Piles - Treatment & Surgical Procedure

Piles - Treatment & Surgical Procedure

Piles & Piles Treatment Awareness Guide

What are Piles?

Haemorrhoids (piles) are swellings that develop from the lining of the anus and lower rectum (back passage). There is a network of small veins (blood vessels) within the lining of the anus and lower rectum. These veins help in movement of stools for excretion. These veins sometimes become wider and fill up with more blood than usual (dilate). The veins and the overlying tissue may then get inflammation (swelling) called haemorrhoids. Sometimes they may be felt outside anus. This stage is called prolapsed hemorrhoids. Hemorrhoids are classified as internal and external haemorrhoids. A person suffering from piles or hemorrhoids will present with bleeding while passing stools, this bleeding is depending on the grade/stage of hemorrhoids (Piles).

 

50 to 85% of people world over suffer from piles or hemorrhoids.

 

How common is incidence of piles?

Incidence of piles is common in both men and women. Those with improper dietary habits and sedentary lifestyle have a greater incidence of piles. According to a recent health estimate, over 40% of the world population suffers from piles and as many as 40% of the population have experienced symptoms of this disease sometime in their life. In India, approximately 80% of the patients belong to the age group of 21 – 50 years. Piles are also seen during pregnancy.

What are the causes of piles?

 

  1. More pressure in and around the anus and blood vessels due to straining to pass stools in constipation causes Hemorrhoids (Piles)
  2. If you eat too much spicy food- As the heat generated by the spicy food is very high and while passing the stool it results in inflammation and swelling in blood vessels
  3. If you are eating hard food daily results it in piles too. Harder the food harder the stool. As the hardness of the stool increases the pain while passing the stool which also puts pressure on the blood vessels in the rectum and anal canal that results in their inflammation and swelling
  4. If you have less consumption of water it also makes your stool harder resulting the same
  5. Sitting at the same place for a long period will also result in piles
  6. Weightlifting - Carrying heavyweights will put pressure on your whole body. Usually, we hold breath while lifting weights; this makes the air pass downwards from the lungs which puts pressure on your internal organs and veins in the rectum.
  7. Obesity or Overweight -The pressure on the veins and blood vessels near the anus and colon increases in obese individuals.

 

What are the symptoms of piles?

 

Symptoms range from temporary and mild, to persistent and painful. In many cases, hemorrhoids or Piles are small and symptoms settle down without treatment. If required, treatment is usually effective. There are various treatment options. Symptoms vary for internal and external piles. In different stages of development, the symptoms vary, gradually becoming worse.

  • The main symptoms of piles are swelling and itching in or around the rectum.
  • In late stage, pain and itching are also with bleeding while passing the stools.
  • Patient might feel an uncomfortable mass inside the anal canal.
  • If the piles are prolapsed, patient may feel them while washing after the use of the toilet.

Internal hemorrhoids

Internal (inside) hemorrhoids or Piles are found about 2 to 4 cm above the rim (opening) of the anus. Their severity and size are classified into grades 1 to 4. It can cause severe pain if it is completely "prolapsed". This means that it is coming out the anal opening and can’t be pushed back inside.

 

4 grades of hemorrhoids are

  1. Grade one where in the haemorrhoidal mass or the bunch of veins which are enlarged are still within the anal canal and not visible outside. Small swellings on the inside lining of the back passage.
  2. Grade two is when they come out while passing the hard stools may bleed and then go back in once the person passes the stools. They are larger as compare to grade 1. It may be partly pushed out (prolapsed) from the anus when you go to the toilet and spontaneously disappear back inside again.
  3. Grade three is once the hemorrhoid mass comes out while passing stools, the person has to actively push the mass back into the anal canal to prevent it from causing any further problems. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
  4. Grade four is when the mass comes out and is not going in even after act of or manually trying push the whole mass inside.

 

External (outside) hemorrhoids

External (outside) hemorrhoids are found near the anal opening. Sometimes a blood clot (thrombosis) can happen with outer hemorrhoids. Patients may feel skin tags that develop from stretching of peri (around) anal skin.

