Hemorrhoids are vascular structures in the anal canal which primarily act as cushions for the anal cavity aiding in passing of the stool.
Hemorrhoids get swollen & inflamed due to certain causes & this is classified as a condition, it is also called as Piles.
There are two types of hemorrhoids:
- Internal hemorrhoids: These fleshy structures are present on the inside of the anus & get swollen inside the anus, however these are usually painless with internal bleeding
- External hemorrhoids: These are structures present outside the anus & present with swelling & pain, blood may or may not be present.
SIGNS & SYMPTOMS OF HEMORRHOIDS
- Pain around the anus.
- Swelling around the anus.
- Skin tag formation i.e. small benign tumor formed around the anal opening.
- Irritation and itchiness around the anus.
- Rectal bleeding during or followed by bowel movement.
- Bright red bleeding in internal hemorrhoids without pain.
- Dark red bleeding in external hemorrhoids with pain.
- Mucous discharge
- Fecal incontinence.
CAUSES & RISK FACTORS OF HEMORRHOIDS
- Irregular bowel habits like constipation & diarrhea.
- Lack of exercise
- Low fiber diet
- Increased intra-abdominal pressure
- Straining or sitting on the toilet for too long
- Fluid accumulation in the abdomen
- Squatting position for defecation
- Chronic cough
- Pregnancy
- Genetics
- Obesity
- Aging
- Anal intercourse
- Regular heavy lifting.
COMPLICATIONS
- Anemia
- Blood clots
- Thromboses if the upper part of the body
- Strangulated hemorrhoid
- Fainting
- Fissure
- Fistula
- Bursting of a clot in the brain.
DIAGNOSIS
- Physical examination of the condition by visual examination of the affected area.
- Rectal exam of the affected area for detection of hematoma, polyps, tumor, or an enlarged prostrate etc.
- Diagnosis of the internal hemorrhoids is done by implication of a visual device like an anoscope which will have a small light attached to it.
- Internal hemorrhoids are classified on the basis of grade as;
- a) Grade I: No prolapse, just prominent blood vessels.
- b) Grade II: Prolapse upon bearing down, but spontaneous reduction.
- c) Grade III: Prolapse upon bearing down requiring manual reduction.
- d) Grade IV: Prolapse with inability to be manually reduced.
DIFFERENTIAL DIAGNOSIS
- Fissure
- Fistula
- Abscess
- Varices
- Polyps
- IBD disease
- Colon Cancer.
TREATMENT FOR HEMORRHOIDS
Medication:
- Pain killers like ibuprofen
- Anesthetic topical cream/gel containing like lidocaine
- Topical cream/gel containing sucralfate
- Topical gel containing diltiazem for increasing blood flow to the area and natural healing of injured spots.
- Fiber supplements like isapgul husk & PEG fiber.
- A new drug called prucalopride, used for stimulation of serotonin receptors in the anal canal, eases bowel movement.
Surgical procedures:
- Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid recommended in people with thrombosed external hemorrhoids.
- Procedure called THD uses doppler ultrasound for llocation of arteries, therefore these arteries are tied off & the hemorrhoids are put back in place.
- Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, involves the removal of much of the abnormally enlarged hemorrhoidal tissue.
Minimally invasive procedures
- Rubber band ligation: A rubber is used to tie the base of the internal hemorrhoid, therefore it cuts off the blood supply, thus the hemorrhoid withers and falls off.
- Sclerotherapy: A chemical solution such as phenol is injected into the hemorrhoid walls to collapse & shrink.
- Cauterization techniques that employ laser or infrared light or heat.
MANAGEMENT & PREVENTION
- Regular exercise & physical activity.
- High fiber diet
- Drink plenty of fluids
- Avoid sitting on the toilet too long.
- Don’t strain
- Reduce alcohol consumption & smoking
- Ayurvedic medicines are used for stimulation & easing of defecation.
- Ayurvedic oils are also employed for pain management, faster healing of injuries & shrinkage of swelling.
- Avoiding diet that causes allergy & complications.