Haemorrhoids ( Piles ) By Dr Anmol Arora ( Sr Homoeopathic Physician )

Haemorrhoids ( Piles ) By Dr Anmol Arora ( Sr Homoeopathic Physician )

piles

piles

Haemorrhoids are the swellings that can occur in the anus and lower rectum (back passage).

There is a network of small veins (blood vessels) within the inside lining of the anus and lower rectum. These veins sometimes become wider and engorged with more blood than usual. These engorged veins and the overlying tissue may then form into one or more small swellings called haemorrhoids.

The exact reason why these changes occur and lead to haemorrhoids forming is not clear. Some haemorrhoids seem to develop for no apparent reason. However, it is thought that the pressure in and around the anus can be a major factor in many cases. If the pressure in and around the anus is increased, then it is thought that this can lead to haemorrhoids developing.

. Certain situations increase the chance of haemorrhoids developing:

  • Constipation, passing large stools (faeces), and straining at the toilet. These increase the pressure in and around the veins in the anus and seem to be a common reason for haemorrhoids to develop.
  • Pregnancy. Haemorrhoids are common during pregnancy. This is probably due to pressure effects of the baby lying above the rectum and anus, and the affect that the change in hormones during pregnancy can have on the veins.
  • Ageing. The tissues in the lining of the anus may become less supportive as we get older.
  • Hereditary factors. Some people may inherit a weakness of the wall of the veins in the anal region.

Symptoms

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is

  • bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include

  • painful swelling or
  • a hard lump around the anus that results when a blood clot forms.

This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

How common are hemorrhoids?

Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

Types of hemorrhoids

type of piles

type of piles

External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.

External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.

Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.

Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:

    • Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
    • If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.

piles3

piles3

By degree of prolapse

  • Grading of Internal Hemorrhoids
    • Grade I: The hemorrhoids do not prolapse.
    • Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.
    • Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.
    • Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.

How are hemorrhoids diagnosed?

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

What is the treatment for haemorrhoids?

Avoid constipation and straining at the toilet

Keep the faeces (sometimes called stools or motions) soft, and don’t strain on the toilet. You can do this by the following:

  • Eat plenty of fibre such as fruit, vegetables, cereals, wholemeal bread, etc.
  • Have lots to drink. Adults should aim to drink at least two litres (10-12 cups) per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens faeces. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
  • Fibre supplements. If a high fibre diet is not helping, you can take bran, or other fibre supplements (‘bulking agents’) such as ispaghula, methylcellulose, or sterculia. You can buy these at pharmacies or get them on prescription. Methylcellulose also helps to soften faeces directly which makes them easier to pass.
  • Avoid painkillers that contain codeine such as co-codamol, as they are a common cause of constipation.
  • Toileting. Go to the toilet as soon as possible after feeling the need. Some people suppress this feeling and plan to go to the toilet later. This may result in bigger and harder faeces forming which are then more difficult to pass. Do not strain on the toilet. Haemorrhoids may cause a feeling of ‘fullness’ in the rectum and it is tempting to strain at the end to try and empty the rectum further. Resist this. Do not spend too long on the toilet which may encourage you to strain. (For example, do not read whilst on the toilet.)

Homeopathic treatment for piles

Homeopathy greatly helps in curing piles specially the 1st 2nd and 3rd degree piles and no surgery should be thought of till homeopathy has been tried. Some of the most commonly used medicines in treating piles are:

Hamamelis –Q –very very useful in controlling bleeding caused due to piles

Aesculus hip-piles with acute pain in the back

Collinsonia..chronic painful bleeding piles with pain as if sticks were placed in the rectum.

Graphitis-for piles and fissures with hard stools

Ratanhia-pain as if splinters of glass were sticking in the rectum

Other commonly used medicines are ..Sulphur,Nux.Vomica,silicea etc.

More troublesome haemorrhoids may require additional treatment.

  • Rubber band ligation — this may be recommended in more severe cases. This involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid and the haemorrhoid falls off after a few days. This procedure can be performed at an outpatient clinic and does not require hospital admission.
  • Sclerotherapy — in severe cases the affected vein can be injected with a substance that makes the blood in the haemorrhoid clot.
  • Surgical removal — this will usually be recommended only for severe cases such as third degree haemorrhoids, which protrude through the back passage. After surgery, small skin tags can develop beside the back passage and may be slightly painful or itchy. These can also be surgically removed by a minor operation.
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