Piles (Hemorrhoids) - Causes, Symptoms, and Treatment!

What are Piles? 
Piles, originally known as hemorrhoids, are a medical condition characterized by the swelling of veins in the lower rectum and the anus.  The veins are twisted and swollen, restricting the conventional blood flow in the anus and rectum. Even though it is very difficult to actually ascertain the cause of piles, the occurrence of this condition can be due to multiple reasons.

The most common causes of piles range from straining the veins at the time of being pregnant to additional pressure being applied to the veins during a bowel movement.   This condition can occur internally or on the surface of the skin, depending on the cause and effect of the reason behind the occurrence of this condition. 

Piles is a very common condition and are said to affect 3 out of 4 adults multiple times during their life.  Symptoms of the disease are often spotted amongst patients before they even reach the age of 50.  The symptoms of piles may be minimal or very evident, depending on the severity of the situation.  In a basic situation, a patient usually feels a little discomfort. While in a more serious situation such as thrombosed hemorrhoid, there may be the formation of blood clots which can cause excruciating pain. There are various treatments for this disease. Piles is not a very dangerous medical condition can usually be treated by making changes in the lifestyle or by easy home remedies which cause relief to the patient.

What are  The Types of Piles?
The piles disease can be divided into 4 different classifications based on the location, symptoms, and side- effects caused by their occurrence.

Internal hemorrhoids
External hemorrhoids
Thrombosed External Haemorrhoids
Prolapsed Haemorrhoids

1) Internal hemorrhoids-
This condition is the least restrictive type of piles. The symptoms of this piles condition arise inside the rectum and are found on the border that divides the upper part of the anal canal from the lower of the rectum. Internal piles don’t cause too much discomfort to the patient as they are enclosed in an external lining called mucosa, which protects it from causing pain to the patient. This is because the mucosa is insensitive to temperature, touch, stretching or pain.

On the basis of the level of the protrusion, internal hemorrhoids or internal piles can be classified in 4 levels-

Grade I: It is possible to bleed during this stage as the hemorrhoids are noticeable but they don't poke into the anal canal.
Grade II: At this piles stage, the hemorrhoids protrude momentarily outside the anal canal during a bowel movement, but shift back inside after the movement.
Grade III: In this piles stage, any pressure or exertion causes the hemorrhoids to protrude outside the anal canal. Fingers need to be used to push the hemorrhoids back in the anal canal.
Grade IV: Hemorrhoids have fallen out of the anal canal remain outside the rectum in this stage. They cannot be pushed back in and thus are quite uncomfortable.

2) External hemorrhoids-
This type of hemorrhoids is also known as a perianal hematoma. The side effects of this piles condition are usually bluish in color and feel painful and lumpy and are noticeable under the skin around the outer part of the anus. This type of hemorrhoids is similar in nature to the above described prolapsed internal hemorrhoids. External hemorrhoids may lead to additional skin tags on the verge of the anus, which may feel very uncomfortable to the patient. This happens due to the fact that these hemorrhoids are covered by normal skin which causes discomfort.

The occurrence of these skin tags is caused by the clot of blood formed due to stretching of the overlying skin.

3) Thrombosed External Haemorrhoids-
Thrombosed external hemorrhoids occur due to the formation of a clot in various small veins which causes pain and discomfort to the patient. This type of hemorrhoids is characterized by the presence of a painful and hard lump in the anus. The main cause of this type of piles is the excessive stretching of the skin which covers hemorrhoid. This causes the splitting of the vein, making it inflamed and cutting off the blood supply in it.

4) Prolapsed Haemorrhoids-
This is a type of hemorrhoids which have fallen out of the anal canal. The most common symptoms of prolapsed hemorrhoids are bleeding in the stool, toilet or on the toilet paper.   Most patients of this condition experience a feeling of not being able to completely pass stools. Prolapsed hemorrhoids can be quite painful because of the presence of nerves in them which can easily sense pain. Pain can arise in prolapsed hemorrhoids because of the pain-sensing nerves within them. Other possible causes of pain are -

• Swelling with hemorrhoid or abnormal accumulation of fluid in the hemorrhoid
• Blood clot formation or thrombosis
• Obstructed supply of blood in the hemorrhoid
• Overstretching of hemorrhoid caused by external pressure

What are the symptoms of piles?
The warning signs and common symptoms of hemorrhoids are listed below:

• Irritation or itching near the anal region
• Pain and bleeding during bowel movements
• Swelling in the anal region
• Lump near the anus which is painful and uncomfortable
• Painless bleeding

The various types of hemorrhoids or piles have specific symptoms depending on the location of their occurrence:

Internal hemorrhoids or Internal  piles
These hemorrhoids usually do not carry any specific symptoms which can be noticed by the patient. Excess straining of this type of hemorrhoids can lead to damage on the surface or minor bleeding. In case internal hemorrhoid passes through the anal canal, it becomes a prolapsed hemorrhoid which may be painful.

