Piles

Piles

DIGESTIVE DISORDERS - Piles

“Piles” is often feared as the tumour of the anus. Actually, piles is not tumourous and not dangerous. It is a simple enlarged / engorged blood vessel(s) of the anus. It is also called haemorrhoids in medical terminology. It is the dilatation (varicosity) of the haemorrhoidal plexus (veins of anus). It appears as bluish or purple coloured swellings due to stagnated blood. Piles may cause symptoms like bleeding, itching, pain and lump feeling in the anus.

Blood vessels are supposed to suffer with varicosity, when there is obstruction or resistance/ sluggish or reduced or back flow of blood / valvelessness, etc. Varicosity is often noticed in the legs of pregnant women or policemen or in persons whose job/habit is to stand continuously for a prolonged period. Veins of the legs are most commonly affected with varicosity, since it is the most dependent part of the body, where the gravitational force constantly gives pressure with stagnation. Other than varicosity of legs, the next commonest spot of varicosity is the anus since it has a cluster of loosely supported blood vessels anastamosing (joining) systemic & portal (liver) circulation. These blood vessels have no valves to avoid back flow and is more prone to varicosity.

Piles patients mostly suffer silently with their complaints due to shyness to explain or show the thing to the doctor. They bear the pain and complaints as far as possible and go for treatment only in unbearable conditions, which usually leads them directly to the surgeon’s table. Every complaint should be treated then and there, for easy cure and to avoid progress of the disease into complications. Also, nowadays piles is often misspelled for all anal complaints (fissures, fistulas, rectal tumours, prolapsed anus, etc.) Every complaint should be clearly analysed by examination and investigation before being diagnosed and treated.

Incidences – Piles is very commonly seen nowadays. Women have higher incidence than men. The reason behind it is not clearly known. It is more commonly seen in adolescent age group and aged persons who all seem to be more tensed. There must be a relation between piles and tension/psychological factors. Its incidences is more common in persons who deviate more from nature in diet, living style and sitting habits. Sufferers are mostly

• Long sitting travellers
• Sedentary workers
• Alcoholics and those who suffer from liver disorders
• One who suffers often from constipation or diarrhoea

Anal architecture – is designed in such a manner to control even the release of air (flatus) and watery stools i.e., airtight and leak-proof. It is well-formed with internal sphincter and external sphincter muscles. Anal canal is anatomically divided into two parts (namely upper part and lower part) by Hilton’s line (bluish pink ring). This upper anal part originates from the endoderm and is covered with mucous membranes. The nerve supply of the upper part is supplied from the autonomic nervous system which doesn’t have any pain sensitive nerve fibres. The lower part of the anal canal originates from ectoderm and is covered by skin. Unlike the upper part, it is supplied by spinal nerves which have pain sensitive nerve fibres. The blood supply to upper part of the anus is supplied by superior haemorrhoidal plexus and the lower part is supplied with inferior haemorrhoidal plexus. The occurrence of swelling/varicosity in the anus (piles) is more common in 3 O’, 7 O’ & 11 O’ clock position of anus which are all supposed to be weak points of the anus.

Types – Piles is classified in two ways.

Internal piles – lies inside the anus. Usually internal piles originates from superior haemorrhoidal plexus of the upper part of anal canal and lies above the Hilton’s line. This type usually will not be painful, since it lies in the upper part of anal canal, which lacks pain-sensitive nerve innervations.

External piles – lies outside the anus. External piles originates from inferior haemorrhoidal plexus of the lower part of the anal canal i.e. it lies lower to the Hilton’s line. This type of external piles is most painful, since the lower part of the anal canal has pain-sensitive nerve fibres. Some piles patients may have both types. Piles can also be classified as

Primary piles – occurs due to hereditary reason without any causative factor or obstruction

Secondary piles – occurs in continuation with other diseases or obstruction to portal circulation like liver disorders, portal hypertension due to obstruction, rectal or pelvic tumours, cancer, spleenomegally, etc.

