Piles (Haemorrhoids) - Symptoms, Causes and Treatment

About Piles

Piles, medically referred to as hemorrhoids, are swollen veins in the lower rectum and anus. They may be located inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Though not usually life-threatening, they can cause significant discomfort and may require treatment if persistent or painful. At Royal Care Hospital, we offer comprehensive, patient-focused care using both conservative and advanced surgical methods to treat piles effectively.

Distinct from piles, an anal fistula is an abnormal, infected tunnel that forms between the inside of the anal canal or rectum and the skin around the anus. This condition typically arises from an anal abscess that has not healed properly, creating a persistent channel that can discharge pus or fluid. Unlike hemorrhoids, anal fistulas rarely resolve on their own and almost always necessitate surgical intervention for complete and lasting relief. At Royal Care Hospital, our specialists are equipped with the expertise and advanced surgical techniques to accurately diagnose and effectively treat anal fistulas, aiming for optimal patient comfort and successful long-term outcomes.

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Signs and Symptoms of Piles

Pain or burning sensation while passing stools

This symptom often manifests as discomfort, sharpness, or a searing feeling in the anal area during or immediately after a bowel movement. The act of stool passing can irritate swollen, inflamed hemorrhoids, leading to this localized pain or burning. For internal hemorrhoids, this might be more of a dull ache or pressure, while external hemorrhoids, especially if thrombosed (containing a blood clot), can cause acute, throbbing pain that is significantly worse during defecation due to pressure and friction. The pain can range from mild to severe, impacting daily comfort.

Bright red bleeding during bowel movements

The blood is typically bright red because it's fresh, indicating that the bleeding originates from superficial blood vessels near the anus or lower rectum. It can be noticed on the toilet paper after wiping, in the toilet bowl, or as streaks on the stool itself. Crucially, the bleeding is usually painless. While often minimal, in some cases, it can be more significant and alarming. It's important to note that while bleeding is common with piles, it always warrants medical evaluation to rule out more serious conditions.

Swelling or lump near the anus

This refers to the presence of a palpable (can be felt) bulge or mass around the anal opening. This swelling is typically associated with external hemorrhoids, which are located just under the skin around the anus. They can become swollen and painful, especially if they are thrombosed (where a blood clot forms inside the hemorrhoid). Internal hemorrhoids, on the other hand, might prolapse (protrude) outside the anus during a bowel movement or even permanently, appearing as a soft, fleshy, and sometimes tender lump. This lump might be reducible (can be pushed back in) or remain outside.

Itching or irritation in the anal area

Known medically as pruritus ani, this symptom is a persistent and often intense itching sensation around the anus. It occurs because the swollen hemorrhoids can trap moisture and small amounts of stool, leading to irritation and inflammation of the sensitive skin. The itching can be worse at night, after bowel movements, or after strenuous activity. Constant scratching can further aggravate the area, leading to skin damage, soreness, and a vicious cycle of irritation.

Mucus discharge from the anus

This refers to the leakage of a clear or yellowish, slimy fluid from the anus. Internal hemorrhoids, especially those that prolapse, can secrete mucus. This discharge can cause further irritation and itching of the surrounding skin, contributing to discomfort. It's often noticed on underwear or when wiping after a bowel movement, and it can sometimes be confused with stool leakage if not clearly observed.

A sense of incomplete bowel evacuation

This symptom describes a persistent feeling that the bowels haven't been fully emptied even after a bowel movement has occurred. This sensation arises because swollen hemorrhoids, particularly larger internal ones, can create a feeling of fullness or obstruction in the anal canal. The presence of the swollen tissue can trick the rectum into signaling that there's still stool to be passed, leading to repeated attempts at defecation that are often unproductive and can worsen other symptoms.

Diagnosis / Investigations

Physical Examination

Visual inspection of the anal area to identify external hemorrhoids.

Digital Rectal Examination (DRE)

A manual check to feel for abnormalities.

Anoscopy

A short, lighted tube used to inspect internal hemorrhoids.

Proctoscopy/Colonoscopy

Recommended in cases of chronic bleeding or for screening other conditions.