External hemorrhoids or External Piles
In case of application of pressure or external strain, these hemorrhoids can bleed or cause itching and discomfort.

Thrombosed hemorrhoids or Thrombosed Piles
This type of hemorrhoids is characterized by the formation of a blood clot in the anal region. This blood clot causes swelling, severe pain, inflammation or a hard lump near the anus.

 How are piles diagnosed?
Since there are multiple types of piles or hemorrhoids, they are all diagnosed differently.

Internal hemorrhoids can be diagnosed in the following ways-

• Digital rectal exam- This exam is done by the method of inserting a gloved and lubricated finger in the patient’s anus in order to identify any abnormalities. In case of any additional growth or abnormal diagnosis, the additional examination is prescribed.
• Sigmoidoscopy- This physical exam is done by inserting a really tiny fiber-optic camera in the rectum.  This allows the physician to check the surface for hemorrhoids.
• Proctoscopy- The physician inserts a hollow tube with a light at the end of the rectum in order to clearly review the anal canal and a large part of the large intestine.
• Anoscopy- This procedure entails the insertion of an anoscope in the anus in order to examine the anal region for hemorrhoids. An anoscope is generally made of stainless steel or plastic.
• Colonoscopy- This is a procedure in which a colonoscope is inserted in the anus and slowly moved around the colon area. This apparatus has a light source and camera attached to it which enables the physician to check for hemorrhoids.

This procedure may be additionally prescribed if the physician suspects any of the following situations in people who might have-
Any other disease related to digestive system

Signs and symptoms of colorectal cancer-
Are over the age of 50, and have never undergone a rectal examination
External hemorrhoids or external piles can be identified by a physician by simply undertaking a physical exam and visual notice.

What are Causes of Piles?
Veins have a tendency to swell up or bulge on the application of increased pressure. 

The various causes for swelling up of the veins, causing hemorrhoids or piles are-

• The excessive strain caused by pressure applied during a bowel movement
• Sitting on the toilet bowl for too long
• Constipation, Diarrhea or some other digestive system related problem
• Pregnancy
• Anal intercourse
• Low- Fiber Diet
• Obesity
• People over the age of 50 are more susceptible to hemorrhoids becomes over time, the veins in the anus and rectum that support their functioning tend to get overstretched or weak.  

Prevention from Piles/Hemorrhoid:
The most appropriate way to avoid getting hemorrhoids is to ensure that the stool to be passed by the anus is soft so that it passes easily.

Other than this, to prevent and reduce the occurrence of the symptoms of piles or hemorrhoids, the following steps can be followed.

• Eating high fiber food- Consuming more fruits, vegetables, and whole grains increases the fiber content in the body. This fiber ensures that the stool is soft and is easy to pass through the anus. This helps in avoiding a situation of application of additional pressure during a bowel movement.
• Drinking plenty of fluids- It is essential for everyone to consume at least 6- 8 glasses of water and juices in order to maintain the proper procedure of the body functions. This also ensures that the stool remains soft.
• Taking fiber supplements- The average recommended intake of fiber for males is 38 grams and for females is 25 grams. Most population is unable to fulfill the daily requirement of recommended fiber intake. This substantially affects the functioning of the digestive system as well as the consistency of the stool passed by a person. In order to maintain the proper functioning of the digestive system and produce soft stools.
• Not applying pressure- Most people have the tendency to hold their breath and apply strain while passing stool. This often causes a buildup of pressure in the veins of the lower rectum. Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
• Following the urge- It is very important to go to the washroom to pass the stool as soon as the urge arises. In case the urge goes away, the stool becomes harder to pass.
• Exercising- Being active is a quintessential requirement for a healthy body. Being active and exercising helps in avoiding constipation and to reduce pressure on veins.
• Avoiding sitting in one place for a long time- sitting in one place for a long times puts added pressure on the anus, thus contributing to the occurrence of piles or hemorrhoids.

What are Home Remedies for Piles?
The mild swelling, inflammation, and pain caused hemorrhoids can be relieved or reduced by use of simple home remedies and change in food habits. 

A few of these home remedies for piles or Haemorrhoids are mentioned below-

• Eating a high fiber diet
• Using tropical treatment
• Soaking regularly in warm water
• Keeping the anal area clean
• Avoiding the using of dry toilet paper
• Applying cold water
• Taking oral pain relievers

The symptoms of hemorrhoids generally subside within a week of following the above- stated remedies.

