Articles on haemorrhoids

A Review of Haemorrhoid

Dr. Virendra Kale, Gastroentrology Surgeon
DefinitionHaemorrhoids (derived from Greek word “haima” means blood and “rhoos” means flowing) or piles (in Latin “pila” means a ball) refers to dilated veins occurring in relation to the anus.Hemorrhoids is a common problem. 50% of the people above 50 years of age tend to develop hemorrhoids Haemorrhoids is a Common in both men and women. Disease is the tendency to run in families. Haemorrhoids is Uncommon below the age of 20 years Structure of Rectum and Anal canalRectumRectum is a lowest part of the large intestine (colon). Its a small, straight muscular tube, approx 5” long continues in to the anal canal. Upper part of the rectum acts as a reservoir for stool (contains horizontal mucosal folds known as valves of houston) lower part of the rectum is sensitive to stretch; accumulation of stool in the upper rectum stretches the lower part causing a desire to defecate the stool finally passes through the anal canal and is expelled from the body through an opening called the anus.Anal canalAnal canal is 1.5” long extending from anorectal junction to the anus consists of 2 sphincters (muscular valves): internal sphincter (involuntary in nature) and external sphincter (under voluntary control). Both of these sphincters help to keep the stool in the rectum till they can be eliminated. The upper half of the anal canal is thrown into 6-10 vertical folds known as anal columns. At the lower end, anal columns are joined by short horizontal folds called anal valves and these valves together form a horizontal line known as dentate or pectinate line the dentate line demarcates the upper half of anal canal from the lower halfBlood SupplySuperior rectal artery mainly supplies blood to the rectum and the upper part of the anal canal (above the dentate line)Inferior rectal artery supplies the blood to the lower part of anal  canal (below the dentate line)Venous DrainageA network of veins called internal rectal venous plexus (haemorrhoidal plexus) lies in the submucosa (the layer below the inner lining or mucosa) of upper half of the anal canal. The tributaries from the plexus drain into the superior rectal vein.The external rectal venous plexus lies in the lower part of the anal canal at the anal margin and it drains into the inferior rectal vein.What happens in Hemorrhoids?Whenever there is increased pressure on superior rectal veins (as due chronic constipation, pregnancy, obesity etc.) the venous drainage is impeded and this causes a back pressure in the internal venous plexus resulting in dilated veins. These are called internal hemorrhoids. The branches of superior rectal vein, located at 3, 7 and 11 o’clock positions in the anal canal are common sites for Internal hemorrhoids. Pressure on the inferior rectal vein (which runs along the anal margin) can cause External hemorrhoids.Types of HemorrhoidsDepending upon the site of origin, haemorrhoids can be divided into two typesExternal HemorrhoidsDevelops at the margins of the anal opening. They are usually painful because richly supplied by nerves Can be seen outside as a small, tender lump (due to thrombosis)Internal HemorrhoidsDevelops inside the anus. They are usually painless because not richly supplied by nerves. Tendency to bulge out of the anal opening in various degrees. When both the external and internal varieties are associated, the condition is called interoexternal haemorrhoids.Classification of Internal HemorrhoidsDepending upon the degree of protrusion, the internal hemorrhoids can bedivided into: First Degree Hemorrhoids Second Degree Hemorrhoids Third Degree Hemorrhoids Fourth Degree HemorrhoidsTypes of HemorrhoidsFirst degree hemorrhoids: The dilated veins remains entirely within the anal canal and do not bulge out of the anal opening.Second degree hemorrhoids: Piles protrudes during the passage of stool but recede back on its ownThird degree hemorrhoids: The protrusion does not recede back on its own and has to be replaced by hand.Fourth degree hemorrhoids: Piles may protrude anytime of the day and remains permanently protruded.What causes HemorrhoidsThe factors, which may be responsible in increasing abdominal pressure resulting into formation of haemorrhoids, include:Constant straining due to constipation. Diet high in processed food and low in fiber (noodles, cold drinks, fried food, etc.) Laxative abuse and frequent enemas. Sedentary lifestyle Obesity Lifting heavy objects Repeated coughing and sneezingHeredity : Frequently seen in the members of the same family presumably due to weakness of vein walls since birth. Pregnancy : Pressure of the fetus in the abdomen cause the blood vessels around the anus to enlarge. Some diseases/ conditions such as enlarged prostrate, urethral stricture (narrowing of the urinary opening) and cancer of rectum. Occupations involving : Lot of traveling (e.g. marketing and sales professionals) or prolonged standing (e.g. traffic police, waiters, etc.)Symptoms of HemorrhoidsManifestations of hemorrhoids may vary depending upon the type of hemorrhoidsSymptoms of External HemorrhoidsThey may be quite painful as they lie under the skin that has rich supply of nerves.May appear as a tender blue swelling at the anal margin (due to thrombosis). Since the blood clot usually lies at the level of external sphincter muscles, anal spasm often occurs.Bleeding and itching in and around anus may also occur in some cases (due to co-existence of internal hemorrhoids, passage of hard stools or poor anal hygiene).Symptoms of Internal HemorrhoidsBleeding while passing the stool may be the only symptom in early stages. The bleeding is bright red in color and occurs as a “splash in the pan”.Prolapse of hemorrhoids is usually a later symptom. The degree of protrusion depends upon the progress of the disease.Feeling of vague anal discomfort usually accompanies bleeding. It increases when Piles protrudes through the anal opening.A mucoid (slimy) anal discharge and fecal leakage usually accompanies prolapsed haemorrhoids.Itching in and around the anal area follows mucoid discharge from the prolapsed hemorrhoids.Pain is not a common feature unless complicated by thrombosis (formation of blood clot), infection or erosion of the inner lining of the anal canal (mucosa).