Prolapsed piles –is the piles which gets descend from the place of origin, i.e. internal piles descends to get visualised as external piles. This prolapsed piles should be cared for in the initial period itself or otherwise it may get strangulated and develop into gangrene. In the initial period, the protrusion gets inside or recedes without any assistance after passing stool, but in due course, the protruded mass will not recede even with the assistance of fingers.

Commonly suspected causes for development of pilesPressure in the blood vessels may be due to

Obstruction

• Physiological – Pregnancy and delivery can cause temporary increase of venous pressure and thus piles can occur.
• Pathological – Liver and portal vein disorders, pelvic or rectal tumours, cancer, etc., can cause obstruction and lead to piles.

• Erect postures of man – Animals are flat, but humans had become erect by evolution. This has been considered a major factor for development of piles.
• Hereditary – piles is often found to run in families
• Physical strain – pressure exerted while passing stool, coughing continuously for a prolonged time, weight lifting, etc., can also cause piles & tendency to prolapse and relapse
• Foods – Low fibre diet, more Spices, alcohol, lesser intake of water can produce hard stool, which may need of more strain in defecation and thus lead to piles
• Defecation – Both constipation and diarrhoea can cause piles. The strain for passing the stool is the main reason for the development of piles in both cases.
• Habits of alcohol, sedentary life and drugs can also cause piles
• Worries and mental strain can also cause havoc to the intestines and anus.

Symptoms – Symptoms of piles usually vary according to the type and place of origin. Piles in its initial stages is most commonly found to be without any symptoms. It is often noticed after constipation and abrasions. As said earlier internal piles are usually silent except rarely bleeding, but the external piles mostly produce a lot of suffering/symptoms. Internal piles, when get prolapsed or protruded, produce symptoms like external piles.

The most common symptoms of piles are

• Feeling a lump or discomfort in anus
• Frequent ineffectual urge for stool without passing stool or without satisfaction of complete evacuation. Even after passing stool, they will not feel any satisfaction, since the bulge of the blood vessels (pile mass) give the sensation of impacted faecal matter in anus.
• Bleeding from anus – Mostly pile mass bleed as bright red blood in drops just after defecation, but sometimes blood may splash over the toilet pan making the sufferer panic about the loss of blood. Sometimes it may just stain undergarments.
• Pinkish or bluish colour swellings protrudes from anus like bunch of grapes
• Pain – Piles mass will usually have a burning or stabbing or throbbing type of pain which often makes the person restless and doesn’t allow them to sit and relax. They may also have a sensation of having thorns or glass pieces in anus while sitting.
• Itching of anus.
• Mucus discharge or oozing/leakage of faecal matter from anus, since anus could not be able to close so tightly due to pain.
• Strained and frequent urination due to irritability of anus with the contact of expanding, filling bladder.
• Prolapsed or protruded piles often become thrombosed and become hard tender external mass.

Diagnosis – Piles can be easily diagnosed by examination of the anus with finger palpation and proctoscope. The prolapsed internal piles and external piles are easily visible and can be diagnosed on the spot. Sentinal piles – a natural skin tag/knot which guards the extension of fissure – is often misunderstood as pile mass by many patients.

Complications of untreated piles are – bleeding, infection, prolapse, strangulation, necrosis and gangrene. Painful bleeding usually indicates startup of complications.

