While most patients come with self-diagnosis of suffering from piles/hemorrhoids, I reassure them that it’s a normal part of every human being and we are all born with them. Another myth is pain from piles. Piles are painless and cause bleeding, itching and sometimes jelly-like secretions, but they very rarely cause pain.
Do we need piles?
Yes. Contrary to belief, hemorrhoids (piles) are necessary for everyone. They have a role in continence (once ability to control/postpone defecation).
Does piles cause cancer?
They will never cause cancer or turn into one.
How much blood is lost because of bleeding from piles?
Most people are concerned about the huge amount of blood they have lost, but in most cases it’s very little (mls). It looks more as it is mixed with water and the water has turned red. It is very rare for one to lose excess amount of blood because of bleeding from piles. Piles is very rare to cause anemia (low blood count), and if found, one might need colonoscopy to rule out other causes of bleeding.
Bleeding from the piles is bright red in colour and is never mixed with stool. It is usually self-limiting, lasting few days.
If piles are normal, what causes piles to enlarge?
Causes of enlarged piles / bleeding are associated with increased abdominal pressure. Some of the causes of pressure are:
- Constipation, requiring people to put pressure to pass motion
- Chronic cough
- Weight lifting
Other rare causes include soft tissue disorders
How are piles classified? What are different stages of piles?
Depending on size, they are classified into four categories (see the picture):
1st degree: Mildly enlarged
2nd degree: Big enough to meet the opposite side inside the anal canal
3rd degree: Come out but go back in on their own / can be pushed back
4th degree: Always outside and stay outside
What is the treatment of piles?
If piles are bleeding intermittently, then treating the aggravating factor, which is constipation, in most of the cases will solve the problem.
If persistent bleeding is the problem, then hemorrhoids can be dealt with proctoscopy and rubber bands in the clinic for 1st and 2nd degree hemorrhoids.
3rd and 4th degree hemorrhoids need hemorrhoidectomy. This can be a traditional open surgery or no cut stapled hemorrhoidectomy.
Stapled hemorrhoidectomyis as good as, if not better than, open hemorrhoidectomyfor treating piles. Its big advantage is considerably less compared to open hemorrhoidectomy. Both surgeries require the patient to be admitted for one day.