How to Diagnose the Haemorrhoid (Piles)

Dr. Virendra Kale, Gastroentrology Surgeon
Diagnosis of HemorrhoidsDiagnosis of hemorrhoids is made on the basis of history of complaints, inspection, digital examination and direct visualizationHistory of complaints suggestive of hemorrhoids includes: Chronic constipation Fresh bleeding per rectum (splash in the pan) Anal discomfort Anal discharge Perianal itchingDigital examination of anal canal is done  to assess: Tone of external sphincters Pain or tenderness Any thickening in the wall of the anal canalDirect visualization of the Rectum and Anal Canal is done usingProctoscope is an instrument used to  visualize the interior of the anal canal and the rectum. Internal hemorrhoids, anal fissure and any growth can be seenSigmoidoscope helps in viewing anal canal, rectum and sigmoid colon (lower part of large  intestine). Colonoscope provides a much wider view of entire colon (large intestine). Both instruments  help in ruling out other significant causes of bleeding per rectum such as Cancer of rectum  and colon Ulcerative colitis, Crohn’s disease).Conditions mimicking HemorrhoidsHemorrhoids has to be differentiated from the following conditions:Anal fissure :  A longitudinal tear in anal mucosaAssociated with streaks of blood with the passage of stoolHighly painful and causes spasm of the anal sphincters  Anal fistula : An abnormal communication between the anal canal or rectum and skin around the anus  May cause swelling, pain, discomfort & discharge in perianal region   intermittentlyCarcinoma of  rectum : May manifest as painless bleeding per rectum Tendency to empty the rectum several times a day often with passage of    blood and mucus  Sudden change in bowel habits, weight loss & anemia are also commonRectal Prolapse : Refers to protrusion of rectum through anal canal Common in elderly age group especially among women Main complaint is “something coming out” during defecation or even during   standing, walking or coughing Bleeding, mucus discharge and pain are absentAno - rectal abscess :An acute, very tender, rounded lump Can be seen or and felt by the side of anus Usually accompanied by fever

Does Everyone Have Piles?

Dr. Maruthesh Gowda, Bariatric Surgeon
While most patients come with self diagnosis of suffering from piles/haemorrhoids, I reassure them it's 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 some time jelly like secretions but they very rarely cause pain.Do we need piles?Yes. Contrary to belief Haemorrhoids (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 water has turned red. It is very rare for one to loose excess amount of blood because of bleeding from piles. This is very rare to cause anaemia (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 self limiting usually 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 them being1. Constipation requiring people to put pressure to pass motion.2. Chronic cough 3. 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 4 categories. (see the picture) 1st Degree---mildly enlarged 2nd degree--- big enough to meet opposite side inside anal canal3rd degree --- come out but go back in on their own/can be pushed back4th degree--- always outside and stay outsideWhat is the treatment of piles?If piles are bleeding intermittently then treating aggravating factor which is constipation in most of the cases will solve the problem.If persistent bleeding is the problem then haemorrhoids can be dealt with proctoscopy and rubber bands in the clinic for 1st and 2nd degree haemorrhoids.3rd and 4th degree haemorrhoids need haemorroidectomy. This can be traditional open surgery or no cut stapled haemorroidectomy. Stapled haemorroidectomy is as good if not better to open haemorroidectomy for treating piles. It's big advantage is considerably less compared to open haemorroidectomy. Both surgery need one day admission.

