PILES

Piles are hemorrhoids that become inflamed. Hemorrhoids are masses, clumps, cushions of tissue in the anal canal - they are full of blood vessels, support tissue, muscle and elastic fibers.

Although hemorrhoids are thought of as unpleasant inflammations, we all have them. It is when the hemorrhoidal cushions become too big (inflamed) that problems occur - when this happens they are called piles or pathological hemorrhoids.

Put simply, 'piles' are the swollen ones that are painful and cause problems, hemorrhoids can refer to the swollen ones (pathological hemorrhoids) or simply the normal structure. However, in most cases these days, the words piles and hemorrhoids are nearly always used interchangeably.

Piles can be of various sizes and may be internal (inside the anus) or external ones (outside the anus). Typically, internal piles occur from 2 to 4cm above the opening of the anus. External piles (perianal hematoma) occur on the outside edge of the anus. The internal ones are much more common.

According to the National Institutes of Health (NIH), USA, symptomatic hemorrhoids affect at least half the US population at some time in their lives, and approximately 5% of all adults have piles at any given time.

According to the National Health Service (NHS, UK), piles affect between 4% to 25% of the UK adult population. They are more common among adults aged between 45 and 65 years, as well as pregnant mothers.

Males and females are equally susceptible to developing troublesome hemorrhoids.
In the vast majority of cases, piles are effectively treated with OTC medications, a good fluid intake, and by following a diet high in fiber. In severe cases the piles may have to be surgically removed. Approximately 10% of patients who go and see their doctor about piles eventually require surgical intervention.

According to Medilexicons medical dictionary:

• Hemorrhoids are 'A varicose condition of the external hemorrhoidal veins causing painful swellings at the anus.'
• Internal Hemorrhoids are 'Dilated veins beneath the mucous membrane within the sphincter.'
• External Hemorrhoids are 'dilated veins forming tumors at the outer side of the external sphincter.'
• Hemorrhoid
• Schematic demonstrating the anatomy of hemorrhoids

A symptom is something the patient feels and describes, such as a pain, while a sign is something everybody can see, such as a rash.

In most cases piles are not serious and go away on their own after a few days. In fact, a considerable number of people with hemorrhoids do not experience any symptoms and do not even know they have them.

An individual with piles may experience the following symptoms:

• A hard lump may be felt around the anus. It consists of coagulated blood, called a thrombosed external hemorrhoid. This can be extremely painful
• After going to the toilet, a feeling that the bowels are still full
• Bright red blood when doing a bowel movement
• Itchiness in the anus area
• Mucus discharge when emptying the bowels
• Pain while defecating
• The anus area may be red and sore
• When passing a stool the person may strain excessively

Internal hemorrhoids - they are classified into four grades:

• Grade 1 - there are small inflammations, usually inside the lining of the anus. They are not visible.
• Grade 2 - larger than Grade 1 hemorrhoids, and also inside the anus. When passing a stool they may get pushed out, but soon return.
• Grade 3 - often called 'prolapsed hemorrhoids'; these appear outside the anus. The patient may feel them hanging out. They can be pushed back in if the patient presses with his/her finger.
• Grade 4 - these cannot be pushed back in and need to be treated by a doctor. They are large and stay outside the anus all the time.

External hemorrhoids - called perianal hematoma. These are small lumps that are located on the outside edge of the anus. They are extremely itchy and can be painful if a blood clot forms inside (thrombosed external hemorrhoid). Thrombosed external hemorrhoid requires medical treatment straight away.

A qualified doctor can usually diagnose piles fairly rapidly after carrying out a physical examination. He/she will examine the patient's anus for swollen veins.

The doctor may ask the following questions:

• Do any close relatives (parents, siblings) have piles?
• Has there been any blood on the stools?
• Has there been any mucus on the stools?
• Has there been any recent weight loss?
• Have bowel movements changed recently?
• What color are the stools?

Internal hemorrhoids - the doctor may perform a DRE (digital rectal exam). The doctor may use a proctoscope - a hollow tube fitted with a light. The proctoscope allows the doctor to see the anal canal and take a small tissue sample from inside the rectum, which can be sent to the lab for analysis.

If the physician is presented with signs and symptoms which may suggest another digestive system disease, risk factors for colorectal cancer, and some other factors, he/she may recommend ordering an examination of the colon using colonoscopy.

A good doctor will initially recommend some lifestyle changes.

Diet - piles can be caused by too much straining when doing bowel movements, which is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or even switching your cereal breakfast to bran.

Water is the best drink, and the patient may be advised to increase his/her water consumption. Some experts say too much caffeine is not good.

Homeopathic treatment is very much effective treatment in piles(all stages), fissures, fistulae-in-ano etc.