What are Piles/ Haemorrhoids?

Piles, also known as Haemorrhoids, are vascular cushions that produce symptoms when they become enlarged, inflamed, thrombosed, or prolapsed. There are two types of piles.

1- Internal Haemorrhoids/Piles

They are situated above the dentate line (which is an imaginary line that separates the upper 2/3rds and the lower 1/3 of the anal canal). Internal piles are usually not painful and do not cause a lot of discomfort. The most common symptom is painless bleeding.

2- External Haemorrhoids/ Piles

External hemorrhoids are situated below the dentate line. Since the anal canal below the dentate line is richly innervated, the formation of hemorrhoids causes significant pain.

What causes piles?

Piles or Haemorrhoids have been associated with increased pressure in the lower portion of the rectum, decreased venous return and loss of elasticity causing inflamed, engorged and thrombosed vascular cushions. Risk factors associated with the development of hemorrhoids are as follows: • An improper diet such as a diet low in fibre resulting in excessive straining during passing stools. • Chronic diarrhoea or constipation- prolonged sitting is believed to cause a relative decrease in venous return. • Pregnancy – usually resolved after giving birth. • Obesity. • Family history of piles/hemorrhoids. • Spinal cord injuries. • Improper Posture. • Increased prevalence with increasing age. • Inflammatory bowel disease, Crohn/Ulcerative colitis.

What are the Signs and Symptoms?

• Bleeding – bright red bleeding on stools during bowel movements. This can be observed in tissue paper or the toilet bowl. • Pain – during a sitting or bowel movement. • Swelling around the anus associated with or without severe itching. • Single or multiple lumps near the anus which might be painful to touch.

How do you Diagnose Piles?

Clinical Visual Inspection • Advanced piles (3rd or 4th degree) can be seen on visual inspection. Digital Rectal Examination (DRE) • The health professional introduces a lubricated, gloved finger into the rectum to feel for piles or growths. DRE is done to rule out any other causes of rectal bleeding such as rectal prolapse, fissures, fistula or carcinoma of the rectum. Proctoscopy This is the best investigation done to confirm the presence of piles. A camera is introduced into the rectum and the walls of the rectum are observed. Grading of hemorrhoids is essential for appropriate management. • Sigmoidoscopy (viewing the sigmoid colon with an endoscopic camera) and a colonoscopy (viewing the colon with a camera) is also done to rule out any other cause of rectal bleeding.

Treatment and Management Options Prevention

Lifestyle modifications

• Increasing the intake of dietary fibers and low fat.
• Increasing fluid intake
• Weight loss – in case of obesity
• Toilet Habit Retraining-Avoid straining in the toilet.
• Use moist towelettes or wet toilet paper (to keep the anal area clean)
• Ensure the anal area is clean by bathing or showering every day and dry the anal region well.
• Get plenty of exercises.
• Avoid sitting for long hours while in the toilet.

Avoid medications that cause constipation such as codeine pain killers Medical Therapy • Recommended for first and second-degree piles – Stool softeners – helps stool pass more easily, especially in constipation. – Mild pain medication such as paracetamol, ibuprofen to relieve discomfort. – Sitz Bath. Non-Surgical Procedures Injection Sclerotherapy

• • It is used as the first line of treatment for first and second-degree hemorrhoids.
  • most commonly used sclerosing agent such as sodium tetradecyl sulphate is injected above the dentate line.
  • The sclerosis agent induces an inflammatory reaction and that causes the mass to shrink.
  • Success rate – 88% of patients with first degree piles feel improvement,
  • Complications are rare. But prostatitis, prostatic abscess, epididymal-orchitis can occur if the sclerosing agent is placed too deeply.

Rubber Band Ligation

• • Performed for first and second-degree hemorrhoids.
  • A rubber band is placed strategically to reduce the blood supply to the hemorrhoids. This causes it to slough off and heals within 5-7 days.
  • Success rate – 60%-80%

Photocoagulation

• • Performed for non-prolapsing symptomatic hemorrhoids.

Surgical Procedures Haemorrhoidectomy

• This is the most effective treatment for 3rd and 4th-degree hemorrhoids.
• Haemorrhoidectomy is also done for second-degree hemorrhoids where non-operative treatment has failed, interno-externo hemorrhoids, and thrombosed hemorrhoids.

Haemorrhoidectomy is performed in various ways 1- Open Haemorrhoidectomy The haemorrhoidal/ piles tissue is removed and the wound is left open to heal by secondary intention. 2- Closed Haemorrhoidectomy   The haemorrhoidal tissue is removed and the wound is closed. 3- Stapled Haemorrhoidectomy The haemorrhoidal tissue is not removed.  Instead, a short circumferential segment of the anal mucosa above the dentate line is removed using a circular stapler. This ligates the venous feeding of the piles and fixes the mucosa high in the anal canal. 4- Complications of Haemorrhoidectomy • Pain • Retention of urine • Bleeding • Anal stricture formation • Anal fissure formation • Anal incontinence • Submucous abscess

Complications of Piles if left untreated

• Strangulation of the part of the hemorrhoid that comes out of the anus. • Ulceration of the tissue due to frequent friction with food and due to movement. • Gangrene – the part of the hemorrhoid may not receive blood and might affect blood supply causing the tissue to be gangrenous. • Fibrosis • Suppuration due to infection.

What is the usual fee charged by a top Piles/ Haemorrhoids Specialist?

To find out if you have piles / hemorrhoids we advise  to consult our General Surgeon ( our usual fee is 150 AED per consultation). The cost of surgery ranges between 5000 to 9000 AED.