Do I Need to Worry About Blood in the Stool? (Rectal Bleeding)

Dr. Maruthesh Gowda, Bariatric Surgeon
When anyone notices blood in the toilet, it brings panic and fear in most people's mind. It is rightly so. But what we have to know is that most of them do not suffer from dreaded colorectal cancer. What are causes of rectal bleeding?? What are likely symptoms? 1. Piles (Haemorrhoids) -- Painless, Recurrent, May be associated with constipation, recurrent, Usually self limiting lasting few days, Like a splash on pan. (separate blog) 2. Fissure -- Painful, few drops, few days. 3. Divericular -- Painless, large quantity, self  limiting, 4.  Colorectal cancer -- few mls, persistent, Associated with other symptoms (Separate blog), mixed with stool.  5. Inflammatory bowel disease  -- Long standing,  loose motion, slime/jelly6. Infective colitis -- few days of loose motion and vomiting, settles when infection subsides.When should one worry about rectal bleeding?If it is happening for the first time in people above the age of 50 years then you are likely to need colonoscopy to rule out colorectal cancer. Again, it is to rule out and incidence is low in India. But it is almost mandatory for this group of patients.If there is family history of cancer, then irrespective of age colorectal cancer needs to be ruled out.When there are symptoms of colorectal cancer or inflammatory bowel disease. (Both explained in separate blogs).What is the common cause of rectal bleeding? What are its features?Most of the times it is from piles (haemorrhoids). When one thinks of the following facts, it puts rectal bleeding in new light:A. Everyone is born with piles and dies with piles. It's normal part of the body.B. They will never cause cancer or turn into one.C. Almost never cause pain.D. Most times its is self limiting.                                                                                                                                            E. Usually aggravated by constipation

Haemorrhoides, The Fear Factor

Dr. Pravin Gore, Gastroentrology Surgeon
Once a patient witnesses blood passing through his own body i.e. in stools, it is the most scary part in his/her life.Immediately through his limited hear-say knowledge he self diagnoses to be 'Suffering ' from haemorrhoides / Piles.And the doors of hell open up in his mind. He starts thinking that its a curse, I am going to suffer, there is no cure, he now has to be in pain throughout his life, worst of all, how can I keep this vital horrific truth away from my day to day living beings starting from his spouseIt is the fear of the unknown that is more frightening than the actual hidden fact that he is ignorant about the advances in medical sciences over decades.What will people say, how do I save my embarrassment and my face from my peers and relatives and family and the whole world?He loses self confidence. He does not make eye contact while having a conversation with anyone on any topic just to prevent the fact that the topic should not be diverted to his misery. He walks consciously, eats sparingly, searches for that golden remedy on the net when he can be his own super specialist and cure himself.He wants to bury his sufferings in silence.This is a typical haemorrhoid patient who can be spotted among the crowd easily. It is the apprehension more worry some than the actual problem, blood in his own stools. And he goes on & on & on suffering, anxious, schizophrenic, self stooped, shying away, locked in his own world - the toilet door

Importance of High Fiber Foods in Your Diet

Ms. Swati Kapoor, Dietitian/Nutritionist
Fiber is a substance found in plant and the dietary fiber that you eat is found in fruits, vegetables and grains. It’s very important part of a healthy diet. Eat more fiber to get maximum benefits. High fiber foods can provide other health benefits as well, such as helping to maintain a healthy weight and lowering your risk of diabetes and heart disease other than its main function of bowel stability and strength.There are broadly two categories of fiber and we need to eat both in our daily diets for a better health and functioning of our body. Soluble fiber – Includes pectins, gums and mucilage, which are found mainly in plant cells. One of its major roles is to lower blood cholesterol levels. Good sources of soluble fiber include fruits, vegetables, oat bran, barley, seed husks, flax-seed, psyllium, dried beans, lentils, peas, soy milk and soy products. Soluble fiber can also help with constipation.Insoluble fiber – Includes cellulose, hemicelluloses and lignin, which make up the structural parts of plant cell walls. A major role of insoluble fiber is to add bulk to faeces and to prevent constipation and associated problems such as haemorrhoids. Good sources include wheat bran, corn bran, rice bran, the skins of fruits and vegetables, nuts, seeds, dried beans and wholegrain foods. Most plant-based foods, such as oatmeal and beans, contain both soluble and insoluble fiber. However, the amount of each type varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods. Health Benefits of high fiber foods.Aids in achieving healthy weight: High fiber foods generally require more chewing time, which gives your body time to register when you’re no longer hungry, so you’re less likely to overeat. Also, a high-fiber diet tends to make a meal feel larger and linger longer, so you stay full for a greater amount of time. And high-fiber diets also tend to be less “energy dense,” which means they have fewer calories for the same volume of food.Lowers cholesterol levels : High fiber foods like soluble fiber found in beans, oats, flax-seed and oat bran may help lower total blood cholesterol levels by lowering low-density lipo-protein, or “bad,” cholesterol levels. Studies also have shown that fiber may have other heart-health benefits, such as reducing blood pressure and inflammation. Helps control blood sugar levels: In people with diabetes, fiber particularly soluble fiber can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes insoluble fiber may also reduce the risk of developing type 2 diabetesNormalizes bowel movements: Dietary fiber increases the weight and size of your stool and softens it. A bulky stool is easier to pass, decreasing your chance of constipation. If you have loose, watery stools, fiber may also help to solidify the stool because it absorbs water and adds bulk to stool. Fiber and ageing : Fiber is even more important for older people. The digestive system slows down with age, so a high fiber foods becomes even more important.High-fiber foods are good for your health. But adding too much fiber too quickly can promote intestinal gas, abdominal bloating and cramping. Increase fiber in your diet gradually over a period of a few weeks. This allows the natural bacteria in your digestive system to adjust to the change.Also, drink plenty of water. Fiber works best when it absorbs water, making your stool soft and bulky.So bulk up your daily diet with high fiber foods for satiety, wholesome meal experience and a route to a healthy you!

