Hemorrhoids or piles: Know all about hemorrhoids

What are hemorrhoids?

Hemorrhoids are also known as piles. The swollen or enlarged veins usually in the lower portion of the rectum or outside the anus are called hemorrhoids.  

The enlargement of the blood vessels may be a result of increased pressure on the veins. It may be due to prolonged standing or sitting, excess weight of the body or pregnancy.
Piles during pregnancy is a common problem experienced by many women.

Hemorhoids may be present in most of the people but it does not trouble all.  Some people feel more discomfort and pain when the hemorrhoids are too much enlarged and they experience difficulty during bowel movement.

The hemorrhoids may feel like a bulging of the veins or bubbles like feeling when touched in squatting position. 

It can be irritating, painful and discomforting while passing stools. In some people, the hemorrhoids may be too painful to tolerate and even bleed more,eventually turning into more serious complications. In such cases, the hemorrhoids are removed surgically. 

What are the types of Hemorrhoids?

Based on the site of enlargement or swelling of the veins, the hemorrhoids can be:

1. Internal hemorrhoids

• Located inside the rectum. The lowest portion of the intestine connecting the colon and anus.
• The internal hemorrhoids may not be visible to naked eyes and need a proctoscopy or per-rectum examination. 
• These type of hemorrhoids may bleed but it may be less painful. 
• It cannot be felt but can prolapse outside and may stick out like a skin or flesh around the anus. 
• Internal hemorrhoids  may protrude out while passing stools and may be needed to manipulate to push them inside.

2. External hemorrhoids

• These are located on the outside around the anus. The anus is the opening of the rectum from which the stool or poop comes out of the bowel. 
• Such hemorrhoid do not bleed most of the time but some sort of clot formation may occur sometimes making it painful while sitting.
• External hemorrhoids are apparent on physical examination. The person may be able to feel the swollen veins.   
• Such hemorrhoids are commonly seen in many people.

3. Prolapsed hemorrhoids

• The prolapsed type is the one in which either the internal or external hemorrhoid comes out as a buldging through the anus.
• External hemorrhoids are more troublesome and may be painful for most people. The people with external piles may find it difficult to sit for long, defecate or poop,etc.

What are the symptoms of hemorrhoids or piles?

The symptoms of piles or hemorrhoids are:

• Rectal or perianal itching
• Pain while defecation or pooping
• Protrusion of venous lumps while defecation
• Bleeding per rectum 
• Mucus or pus discharge 
• Extreme pain on sitting if the external hemorrhoids are large enough
• Prolapse of the internal hemorrhoids
• Formation of clot around the anus.

What are the common causes or risk factors of hemorrhoids or piles?

• Excessive straining while passing stools 
• Prolonged hours of sitting 
• Prolonged hours of standing
• Obesity or excess fat 
• Pregnancy which causes excess pelvic pressure on the colon due to enlarged uterus
• Chronic constipation
• Lack of fibre-rich diet
• Lifting heavy weight objects for prolonged time
• Having a family history of piles
• Anal intercourse may aggravate the hemorrhoids that are normally present.

Is it common to have piles or hemorrhoids? Do all people get piles in their lifetime?

Piles or hemorrhoids are much common and as we age the valves in our veins get loose and they end up dilating or enlarged due to low venous return.  As the valve loses its capacity as we grow old and the contributing risk factors  together may increase the chances of having hemorrhoids. 

Not all people may have piles during the lifetime that are painful or too difficult to live with. Almost all have piles but they are not troubled by its presence. While there are people who need medical as well as surgical intervention for the hemorrhoids, it can be a least bothering thing for the most.

Which people are likely to have hemorrhoids?

People likely to develop hemorrhoids or piles may be the one:

• Who strains more while pooping
• Who remains mostly constipated
• Who drinks less water and ends up getting constipated
• Who eats low fibre diet
• Who is overweight and has sedentary lifestyle
• Who is pregnant 
• Who is working as heavy weight lifter
• Who stands or sits for long hours
• Who are above 50 years of age

Even though these causes may be the reason to have hemorrhoids, the exact cause can't be defined.

How to get checked if you have piles or not? How is the diagnosis of hemorhhoids or piles done?

The doctor may diagnose the presence of piles by:

• Taking a thorough patient history: Your doctor may ask you about the chief complaints, the bowel movement, eating habits, family history or any other medical history. 
• Performing a physical exam:  Your doctor may examine your anus and assess for any external piles, or  fissures or cuts around your anus. The external hemorrhoids can be easily seen on physical exam. 
• Performing a digital rectal examination: Your doctor may use a gloved finger to palpate or feel the inner portion of the rectum and its muscle tone and mucosa.  The doctor also checks for the presence of any excess mucus or discharge and bleeding inside your rectum.
• Anoscopy or Proctoscopy: Your doctor may need to use a proctoscope to visualise the inner portion of the rectum and rule out any internal hemorrhoids and check for any internal bleeding. Your doctor may ask you to strain a little or cough out heavily to see the prolapse of the internal hemorrhoids.
• Differential diagnosis: If a patient complains of having rectal bleeding, it may be a necessary to rule out the other possibilities such as ulcerative colitis or Crohn's disease or cancers.  These conditions may also cause gastro-intestinal bleeding.  See: Helicobacter Pylori infection and Gastritis

What are the complications of hemorrhoids?

Hemorrhoids can be treated with medical care and surgical intervention. However if they are troublesome and yet are ignored a lot, you may suffer some of the complications in future.  These complications may occur rarely though.

