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Haemorrhoids (derived from Greek word “haima” means blood and “rhoos” means flowing) or piles (in Latin “pila” means a ball) refers to dilated veins occurring in relation to the anus.

Types of haemorrhoids

• Internal hemorrhoids-  Whenever there is increased pressure on superior rectal veins (as due chronic    constipation, pregnancy, obesity etc.) the venous drainage is impeded and this   causes a back  pressure in the internal venous plexus resulting in dilated veins.  These are called internal hemorrhoids. The branches of superior rectal vein, located at  3, 7 and 11 o’clock positions in   the anal canal are common sites for Internal hemorrhoids.
• External hemorrhoids- Pressure on the inferior rectal vein (which runs along the anal margin) can  cause External hemorrhoids.

Internal haemorrhoids-Internal haemorrhoids are classified using a grading system from one to four.

• Grade one haemorrhoids are small swellings often inside the lining of your anus. They cannot be seen and are very common. In some cases they will enlarge to grade two.
• Grade two haemorrhoids are larger in size but are still within your anus. Sometimes they become pushed out when you pass a stool, but will return inside immediately afteron their own.
• Grade three haemorrhoids appear outside your anus; you may be able to feel one or more small lumps hanging out. They are also referred to as prolapsed haemorrhoids. You'll usually be able to push them back inside using your finger.
• Grade four haemorrhoids can become quite large and remain outside your anus permanently. They cannot be pushed back inside and will need to be treated by your SURGEON.

External haemorrhoids
External haemorrhoids, also known as perianal haematoma, are small lumps that develop on the outside edge of the anus. They can become increasingly itchy. If a blood clot forms inside them (thrombosed external haemorrhoid) it can cause a lot of pain, requiring immediate treatment. This type of haemorrhoid is less common.

Risk factors:

• Constant straining due to constipation. 
• Diet high in processed food and low in fiber  
• Laxative abuse and frequent enemas.
• Sedentary lifestyle
• Obesity
• Lifting heavy objects
• Repeated coughing and sneezing
• Prolonged diarrhoea,
• Pregnancy - increased abdominal pressure on  pelvic blood vessel, causing blood vessels to enlarge (the haemorrhoids often disappear after giving birth).
• Over the age of 50.
• Some diseases/ conditions such as enlarged  prostrate, urethral stricture (narrowing of the urinary opening) and cancer of rectum.
• Occupations involving : Lot of traveling (e.g. marketing and sales professionals) Prolonged standing (e.g. traffic police, waiters, etc.)

Haemorrhoids (piles) are easily diagnosed by your SURGEON. They will examine your anus to check for swollen blood vessels.

It's important to inform your SURGEON of the following information:

• Recent loss  of weight
• Changed bowel movements
• Colour are stools
• Any blood in stools 
• Mucus in stools

The symptoms of haemorrhoids include:

• Pain
• Bright red Bleeding
• Ithching & mucus discharge
• Incomplete evacuation
• Constipation
• Prolapse
• Anaemia

Digital rectal examination (DRE). If your haemorrhoids are internal, your SURGEON may perform a digital rectal examination. Wearing gloves and using lubricant, they will use their finger to feel for any internal abnormalities.

Proctoscopy. If a closer examination is necessary your SURGEON may use an anoscope. This is a hollow tube fitted with a light on the end. An anoscope makes it possible for your SURGEON to see your entire anal canal. It also allows your SURGEON to take a small tissue sample from inside your rectum, if laboratory tests need to be carried out. Inspection.

Sigmoidoscopy: if there is any unexplained or alarming symptoms then examination under vision through colonoscopy os sigmoidoscopy id done to rule out makignancy.

It is important to see your SURGEON if you experience bleeding from your anus.

AIM OF TREATMENT

Effective relief from Signs & Symptoms  
Effective management of precipitating factors
Practical & Relevant health education

General measures & home care:

• Eating plenty of fresh fruit and vegetables (at least five portions a day).
• Cutting down on fat (particularly animal fat), sugary food, and refined and processed food.
• Eating plenty of pulses such as peas, beans and lentils.
• Eating plenty of wholegrain foods such as wholemeal bread, pasta and breakfast cereals.
• Drinking plenty of fluid. You should drink one to two litres (six to eight glasses) of water every day in order to keep your faeces soft.
• Drinking alcohol in moderation.
• Losing weight - being overweight can be a contributing factor to having haemorrhoids.
• Exercising regularly - this can prevent constipation, reduce the pressure in your blood vessels, and help you lose weight.
• Avoiding medication that causes constipation - such as painkillers that contain codeine.

Management:

Hot seitz Bath

Local application: steroids, local anaesthetics,

Drugs : favinoids, calcium dobisilate etc.

Sclerotherapy : injection of almond oil or satrol.

Banding : barron’s banding to cut off blood supply

Infrared coagulation; to achieve blood coagulation.

Haemorrhoidal artery ligation operation (HALO)

Surgery:

1. open ( Milligan & Morgan)
2. minimally invasive procedure of piles ( MIPH)- latest & painless piles surgery

Surgery is often used to treat internal haemorrhoids that are either very large or are grade four.

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