Enjoy Monsoon with Babycorns

Dr. Richa Garg, Ayurveda
Baby corn provides the valuable nutrition which lacks in most people’s diets. It is extremely low in fat as well, which can help with their weight loss goals. Baby corn is high in potassium and folic acid. It also has a lower glycemic index than regular corn, making it a great substitute.A serving of baby corn would contain only 8 grams of carbohydrates. This is because in the immature baby corn the sugars have not yet developed. Baby corn is a good low-carbohydrate food for people on diets that cut carbohydrates. Baby corn is an excellent source of B vitamins. Baby corn provides folic acid, thiamin, riboflavin, and niacinA few of the important benefits provided by corn are:A power house of mineralsThose little yellow kernels contain more minerals than you can ever think of! Corn contains a large proportion of magnesium, iron, copper and most importantly phosphorus, which is needed for healthy bones. These nutrients not only prevent your bones from cracking as you grow older but also enhances the normal kidney functioning.Improves digestionCorn is filled with fibre that is a huge boon for digestion. It prevents constipation, haemorrhoids and even lowers the risk of colon cancer considerably.Skin CareCorn is rich in antioxidants, which help in keeping the skin younger for longer. Apart from the regular consumption of corn, it can also be applied as Corn Oil which is a rich source of Linoleic acid.Controls cholesterolCholesterol is a substance that is produced by the liver. There are two types of cholesterol; good cholesterol (HDL) and bad cholesterol (LDL). An increase in the bad cholesterol due to the intake of fatty foods weakens your heart and can also lead to cardiovascular diseases. The vitamin C, carotenoids and bioflavonoids contained in baby corn keep your heart healthy by controlling cholesterol levels and increasing the flow of blood in the bodyPrevents anemiaAnemia is a condition where the red blood cell count is reduced considerably due to the lack of iron. Thus, baby corn benefits health as it is rich in vitamin B and folic acid that prevents anaemia.Essential during pregnancyPregnant women should make it a point to include some corn in their diet. Consumption of corn provides a rich source of folic acid. Make sure you clean it thoroughly. The deficiency of folic acid in pregnant women affects the baby. Lack of folic acid in the body affects the brain development of the baby. Baby corn Benefits the health of both the expecting mother and baby.So here we can go for the recipe which is good for weight loss and a variant in your salad can be added.Baby Corn and Mushroom Salad recipePreparation Time: 10 minutes   Cooking Time: 2 minutes   Total Time: 12 mins    Serves 4.Ingredients1/2 cup spring onion cubes1/2 cup fresh mushrooms (khumbh), sliced1/2 cup blanched and cubed baby corn3/4 cup bean sprouts1/2 cup red and green capsicum cubes1/2 cup cucumber cubesFor the dressing1 tbsp olive oil3 cloves finely chopped garlic (lehsun)1 tbsp finely chopped fresh basil leaves2 tsp lemon juicesalt and black pepper (kalimirch) powder to tasteMethod for the dressingHeat the oil in a non-stick pan, add the garlic and sauté till it browns lightly.Add the basil leaves and mix well. Cool completely.Add the lemon juice, salt and pepper and mix well.How to proceedCombine all the ingredients in a bowl and toss lightly. Refrigerate.Just before serving, add the dressing to the salad and toss well.Serve immediately.