Types of Piles

Internal Hemorrhoids Location and Characteristics: These hemorrhoids develop inside the rectum, above a line called the dentate line, where there are fewer pain-sensing nerves. This explains why they are often painless unless they prolapse significantly or become thrombosed. They are essentially swollen veins covered by the lining of the rectum. Symptoms: The most common symptom is painless bright red bleeding during or after a bowel movement, which can be noticed on toilet paper, in the toilet bowl, or on the stool. They might also prolapse (protrude) outside the anus during straining, appearing as a soft, moist lump. Prolapsed internal hemorrhoids are often graded by severity (Grade I to IV), with Grade IV being permanently prolapsed and usually irreducible. While generally painless when internal, if they prolapse and get "strangulated" (blood supply cut off), they can become extremely painful.
External Hemorrhoids: These form under the skin around the anus, below the dentate line. This area has a rich supply of pain-sensing nerves, which is why external hemorrhoids are typically much more painful than internal ones. They often appear as lumps or bulges near the anal opening. Symptoms: Symptoms usually include pain, itching, irritation, and swelling around the anus. The pain can worsen with sitting, walking, or during bowel movements. They can make hygiene difficult and cause general discomfort. Unlike internal hemorrhoids, they don't usually bleed unless they are injured or rupture (e.g., from excessive wiping).
Thrombosed Hemorrhoids: This is a specific complication of an external hemorrhoid where a blood clot (thrombus) forms inside the swollen vein. The blood clot causes the external hemorrhoid to become hard, extremely swollen, and take on a bluish or purplish color. Symptoms: They are characterized by sudden onset of severe, constant pain, which can be excruciating and debilitating. The lump is firm, tender to the touch, and often visibly swollen. The pain usually peaks within the first 48 hours and then gradually subsides over several days or weeks as the clot is reabsorbed or breaks down. While the pain may decrease, the lump might persist for some time. In some cases, the clot can rupture, leading to bleeding and temporary relief from pressure. This type almost always requires medical attention due to the intensity of the pain.

Causes of Piles

Straining during bowel movements: Straining significantly increases pressure in the veins around the anus and rectum. This excessive pressure can cause these veins to swell and bulge, leading to the formation of hemorrhoids. It's a direct force that pushes blood into the vessels and weakens their walls over time.
Chronic constipation or diarrhea: Both chronic constipation (due to straining from hard stools) and chronic diarrhea (due to frequent bowel movements and irritation) put immense stress on the anal cushions. This repeated pressure and irritation can inflame and weaken the anal veins, making them prone to swelling and developing into piles.
Sitting for extended periods, especially on the toilet: Prolonged sitting, particularly on a toilet, allows gravity to exert continuous downward pressure on the anal and rectal veins. This sustained pressure can lead to blood pooling in these veins, causing them to engorge, stretch, and eventually form hemorrhoids. The toilet seat opening also allows the veins to be unsupported, exacerbating the issue.
Low-fiber diet: A diet lacking in fiber often results in hard, dry stools and can lead to constipation. Hard stools are difficult to pass, requiring more straining, which directly contributes to increased pressure on the anal veins and the development of piles. Fiber helps to soften stools and promote regular, easy bowel movements.
Obesity: Excess body weight significantly increases abdominal pressure. This constant downward pressure on the pelvic area and the veins in the rectum and anus can impede blood flow, causing these veins to swell and become hemorrhoids. Obesity also often correlates with a more sedentary lifestyle, which can further exacerbate the risk.
Pregnancy (increased pressure on veins): During pregnancy, the growing uterus places increased pressure on the pelvic veins and the inferior vena cava, which drains blood from the lower body. This increased pressure restricts blood flow back from the rectum and anus, causing the veins there to swell and become hemorrhoids. Hormonal changes during pregnancy can also relax blood vessel walls, making them more susceptible.
Aging, which can weaken supporting tissues: As individuals age, the tissues and veins in the rectum and anus naturally lose elasticity and become weaker. The supportive connective tissues around the anal canal can also loosen, making the veins more prone to prolapse and swelling, thus increasing the likelihood of developing piles.

Treatments & Procedures at Royal Care Hospital

Lifestyle Modifications

Incorporating plenty of fruits, vegetables, and whole grains adds bulk to stool, making it softer and easier to pass. This reduces straining and the pressure on hemorrhoidal veins..Drinking ample water throughout the day keeps stools soft and helps prevent constipation. Adequate fluid intake is crucial for fiber to work effectively in maintaining bowel regularity. Regular physical activity promotes healthy bowel function and helps prevent constipation. It also improves overall circulation, which can reduce pressure in the anal veins.

