Haemorrhoids are one of the most commonly occurring ailments, affecting both men and women. One reason people do not talk about haemorrhoid problems with their doctors is because they anticipate a painful, traditional haemorrhoid surgery. But the fact is that better understanding of the disease process along with new technological improvements; have enabled more procedures to be performed as day care procedure.

Piles or Haemorrhoids can occur at any age. Many experts believe that they are caused by continuous high pressure in the veins of the body, which occurs because humans stand upright. The causes of haemorrhoids include constipation and excessive straining during bowel movements. Persistent diarrhoea and loose stool movements are also causes of haemorrhoids, and some people inherit a family tendency to develop piles. Women are more susceptible to haemorrhoids during pregnancy, as pressure from the growing uterus restricts blood flow in the pelvic area. Lifestyle factors can also contribute to haemorrhoid development.

Haemorrhoids may be internal or external. Both types of haemorrhoids can be present at the same time. Internal haemorrhoids are classified further based upon the degree to which they protrude from the anal canal. This grading system is important since the grade in part determines which type of treatment is best. But no widely used grading system exists for external haemorrhoids. According to this grading system:

  * Grade I haemorrhoids may bulge into the anal canal but do not protrude through the anus.
  * Grade II haemorrhoids protrude through the anus during straining and defecation, but return spontaneously.
 * Grade III haemorrhoids protrude through the anus with defecation or straining but do not return spontaneously, requiring the patient to gently push it back into its normal position with a finger.
  * Grade IV haemorrhoids cannot be manually returned to their normal position.

What are the symptoms of piles?

The symptoms of piles can come and go. There are five main symptoms:

   * Itching and irritation
   * Aching pain and discomfort
   * Bleeding
   * A lump, which may be tender
   * Soiling of pants or knickers with slime or faeces ('skid marks').

Itching and irritation probably occur because the lumpy piles stop acting as soft pads to keep the mucus in; instead, a little mucus leaks out and irritates the area around the anus. Pain and discomfort comes from swelling around the pile, and from scratching of the lining of the anal canal by faeces as they pass over the lumpy area. The scratching also causes bleeding, which is a fresh bright red colour and may be seen on faeces or toilet paper or dripping in the pan. A pile that has been pushed down (a second- or third-degree pile) may be felt as a lump at the anus. Internal haemorrhoids cannot cause cutaneous pain, but they can bleed and prolapse. Prolapse of internal haemorrhoids can cause perianal pain by causing a spasm of the sphincter complex. This spasm results in discomfort while the prolapsed haemorrhoids are exposed. The discomfort is relieved with reduction.

How is it diagnosed?

Haemorrhoids are diagnosed based upon a history, physical examination and visual inspection of the anal canal and rectum. When the patient reports to the physician with the symptoms of piles, the physician takes detailed case history.

To confirm presence of haemorrhoids, the doctor will do a rectal examination. The doctor will place a gloved and lubricated finger into the rectum to feel for abnormalities. External haemorrhoids can be diagnosed by a visual and/or rectal examination. To diagnose internal haemorrhoids, the doctor will insert a thin tube-like instrument (called an anoscope) into the lower few inches of the rectum. The anoscope has a light at the end and an eyepiece at the front for viewing into the anal canal. The procedure is painless but uncomfortable and lasts about 1 minute and is done in the OPD. Despite the fact that bleeding is common in patients with haemorrhoids, other potential causes of bleeding are excluded. To test for blood that may not be visible, the clinician obtains a small stool sample on a gloved finger. The stool is smeared onto a chemically coated paper and drops of another chemical are added. If blood is present, the colour of the paper will change to blue.

A more detailed look can be done by a procedure called sigmoidoscopy that is done under sedation or anaesthesia and a look upto 25 cm can be done to rule out any sinister disease that may be associated. Occasionally, a barium examination or colonoscopic examination of the large intestine may be required if other diseases are suspected.

Benefits and drawbacks

Studies suggest that Stapled Piles Surgery (also known as PPH - procedure for prolapse and haemorrhoids or MIPH - Minimally invasive procedure for haemorrhoids) is an effective treatment. This technique potentially provides a tool for reducing some of the problems associated with conventional surgery. It considerably reduces operative bleeding, postoperative pain, the length of hospital stay, and encourages a rapid return to normal activities when compared with conventional piles surgery. So the clear advantages of the modern methods for outpatient treatment of internal piles are that they are quick and relatively painless. Patients lose little if any time from work, the complications are minor, and the cure rates are high. So to summarise, given below are the advantages of MIPH in points:

Smaller incisions resulting in reduced pain and discomfort
Minimal scarring
Greater surgical precision
Fewer complications
Less blood loss and a decreased need for blood transfusions
Reduced risk of infection
Shorter hospital stays
Faster recoveries

Care to be taken at home

While no strategy completely removes the risk of haemorrhoids occurring again, following these suggestions can lower the risk:

Avoid straining during bowel movements.
Avoid constipation
Drink enough liquid for proper hydration.
Eat a diet high in fibre.
Exercise regularly.