How does Doctor would do treatment for Piles?
In case of minor discomfort and pain, a physician generally prescribes an over- the- counter cream, ointment, pad or suppository. Ingredients present in these medicines namely witch hazel, lidocaine and hydrocortisone help in relieving pain and discomfort. It is not advised to use this over-the-counter, steroid containing, cream for more than 7 days in case symptoms of piles or hemorrhoid do not subside.
External hemorrhoid thrombectomy is a procedure undertaken by a physician in order to treat a painful blood clot formed in external hemorrhoid. This is a very simple procedure and includes only making an incision in the clot and draining it to provide instant relief to the patient.
In case of constant bleeding and major discomfort caused due to hemorrhoids, a physician may suggest one of many minimally invasive procedures available for treatment.
Rubber band ligation
Injection (sclerotherapy)
Coagulation (infrared, laser or bipolar)
 

What are Surgical Procedures for Piles:
In case all other procedures are unable to treat the disease, the doctor may recommend a surgical treatment. A few of the most commonly performed surgical treatments are mentioned below-

• Hemorrhoid removal
• Hemorrhoidectomy
• Hemorrhoid stapling
   

What are Risk Factors Related to Piles?
Although hemorrhoids can affect anyone, there are a few things that make a person more vulnerable to contract this disease. 

A few of these situations are-

• Alcoholism
• Severe heart disease or liver disease
• Obesity
• Chronic constipation or diarrhea
• Lack of physical activity
• Anal intercourse
• Diet low in fiber (high fiber foods include whole grain foods, fresh fruits, and vegetables)
• Diet high in fat
• Jobs that require sitting or standing for long periods
• Loss of tone of the pelvic floor muscle due to childbirth, age, pregnancy or surgery
   

What are the complications due to piles?
Complications relating to hemorrhoids are very rare but may arise. The less commonly occurring but probable complications for patients with hemorrhoids are-

1. Strangulated hemorrhoid- This situation causes extreme pain to the patient suffering from piles or hemorrhoids. This arises when the blood supply to the hemorrhoid is cut off.
2. Anemia- As it has been inferred that various types of hemorrhoids have a tendency to cause extensive blood loss, it may lead to anemia if left unattended. Anemia is a condition in which the production of healthy red blood cells is not adequate.
 

What are Common Myths Related To Piles?
Myth #1: Elderly people are the only ones who can get hemorrhoids.
Reality- Haemorrhoids can affect people of any age. Although it is a stated fact that people between the age group of 45 to 60 are more susceptible to this disease, it can affect a person of any age.  

Myth #2: Eating spicy foods can cause hemorrhoids.
Reality- Hemorrhoids is caused due to excessive pressure on the veins near the anus and rectum, causing them to swell and even bleed at few instances. Eating spicy food does not have anything to do with the occurrence of this disease.

Myth #3: The composition of the food being consumed does not affect hemorrhoids.
Reality- Constipation is one of the main causes behind developing hemorrhoids. It is quintessential to include fiber and water/ other fluids in the diet in order to have a soft bowel moment. This enables a person to avoid being susceptible to constipation and thus steer clear of being affected by hemorrhoids. 

Myth #4: Surgery is the most common treatment for piles or hemorrhoids.
Reality- Symptoms of this disease usually subside by making a few changes in the lifestyle as well as by using home remedies. Depending on the severity of the situation, a physician often prescribes a few an over-the-counter medicines and ointments to relieve pain and help the symptoms subside.  It should be noted that surgery is the least common treatment for hemorrhoids.

Myth #5: Haemorrhoids causes cancer.
Reality- There is no evidence to associate colon cancer with hemorrhoids. Even though they have similar symptoms such as rectal bleeding, they can easily be differentiated by a physician on examination.  

Myth #6: Once a person gets hemorrhoids, it will be a recurring problem for them.  
Reality- People may develop hemorrhoids for a temporary duration due to a situation such as pregnancy, childbirth, constipation etc. Most available treatments of this condition are quite effective and are able to cure the problem fully. In case a person takes care of their diet and drinks a lot of fluid, they do not face this problem again.

Myth #7: Having hemorrhoids or piles is a reason for embarrassment.
Reality- By the time most people turn 50, they would have faced the problem of piles at least once. In both men and women, the occurrence is common irrespective of their age and it is nothing to be embarrassed about. 

Myth #8: Eating a lot of fiber eliminates the occurrence of piles completely.
Reality- Although inculcating fibrous food in the diet may help in preventing the development of hemorrhoids; it is not the only contributing factor to its occurrence. Long sitting, especially on the toilet, is also an influential factor in the occurrence of this condition. It is also advised to have at least eight glasses of water to ensure an easy bowel movement.

Myth #9: Haemorrhoids are difficult to treat.
Reality- There are multiple remedies available to treat both internal as well as external hemorrhoids or external piles.  

All modes of treatment ranging from surgery to lifestyle change are effective and painless. Hemorrhoids that cause mild swelling, inflammation, and pain can easily be relieved or reduced by use of simple home remedies such as eating a high fiber diet, drinking plenty of water, taking over the counter ointments and oral medication etc.

Myth #10: Haemorrhoids or piles can be caused by sitting on too hot or too cold surfaces.
Reality- The temperature of the surface you sit on does not affect cause piles. A habit of sitting in one place, especially on the toilet, makes a person more susceptible to having piles.