Prolapsed haemorrhoids 

A more severe and painful form of internal haemorrhoids. Dilated veins push through the anus and hang outside the body, particularly after going to the toilet. Sometimes, the anal sphincter (ring of muscle that control stool passing) can strangulate veins that hang out permanently

 How to diagnose Piles (Hemorrhoids)

Patient with rectal discomfort, swelling, pain, discharge, and bleeding at the time of defecation, it is prudent not to assume it is a result of hemorrhoids, a full evaluation is necessary, including a rectal examination, a proctoscopic examination, and in some cases a sigmoidoscopy or colonoscopy

 The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a close rectal exam with gloved,  

Lubricated finger to feel for abnormalities, with an anoscope (a hollow lighted tube useful for view of internal hemorrhoids)

Pain is absent unless complications supervene, for this reason, any patient complaining of ‘painful hemorrhoids’ must be suspected of having another condition, and examine accordingly.

Several other diseases like fissures, fistula ano, rectal or anal carcinoma, colon cancer and other digestive problems produce somewhat similar symptoms like hemorrhoids, so it is advisable to see a doctor if patient have any rectal bleeding.

What are the complications of piles?

The common complications associated with the problem include blood loss, loss of nutrients and important vitamins. In case if piles are strangulated, one can suffer from the problem of blood loss. If piles go untreated for a long duration, the problems may include:

  • Infection
  • Anal fistula
  • Gangrene
  • Anemia due to excessive blood loss
  • Incontinence in rare cases

 

In case of an infection paired with concomitant diseases such as blood pressure, heart diseases, and diabetes, the condition can get worse and tough to control. It may pose a risk on the life of the patient. In case one has piles, it is important to connect with the doctor and avail treatment at the earliest. Besides treatment, one should also consider to bring moderate changes in the lifestyle and prevent the piles from worsening in the first place.

 

What can be done to prevent piles?

 

  1. Increase the fiber intake through your food vegetables and fruits, fresh food, whole grains and cereals.
  2. Avoid oily and fast food
  3. Establish regular bowel habits and avoid constipation
  4. Avoid spicy food, alcohol, coffee and tea
  5. Exercise regularly to keep weight in check
  6. Avoid prolonged sitting or standing positions
  7. Drink at least 8-10 glasses of water every day. This will soften the stools and will help move the waste through the intestine smoothly.

What are the Option available for Piles Treatment 

  1. It is very important to have a correct diagnosis first. So ask the patient to visit a doctor for proper diagnosis.
  2. If detected early, piles can be cured with medication, life style changes and simple office procedures.
  3. In the later stages, surgery is a must and there are various surgical procedures available to treat piles problems.
  4. Mainly surgical options are classified as conventional and Minimally Invasive Procedure for Hemorrhoids (MIPH).

 

MIRUS HEMORRHOIDS STAPLER is a revolutionary three rows approach for Minimally Invasive Procedure for Prolapsed Hemorrhoids. It is also available in the conventional two rows model. MIRUSTM HEMORRHOIDS STAPLER offers better security, superior homeostasis and ease of use which delivers optimum excision of prolapsed hemorrhoid tissue. Optimized staple formation technique delivers adjustable height staples which causes less tissue tension and delivers right compression and proper staple line with optimum closed height.

 

Get back to normal life in just 48 hours with hemorrhoid stapler.

 

In Piles when is surgery necessary?

Surgery may be needed when there is severe or constant pain from a thrombosed hemorrhoid (a blood clot within a blood vessel). Harmful or large hemorrhoids may need special or surgical treatment. The surgical procedure performed depends on the type, size, grade and location of the hemorrhoid.
Piles Surgery Treatment – The Different Types of Procedures

Depending upon the severity of the haemorrhoids, the doctor decides whether one needs to undergo surgeries with or without anaesthesia

Non-anaesthetic piles treatment (Non-operative)

  • Banding
  • Sclerotherapy
  • Coagulation Therapy
  • Haemorrhoidal Artery Ligation

Anaesthetic Piles Treatment (Operative)

  • Stapled Haemorrhoidopexy/ Minimally invasive procedure for hemorrhoids (MIPH)
  • Haemorrhoidectomy (Conventional surgery)
  • Doppler-guided Haemorrhoidectomy

Usually non-operative treatment methods are used for the patients with the first, second and very early third degree hemorrhoids. Patients with late third and fourth degree haemorrhoids need surgical treatment.

What is the difference between conventional surgery and MIPH?

Since many years, piles' patients have been operated through conventional surgery approach. This approach will generally cost less but has various disadvantages such as pain after operation for 2-3 weeks. Patient might need hospital stay more or less for a week. The surgical wounds need dressing for 2-3 weeks. On an average it takes 4-5 weeks for complete recovery. Patient needs a frequent follow up with the doctor.

