Although surgery may be the best treatment option for severe cases, there are non-surgical options available as well.
What are piles?
Piles, also called hemorrhoids, are clusters of veins immediately below the mucus membranes lining the anus and the lowest portion of the rectum. Hemorrhoids result when the veins enlarge and distend.
What are different types of piles?
There are two types of hemorrhoids:
- Internal hemorrhoids that develop in the lower rectum
- External hemorrhoids that form under the skin around the anus (cause the surrounding skin to become inflamed)
Internal hemorrhoids usually do not hurt even when they bleed. For instance, bright red blood may flow into the toilet bowl or on toilet paper when wiping. Internal hemorrhoids can prolapse or extend outside of the anus, which can lead to several issues. Hemorrhoid protrusion can collect microscopic stools and mucus, which can irritate the skin and lead to pruritus ani. It can get worse if you keep wiping to stop the itching.
The pain may be abrupt and intense if a blood clot develops inside external hemorrhoids. There could be a bulge around the anus that you may feel or see. The clot typically resolves, leaving the extra skin (a skin tag), which may become itchy.
A four-point scale is used to categorize hemorrhoids by grade:
- Grade I: Visible but does not prolapse
- Grade II: Prolapse while performing the Valsalva technique but spontaneously contract
- Grade III: Prolapse during the Valsalva technique and require manual reduction
- Grade IV: Cannot be reduced
What are the treatment options for hemorrhoids?
When selecting treatment for hemorrhoids, factors that are considered include the grade and severity of the disease, level of pain, effect on quality of life, and how likely you are to follow the recommended course of action.
There are three types of treatments: conservative, office-based, and surgical. Doctors should extensively go over all the options with the patient, highlighting the advantages and disadvantages of each.
Conservative treatment measures aim to soften the stool, relieve pain, and change poor bowel habits. Most of the time, your lifestyle is the main triggering factor, and if you do not make changes, you are more likely to experience recurring symptoms over time.
- Increasing fiber intake: Increase your fiber intake through high-fiber foods or fiber supplements (such as Metamucil, Citrucel, or Fibercon) or a combination of the two. Fiber along with adequate hydration softens the stools and makes them easier to pass, relieving pressure on hemorrhoids. Supplemental fiber reduces hemorrhoid swelling, irritation, and bleeding and may decrease irritation brought on by feces fragments that get lodged around blood vessels. Since increasing fiber may increase bloating or gas, it is best to start gradually and increase your daily fiber intake to 25 to 30 grams. Increase your fluid intake as well.
- Sitz baths: A sitz bath is a warm water bath used for the hips and buttocks (comes from the German word “sitzen,” meaning “to sit”). This type of bath can reduce itchiness, discomfort, and sphincter muscle spasms. You can sit in a bathtub filled with a few inches of warm water or use a plastic tub that fits over a toilet seat. Most specialists advise taking a 20-minute sitz bath 2-3 times daily and once immediately following each bowel movement. Do not rub or vigorously wipe the anal area. Instead, gently pat it dry. Drying the region with a hair dryer is another option.
- Laxatives: When there is an organic bowel problem as opposed to a nutritional issue, laxatives, such as docusate, are used to alter the consistency of the stool. They can be utilized as an additional therapy to improve the results of fiber treatment.
- Topical medications: You can apply an over-the-counter hemorrhoid cream or suppository that contains hydrocortisone or use pads with witch hazel or a numbing ingredient.
- Phlebotonics: Phlebotonics is made up of various ingredients, such as natural plant extracts (flavonoids). While the precise mechanism of action is unknown, phlebotonics may improve venous and lymphatic outflow, normalize capillary permeability, and reduce inflammation in the hemorrhoidal cushions.
Avoid sitting on the toilet for long periods: Sitting on the toilet for long periods of time increases pressure on the anal region. Avoid using your cell phone or reading while using the toilet to avoid spending too much time on the toilet.
For grades I, II, and III hemorrhoids that have not responded to conservative management, office-based therapies are frequently employed. Reduced blood flow to the hemorrhoidal sac is the main objective of these treatments.
Rubber ligation method: Rubber band ligation involves wrapping a small elastic band around the base of the hemorrhoids. The band holds the hemorrhoids in place, causing them to contract and the surrounding tissue to scar as it heals. To completely remove the hemorrhoids, 2-4 procedures must be performed, each spaced 6-8 weeks apart. Mild discomfort or tightness, bleeding, and infection are among the potential complications.
Sclerotherapy: Sclerotherapy involves injecting a sclerotic substance into the submucosa of the hemorrhoidal sac, which triggers an inflammatory response and finally develops fibrotic tissue that interrupts the blood supply to the hemorrhoids. Many sclerotic agents are available, such as quinine, ethanolamine, hypertonic saline, and 5% phenol in almond or vegetable oil. Although uncommon, the injection can result in sepsis and prostatic abscess. People with a high fever and postoperative discomfort should be closely monitored.
Infrared photocoagulation: Your physician will use an electric probe, a laser beam, or an infrared light to produce a tiny burn, remove the tissue, and gently seal the end of the hemorrhoids, causing it to close off and shrink. Hemorrhoids that have prolapsed respond best to this treatment.
Even though non-surgical options have significantly improved, surgery is still the most successful and recommended course of therapy for individuals with high-grade internal hemorrhoids (grades III and IV), external and mixed hemorrhoids, and recurrent hemorrhoids.
The most common surgical procedures are Doppler-guided hemorrhoidal artery ligation, stapled hemorrhoidopexy, and open or closed hemorrhoidectomy. Each has varying rates of success and unique complications, which should be discussed with your doctor.
Hemorrhoids and what to do about them. https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
Can Hemorrhoids Go Away on Their Own? https://www.scripps.org/news_items/7229-can-hemorrhoids-go-away-on-their-own
Hemorrhoids Treatment. https://www.webmd.com/digestive-disorders/understanding-hemorrhoids-treatment-medref
Simple, Painless Hemorrhoid Treatment Without Surgery. https://www.capitalhealth.org/news/simple-painless-hemorrhoid-treatment-without-surgery
Hemorrhoids: The Definitive Guide to Medical and Surgical Treatment. https://consultqd.clevelandclinic.org/hemorrhoids-the-definitive-guide-to-medical-and-surgical-treatment/
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