent remedy. This procedure is painless and can be done on a day care basis, it is having no external cuts and no need of any dressing to be applied. The only disadvantage is increased frequency of passage of stools which is also temporary and can be controlled by dietary fibers easily.