Topical ointments Oral medications Stool softeners Rubber Band Ligation Infrared Coagulation (IRC) Sclerotherapy Hemorrhoidectomy: Complete surgical removal Stapled Hemorrhoidopexy: Used for prolapsed hemorrhoids

Topical ointments

Over-the-counter creams, ointments, or suppositories containing corticosteroids or anesthetics can provide temporary relief from pain, itching, and swelling. They aim to soothe the irritated area and reduce inflammation.

Oral medications

Pain relievers can help manage discomfort. Certain medications might be prescribed to strengthen blood vessel walls and reduce inflammation.

Stool softeners

These medications make stools easier to pass by increasing water content in the feces, thus reducing the need for straining. They are particularly helpful for those experiencing constipation.

Rubber Band Ligation

This procedure involves placing a tiny rubber band around the base of an internal hemorrhoid, cutting off its blood supply. The hemorrhoid withers and falls off within a few days to a week.

Infrared Coagulation (IRC)

IRC uses a device that emits a beam of infrared light to coagulate the blood vessels that supply internal hemorrhoids. The heat causes the hemorrhoid to shrink and recede.

Sclerotherapy

A chemical solution is injected into the hemorrhoid, causing it to shrink and scar. This treatment is typically used for smaller internal hemorrhoids.

Hemorrhoidectomy: Complete surgical removal

This traditional surgical procedure involves cutting away the excess tissue that causes bleeding and protrusion. It is highly effective for severe or recurrent hemorrhoids, but can involve more post-operative pain and recovery time.

Stapled Hemorrhoidopexy: Used for prolapsed hemorrhoids

This procedure uses a stapling device to remove a ring of prolapsed hemorrhoidal tissue, pulling the remaining hemorrhoidal tissue back into its normal position within the anal canal. It is often associated with less pain than traditional hemorrhoidectomy.

Cutting-Edge Technologies at RCH

Laser Hemorrhoidoplasty (LHP): A non-invasive laser procedure for painless treatment: LHP uses a precisely directed laser beam to shrink and seal the hemorrhoidal tissue from within, causing it to collapse and disappear. It's a minimally invasive option known for significantly less pain, faster recovery, and no surgical cuts.
DGHAL (Doppler-Guided Hemorrhoidal Artery Ligation): Targets the arterial supply to hemorrhoids, reducing recurrence: This innovative procedure uses a Doppler ultrasound to precisely locate the arteries supplying blood to the hemorrhoids. These arteries are then ligated (tied off), cutting off the blood flow and causing the hemorrhoids to shrink without removing tissue.
Advanced Anesthesia Options: For a pain-free, daycare experience: RCH offers a range of modern anesthesia techniques tailored to the individual, ensuring comfort during the procedure. These options facilitate a "daycare" or outpatient experience, allowing patients to return home on the same day with minimal discomfort.

Prevention and Awareness

Suffering from piles? Don't delay. Our expert team is here to help you heal with dignity and care.

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Gastroenterology team

Dr. S. Paulvannan

MS, DNB, FRCS (Glasg), FRCS (Gen.Surg), CSST, HPB Fellow (Cambridge, UK).,

Consultant Surgical Gastro, Advanced Laparoscopic, HPB and GI Onco & Bariatric Surgeon

Dr. A. Sandip Chandrasekar

MS, M.Ch (SGE), DNB (GI.Surgery), FALS (Bariatric).,

Consultant Surgical Gastro, Advanced Laparoscopic, HPB,GI Oncology and Bariatric Surgeon

Dr. S. Soundappan

MBBS(MMC), MS(KEM, Mum), MRCS(UK), DNB - Surg Gastro (AIG, Hyd), FALS-Robotic, Fellowship-Hepatobiliary Surgery(AIG,Hyd), Fellowship-Liver transplant(CLBS,Delhi).,

Consultant - Gastro, Minimally invasive, and Liver transplantation surgery

Frequently Asked Questions

1. Can piles be cured without surgery?

Yes. Most cases can be managed with medication and lifestyle changes.

2. Is piles treatment painful?

With our advanced technologies, treatments are minimally painful and recovery is faster.

3. How long is the recovery after surgery?

Most patients recover in 5-7 days after minimally invasive procedures.

4. Can piles recur after treatment?

With proper care and preventive practices, recurrence can be minimized.

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