     MIPH- Minimally Invasive Procedure for Hemorrhoids (MIPH)

  1. Recently, the technique has come up to treat piles. It is called as Minimally Invasive Procedure for Hemorrhoids (MIPH).
  2. This advance technique is being increasingly recommended by surgeons around the country. This operation is performed with the help of a stapler device and patient may go home on the same day.
  3. Patients who have undergone this procedure reported minimum post operative pain
  4. No dressings are required
  5. Patient can resume work in 4-5 days time
  6. So if the surgeon recommends surgery, discuss MIPH with him/ her

Hemorrhoid stapling or Stapled hemorrhoidopexy | Piles Treatment

Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that involves the removal of abnormally enlarged hemorrhoid tissue, followed by the repositioning of the remaining hemorrhoid tissue back to its normal anatomic position. Severe cases of hemorrhoid prolapse will normally require surgery.

For stapled hemorrhoidectomy, a circular, hollow tube like instrument is inserted into the anal canal. Through this tube, a suture (a long thread) is placed circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoid supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.

Preparing for operation

This surgery requires a short stay in hospital, usually as a day case. You may come into hospital on the day of your operation or sometimes the day before. The anesthetist will visit you before the operation. You should have nothing to eat for 6 hours before the operation and nothing to drink for 2-3 hours beforehand. Your blood pressure, pulse and wounds will be monitored closely over the first few hours. You will normally be able to start drinking shortly after the procedure, and can start eating as soon as you are hungry. You will normally be able to get out of bed a few hours after surgery, although the nurses will help you for the first time.

Dressings

After the operation there may be a dressing in place, held on with elastic pants. There will be some staining with blood within the first 12 hours. If you have a dressing, it will come off the next day, usually by itself. The wound will be a bit moist for a week or two. There is likely to be a yellow discharge or even some dark blood during this time. You may want to wear a small pad so that if there is still some oozing, your underwear won’t be marked.

Pain

There will be some pain and some people can experience severe pain for a few days. This is usually treated with simple painkillers. By about a week later the wound should be almost pain free.

Going Home

Most patients go home the same day but occasionally an overnight stay may be required. This will depend on how fit you are, who is at home with you and how comfortable you are after the operation. You may feel more tired than usual for the first few days due to the anesthetic.

Stitches

Any threads tied around the stumps of the piles will drop off by themselves within 4-5 days. This can be accompanied by some bleeding. Any other stitches will dissolve.

Other symptoms

There may be some purple bruising around the wound – this is normal and will fade. Occasionally you may notice difficulty in controlling wind through your back passage. This will get better in a day or two.

Washing

You can wash the area with soap and water as soon as the dressing is off. You can bath or shower as often as you wish but dry the area gently by dabbing with a soft towel rather than rubbing.

Constipation

It is important to avoid becoming constipated after the operation. Straining may cause unnecessary bleeding and discomfort. A healthy diet including fiber, fruit and vegetables and drinking plenty of fluids will all help to avoid constipation. (You must drink plenty when taking in fiber or you can get constipation.) You will probably be given a laxative to take at home for the first few days.

The first time you open your bowels may be painful, but this will improve rapidly. Doctor may recommend a laxative, which works by trying to create a soft and ‘easy-to-pass’ stool.

Driving

You can drive as soon as you are comfortable enough to do an emergency stop safely. This is usually within 4-5 days.

Sex

You can restart sexual relations as soon as it is comfortable to do so.

Returning to work

You should be able to return to work within a week or as and when you are comfortable.

MIPH benefits include:

  1. Less pain
  2. Faster recovery
  3. Faster regaining of normal bowel function
  4. Less postoperative care after discharge
  5. Faster return to normal work

Conclusion: A hemorrhoid (Piles) is a common discomfort that gets worst by prolonging immediate treatment in adults, which directly affect the economy. Apart form the prominent symptoms of bleeding and pain; colonoscopy and proctoscopy give the correct state of condition. Non-operative treatment methods are used for the patients with the first, second and very early third degree hemorrhoids. Patients with late third and fourth degree haemorrhoids need surgical treatment. As in case of every disease prevention is the best common treatment, hemorrhoids can also be reduced by changes in life style, diet habit, and intake of appropriate dose of respective botanicals, which can also intervene in the pathogenesis to decrease vascular integrity.

Statutory warning: This information is provided with the objective of creating general awareness of the disease and treatment options considering the best interest of people. Please consult a doctor for the right diagnosis and suitable treatment options as per the situation.

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