ABOUT PILES

What are Piles?

Piles or Haemorrhoids are vascular cushions normally found within the anus and lower rectum. These vascular cushions function to provide control of continence, e.g. allowing us to pass motion without leaking stool. When these cushions swell up or bleed - they may cause problems.

Piles are often categorized as external or internal piles. For the purpose of treatment, piles can be classified into:

First Degree Piles - These are internal piles that bleed but do not prolapse (i.e. pop out).

Second Degree Piles - These are piles that prolapse during bowel movement but reduce spontaneously.

Third Degree Piles - These are piles that are prolapsed but must be digitally reduced.

Fourth Degree Piles - These are piles that are permanently prolapsed and cannot be reduced.

Whereas, first and second degree piles can be treated without surgery, third and fourth degree piles almost always require surgery if symptomatic. Non symptomatic piles need not be treated.

Skin Tags - These may be confused with piles but are really excess skin around the anus.

What cause Piles?

Several factors contribute to the formation of piles. These include:

• Lack of proper toilet training.
• Chronic constipation and excessive straining during bowel movements. " Spending long period of time (e.g. reading) in the toilet.
• Pregnancy.

These factors cause the tissues supporting the blood vessels of those vascular cushions to stretch and break. As a result. the blood vessels enlarge; their walls become thinned out and bleed. With further stretching, the anal cushions enlarge and protrude causing discomfort and bleeding.

What are the symptoms?

If you notice any of the following, you could have piles:

• Bleeding during bowel movement, dripping into the toilet bowl or staining of toilet paper.
• Protrusion during bowel movement.
• Pain or itching in the anal area.
• Anal lumps.

Your doctor may suggest other tests, such as colonoscopy be done as many of these symptoms can overlap with a more serious condition like colorectal cancer.

How are piles treated?

Mild symptoms can be relieved frequently by improving and regularizing bowel habit. Increasing fluid in the diet will help too. Eliminating excessive straining reduces the pressure on piles and helps prevent them from protruding.

Early symptomatic piles may require simple treatment such as injection or tying off with a special rubber band. This is usually done after checking the lower part of the colon to exclude a growth there.

Surgery for Piles

• Open Haemorrhoidectomy
  Surgery is the best method for third or fourth degree piles. It is done under anaesthesia and may require hospitalization. The operation usually involves removal of the piles by cutting them off. This will result in wounds that may take 6 to 8 weeks to heal. The main side effects are pain and bleeding in the postoperative period.
  
  
• Laser Haemorrhoidectomy
  The use of laser does not offer any advantage over standard operative techniques. It is expensive, and is no less painful. Therefore, it is not recommended.
  
  
• Stapler Haemorrhoidectomy
  Stapler Haemorrhoidectomy, also known as the Longo Technique or PPH (Procedure for Prolapse and Haemorrhoids) is a new method of surgery aiming to minimize pain and improve healing properties associated with haemorrhoidectomy. The technique works by removing a cuff of tissue from the area just above the piles. This results in the piles being pulled back into their normal positions within the anal canal. The stapler also interrupts the blood supply to the piles causing them to shrink in size and stop bleeding. Studies show that the wound after stapler haemorrhoidectomy usually heals within 1-2 weeks and less patients complain of severe pain.

• Transanal Haemorrhoidal Dearterialigation. This is a new technique which uses ultrasonography to locate arterial vessels supplying the piles. These are individually ligated leading to a dramatic stop in bleeding from the piles. The incidence of pain after surgery is even less than that following PPH.

Common complications after open surgery:

1. Pain - usually on passing motion and may lead to constipation. You should make sure that you drink enough water.
2. Difficulty in passing urine.
3. Bleeding from the operation site. This is usually minor and should stop after a few minutes. If bleeding is profuse or continues unchecked - you should seek medical attention.

Will my piles recur after surgery?

After surgery for piles, there is still a small risk of recurrence. Further treatment may be required in a small proportion of patients.

Frequently Asked Questions:

Q: Will I feel any pain during the Stapler Haemorrhoidectomy operation?

A: The operation will be performed under the appropriate anesthesia - so that you will not feel any pain.

Q: What will I feel after the procedure?

A: You will feel some pain at the anal area, following stapler haemorrhoidectomy. 80% of patients may not have pain after the first few hours. A few may have pain which subsides within 2-3 days and these should be able to resume normal activities. Conventional Haemorrhoidectomy may be associated with a longer, recovery period and pain for several weeks or up to two months.

Q: When can I expect to go home?

A: Most haemorrhoidectomy surgery is performed on an outpatient basis, although some patients may have to stay overnight.