There are many patients who complain of Piles and visit the Surgical OPD usually with the complaints of bleeding, protrusion and pain in the lower body. Pain is usually there if hemorrhoids are associated with fissures or are thrombosed.
Hemorrhoidal bleeding is described as bright red blood seen either in the toilet or upon wiping. Sometimes patient have significant bleeding which may be due to anemia. However in a patient with bleeding from rectum, presence of a colonic neoplasm must be ruled out. Also, prevalence of hemorrhoidal diseases is not selective for age and sex. But age is known to have deleterious effect on the anal canal.
However, if we compare prevalence of hemorrhoidal disease with western countries than the numbers are less in India and the cases which exist are primarily due to the food and toilet habits.
Hemorrhoids are commonly classified as external and internal. Although small external cushions do exist, standard classification of hemorrhoidal disease is based on the progression of the disease from their internal location to prolapsing external position. Mainstay of treatment is relief from constipation.
In Stage I and II of Hemorrhoids, patient doesn’t require any surgical intervention. Hemorrhoids of Stage I and II can be dealt with fibre supplementation and cortisone suppository and sclerotherapy.
In Stage III, Patients require Protrusion including manual reduction. They also require fibre Supplementation, cortisone suppositories, banding and surgical intervention like Staples.
In Stage IV, Patients have irreducible protrusion and can be healed with operation intervention supplemented by cortisone suppositories and increasing fibres in diet.
Sometimes even Stage II disease should be dealt with surgery (Stapled hemorrhiodectomy), if it is associated with prolase of rectum in the form of mucus secretion.
Other modalities used for hemorrhoidal diseases are
- Laser obliteration of hemorrhoidal vessels.
- RFA ( Radio Frequency Ablation)
DGHAL( Doppler guided Hemorrhoidal Artery Ligation )
- Stapled Hemorrhiodectomy (MIPH – Minimal Invasive Procedure of hemorrhoids)
If properly used, these are fair modalities for piles treatment.