Piles / Hemorrhoids

What are Piles / hemorrhoids ?

Piles or Hemorrhoids are one of the most common of all anal pathologies. They present as swollen blood vessels in the anus and the lower rectum. Hemorrhoidal columns are vascular cushions present in the utero that develop symptoms. They are prolapsed, inflamed, enlarged and thrombosed. Due to this abnormality, the arteriovenous plexus are dilated and engorged. The suspensory muscles are stretched leading to a rectal prolapse through the anal canal.

Piles or Hemorrhoids causes

• Obesity
• Straining and constipation
• Pregnancy
• Portal hypertension and anorectal varices
• Genetics and heredity
• Chronic diarrhea
• Raised anal resting pressures
• Spinal cord injury
• Hepatic disease
• IBD or inflammatory bowel disease

Types of Piles or Hemorrhoids

• Internal hemorrhoids
  • Present in the embryonic endoderm
  • They are usually painless
  • Bleeding is the only symptom noticed
  • They can also prolapse and protrude outside the anal sphincter
  • Prolapsed hemorrhoids can cause pain
• External hemorrhoids
  • Develop in the ectoderm
  • They are painful
  • Itching and irritation are experienced
  • They can be seen and felt when prolapsed or moved
  • Evidence of thrombosis (blood clots) maybe seen in the prolapsed hemorrhoids
  • Thrombosed hemorrhoids are purple and can bleed

Signs and symptoms of Piles 

• Painless bleeding
• Red noticed on toilet paper or toilet bowl
• Itching and irritation
• Discomfort and formation of lumps in the anal region
• Swelling
• Sensitive and painful enlargement in the anal area
• Leaking of feces

Diagnosis of Piles or Hemorrhoids

• Physical examination: Digital rectal examination: a probe is inserted to identify :
  • Ulcerated areas
  • Mucoid discharges
  • Rectal tone
  • Presence of masses
  • Tenderness
• CBC and hematocrit testing
• Anoscopy and flexible sigmoidoscopy
• Colonoscopy
• Barium enema x-ray

Piles or Hemorrhoids Treatment

Surgical classifications

• Grade I :
  • no bleeding noticed
  • no protrusion outside the anus
• Grade II:
  • protrusion or prolapse while passing stool
  • draws back on its own
• Grade III:
  • protrusion or prolapse noted
  • can be placed back manually
• Grade IV:
  • prolapsed and cannot be manually pushed back
  • thrombosis and strangulation noted

Emergency care

External hemorrhoids that are acutely thrombosed, with large amounts of bleeding; patient sensation of dizziness and a feeling of fainting are all emergencies. Incision and drainage is done within 48 to 72 hours of the onset of symptoms.

Recommended surgical Therapies at Jacob’s Hospital

• Surgical hemorrhoidectomy:
  • Extremely effective treatment
  • Especially meant for Grade III and Grade IV hemorrhoids
  • Done under anesthesia
  • Incision is made around the anus and the hemorrhoids are cut away
• MIPH: Procedure for 2nd and early 3rd degree Hemorrhoids (Stapler Piles Treatment)
  • Minimally invasive surgery
  • Stapler device used to remove a cuff of mucosa from the anorectum
  • Blood supply is cut and hemorrhoids get obliterated by getting pulled up
  • Done under anaesthesia
  • Painless after surgery
  • Needs only a day or two of admission at the hospital
• Infrared Coagulation
  
  • Infrared beams coagulate the vessel supplying the hemorrhoids
  • The hemorrhoid falls off
  • Painless
  • Walk in and walk out procedure
  • Done for grade 1 hemorrhoids
• Band ligation
  • A tight rubber band is applied to the hemorrhoid which necroses and falls off
  • Also painless
  • For grade-1 piles
• Injection sclerotherapy

Sclerosant chemical injected into the hemorrhoid causing it to necrose and fall off Also for grade-1 hemorrhoids Under the expert supervision of Dr. Zubin Jacob, Jacob’s hospital provides a variety of repairs for all types of piles. Jacobs Multispeciality Hospital Kochi, Ernakulam provides Piles Treatment or Hemorrhoids treatment by Surgical methods.