MANAGEMENT

• Take rest and avoid long walks, long distance travelling and cycling
• Take plenty of water and follow regular bowel habits to avoid constipation and strain
• Use Indian style toilets since squatting position will be a better position for pain and natural defecation
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid dry hard stool and strain to rectum and anus
• Never suppress an urge. Go for stool whenever there is a call since it is passed on easily
• Don’t strain to evacuate hard faecal matter. Take time in toilet for a natural descend or try enema or stool liquefiers. It is better to have semisolid stool for easy defecation
• Take proper treatment for cause of pile mass, if it is of secondary to any other disease
• Sitz bath – Before passing stool, sit in a shallow bath tub of warm water for 10-15 minutes to relieve the anal spasm and relaxation of anal sphincter. This method also pacifies all painful anal conditions
• Ice application is advised, when there is constant bleeding
• Take easily digestible, simple cooked foods. Avoid spices and chillies
• Take foods containing greens, ginger, onion, garlic, radish, berries, beet root, bitter gourd which helps in healing piles.
• Take plenty of fruits and juices especially papaya, mango, lime, jambul, cherry, figs, etc.
• Vitamin E and zinc supplementation can be taken for better healing.
• Avoid sedentary habits, alcohol, smoking and unnecessary drugs like pain-killers.

General treatment – Mostly, piles becomes better with water, dietary regimen and correcting the constipation. Anyway, care for blood loss should also be taken to avoid anaemia.

Haemorrhoidectomy – Removal of pile mass by surgery. Allopathy usually considers piles as a surgical complaint and treats it mostly with surgery even for painless piles. Patients, also with the fear of getting cancer or tumours, opt for removal. Also, in this advanced laser treatment, most of the surgeries are performed with laser which reduces the duration of hospital stay and blood loss. But in course of time, the recurrence of piles even after surgery will usually make the patient more frustrated and depressed.

Complications of surgery

• Anal stricture
• Leakage of faecal matter due to injured sphincters
• Constipation

The other techniques often followed are:

Creams & ointments – commonly advised as local anaesthetic and moisturiser. It soothes, but it has very little value in treatment.

Sclerotherapy – Scelorising chemicals are injected into the pile mass to make them shrink. This method is helpful only in the case of internal piles.

Banding – The base of pile mass will be banded to get auto slough off due to lack of blood supply.

Cryosurgery – Freezing the pile mass by liquid nitrogen.

Homeopathic approach – Piles usually tend to get worse over time and become more persistent. “Best of all the medicines” is rest, water and diet without which no treatment will be helpful. Treatment of piles often has hindrances since it is often exposed to irritants or frictions of stool. Usually, external treatment such as pain relieving creams and ointments containing anaesthetic agents and moisturisers can help only to pacify the discomfort, but it has very little or no value in treatment of piles. This way of localised approach or treatment will usually suppress/mask the complaint for the time being only. Also, one should be aware of recurrence of piles even after surgical intervention. This confirms that the cause is not localised and it is the effect of internal circulatory or other systemic diseases. So the suppression of the piles mass will leave the internal disease untreated. So this will usually lead to serious progressive internal diseases, since piles occured as an outlet, to avoid the internal burst.

In Homeopathy, the pile mass is not considered a pure surgical disease. It considers piles as the outburst of an internal disease, which should be treated internally only. The internal Homoeopathy medicines usually strengthen the blood vessels and raise the resistance forces without any side-effects. It can also stop the recurrence of piles. Homoeopathy medicines are very effective in the management of piles without any surgical intervention.

Will the pile mass disappear completely with Homeopathytreatment? You should understand one thing: that a blown balloon will never return to its original size, i.e. a deviation from nature will never track back in perfection or to its complete normal anatomy. It will always have its traces of incidences as history. If Homeopathy treatment is opted in the initial disfiguring period, we can surely aim for total cure or complete disappearance of the pile mass. Otherwise, the size of the piles will get reduced to have traces even without any sufferings.

Homeopathic medicines commonly used in case of piles are Acid Nit, Aconite, Aesculus Hip, Aloes, Apis mel, Bryonia, Calc carb, Calc Phos, Capsicum, Carboveg, Causticum, Chamomilla, Collinsonia, Graphites, Hamemelis, Hepasulf, Hypericum, Ficus.R, Ignatia, kali carb, Lachesis, Lycopodium, Mag Phos, Mer cor, Millefolium, Muriatic acid, Nat Sulp, Nux Vom, Paeonia, Phosphorus, Podophyllum, Ratahnia, Silicea, Sulphur, Thuja, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)