These are:

• Formation of clots or hard lumps on the anus which are painful and irritating
• Prolapsed hemorrhoids
• Anemia
• Strangulation of the hemorrhoids causing the cut-off of the blood supply to that portion.
• Skin tags are formed when the clots inside the hemorrhoids get dissolved
• Infection

What is the treatment of hemorrhoids or piles? How to get your piles treated?

Hemorrhoids usually do not need any medical treatment as they go away on their own in few days but if they are discomforting you more, it can be treated with medical care and bringing about changes in food and lifestyle.  

The treatment line-up for hemorrhoids or piles:

Reducing the symptoms and relief from pain

• Anal itching is the most annoying and embarrassing symptom and it can be treated with the application of the ointments or gels as prescribed by your doctor.  Wash your anus thoroughly with preferably warm water and then wipe it gently to dry and apply then ointment with an applicator provided with the ointment.
• Constipation may be treated with laxatives or enema or or rectal suppositories.
• Pain relief can be obtained by taking the over-the-counter medication such as acetaminophen or as ordered by your physician.  Sitting into a tub filled with warm water also provides relief from pain. As advised by your doctor take such Sitz bath for 15-20 min for 2-3 times a day. This helps in reducing the swelling and pain. 
• Rubber band ligation: Your doctor may use this procedure to cut off the blood supply of the hemorrhoid by tying a rubber band around it. These may result into the shrinkage of the hemorrhoid, and finally which gets dissolved.
• Sclerotherapy: It is a procedure in which a chemical/medicine is injected into the hemorrhoid to destroy the tissue of the swollen veins. 
• Use of electrocoagulation and infrared rays to stop the flow of blood to the hemorrhoid.

Recommending the changes in diet and lifestyle:

• Your doctor may recommend including fibre-rich foods to your meals and having plenty of water throughout the day.
• You may be advised to avoid heavy lifting or prolonged sitting or standing.
• You may be told to maintain the hygiene of your anus and rectum by properly cleaning it to keep your hemorrhoids free from infection.
• You may told to use a cushion while sitting.
• You may be advised to exercise in order to reduce your weight, if you are an obese person.

Surgical approaches:

• Your doctor may consider a surgery for the hemorrhoids that are not treatable medically.  
• You may need a hemorrhoidectomy means the removal of hemorrhoids. 
• Hemorrhoids can also be stapled using a special instrument to either remove the internal hemorrhoid or fix the prolapsed ones.
• Cryosurgery can also be done to treat the hemorrhoids by using extreme cold temperature to cut off the hemorrhoids.

How can we get rid of hemorrhoids or piles at home without taking treatment?

While piles are not a major concern for many, it may be an irritating one for the others. People feel it embarrassing to visit the doctor for piles treatment and all they seek is the ways or remedies they can try out to ease out their symptoms at home.

Here are the ways or home remedies to ease your piles and the symptoms:

• Once you come to know you have hemorrhoids, start drinking enough water. Drink more water to keep yourself hydrated.  Water also helps you have easy bowel movements.
• Before you go to bed and after you wake up in the morning, have a glass of warm water.  Adding honey acts as a laxative, thus easing out your bowel movement and lessening your pain associated with defecation.
• Have fibre-rich diet. Include the fresh fruits and vegetables in your diet. This helps in preventing you from getting constipated and straining on your anus.
• Sit into a tub of warm water for 15-20 minutes 2-3 times a day. It is called a Sitz bath. Your doctor may provide you some medicinal powder to mix in the water to get rid of your hemorrhoids faster.
• Applying warm or cold compress to your external hemorrhoids may provide you a quick relief from the pain.
• Do not rub the inflamed veins around your anus. It may cause bleeding or thrombosis.
• Use the over-the-counter ointments or gels or suppositories.  In most of the cases, the results are good and you feel comfortable after using them.
• Take Non steroidal anti-inflammatory drugs to get relief from the pain.
• Do not lift heavy objects or at least try to reduce doing it or simply avoid it.
• Add a teaspoon of ghee or castor oil to a glass of warm water and drink it if you are mostly constipated for more than 2 days.
• Consider doing exercise or workout if you are overweight. 
• Eat small and frequent meals rather than having big fat meals.
• Avoid the use of too much spices and oils in your meals.
• Avoid eating junk or fast foods. 
• Try having bowls of warm soups and fresh veggies. 

How can you prevent hemorrhoids or piles?

Prevention can be the best alternative always. If you do not want to go through the irritation or annoyance, pain and discomfort, the hemorrhoids can bring to your life, you should definitely know and try to incorporate these prevention measures.

• Eat a well balanced diet. Nutrition is always a major factor in keeping up body's health and immunity. 
• Drink plenty of water.
• Consume fibre-rich foods such as brown rice, oats, fresh fruits with their skin, vegetables, salad, etc.  Such foods help in creating an intestinal bulk of feces which can easily pass through in a bowel movement.
• Exercise and keep your body free from excess fat.
• Avoid any food that makes you constipated.
• Avoid heavy lifting, prolonged sitting and standing.
• Practice good anal and rectal hygiene. Keep it clean after each bowel movement and do not ignore symptoms such as bleeding or excess mucus discharge or continuous itching and pain. Seek medical care or try out home remedies. 

Hemorrhoids are one of the most common problems, treatable or usually not needing any treatment. Home remedies and care make you feel at ease and relief from symptoms.

Note: This post is for informational and educational purpose only, It is not a substitute to any medical or professional advice or treatment. See your doctor in any case.