Hemorrhoids - the Bleeding Devil in Your Body

Dr. Deepak Rathi, Ayurveda
Hemorrhoids (Piles)  are one of the most common condition to affect humans, having been mentioned many centuries ago. The first descriptions of problems associated with hemorrhoids are found in the Bible, and the occupation of proctology apparently was established then as well.If you have hemorrhoids, you are not alone. They are a common problem. In fact, hemorrhoidal tissues are a natural part of the body. Most of the time you do not notice them as they help during bowel movements. But if these tissues become swollen or inflamed, they can cause uncomfortable symptoms.The good news is that hemorrhoids can be treated.What are Hemorrhoids (Piles)Hemorrhoids - commonly known as piles - are swollen blood vessels (veins) which develop inside and/or outside the anus. They are felt as lumps around and inside the anus . The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. If they become infected, they can cause bleeding, pain and discomfort and require medical attention.Causes of Hemorrhoids (Piles)The exact cause of piles is not known. One theory is that it is due to weakness of the tissues that connects the anal cushions to the muscle layers underneath. Due to this weakness, the anal cushions slide out of their normal place and down the back passage.You have an increased risk of getting piles if you: Have Constipation – this is the most common cause which leads to straining during defecation. Straining leads to pressure on blood vessels causing them to swell, elongate and slide down the anal opening. Eat a low-fibre diet- Lack of dietary fibre can cause hard stools, constipation and straining. Spend too much time in the toilet and holding the urge when you have to go. Have long-lasting (chronic) diarrhoea.Are pregnant - due to the effect of hormones on the blood vessels, plus the increasing weight of the baby within your abdomen. Are Overweight.Lift heavy weights. Have a family history of piles. Have cancer or growths in your pelvis or bowel, which may put pressure on your abdomen. Old age- Ageing reduces the efficiency of the circulation.Types of Hemorrhoids (Piles)There are two types of hemorrhoids: Internal hemorrhoids - these occur inside the anus - Usually painless External hemorrhoids - these appear outside the anus - may become painfulHemorrhoids are also classified by the Degree of prolapse (dropping outside the anus), their size and if they are infected : GRADE I - hemorrhoids bleeds but do not prolapse (do not come outside the anus while passing stools) GRADE II - hemorrhoids prolapse on straining and then reduce by itself (go back inside the anus by itself) GRADE III - hemorrhoids prolapse on straining and do not reduce by itself and may require manual reduction (have to push it back inside the anus by using your fingers) GRADE IV - prolapsed hemorrhoids are trapped outside the anus and may become strangulated, infected and painful.Symptoms of HemorrhoidsBright red blood spots in the toilet or on the toilet paper. Heavy bleeding during defecation (During Passing Stools) Itching and discomfort around the anus. Feeling of a lump or mass near the anus which may be painful or painless. Discharge around the anus and soiling of clothes. Pain while passing stools and after passing stools. Feeling of incomplete evacuation of your bowels.The most frequent complaint in true Hemorrhoid is Painless bleeding, which usually appears early in the course of the disease. See your doctor if you have blood in your stool. Hemorrhoids could be the problem, but bloody stool could also be a symptom of something far more serious, like colon cancer. ComplicationsIf Hemorrhoids are ignored and no treatment is given to cure them, they can lead to- Iron Deficiency Anaemia (from heavy bleeding) Weakness Prolapse of whole hemorrhoidal tissue outside the anus.How a diagnosis is madeIn most cases, diagnosis is easily made by a thorough history taking and on physical examination by your doctor. In advanced cases some tests may be required like Anoscopy (Proctoscopy) , Sigmoidoscopy and Colonoscopy.It is never a good idea to diagnose the condition yourself. Always consult an Expert.Treatment Options Multifold approach is essential for correct treatment of existing condition and to prevent the recurrence. This includes: Lifestyle Modifications Oral medication: as prescribed by your doctor. These can be used to temporarily treat small bleeding piles. Analgesics: For temporary relief, if pain is present. Laxatives: to keep the bowel clear. Oral medicines: to regularise digestive system and to enhance healing. Topical treatment (Creams and Ointments): as prescribed by your doctor (Avoid prolonged use) Herbal Medicines (Ayurvedic Medicines): Ayurvedic Medicines are very effective treating hemorrhoids. Very effective control in bleeding and pain can be achieved through medicines. Cold pack applied to anal area Hot sitz bath in tub for 20-30 minutes twice daily. Kshar Sutra Therapy: This is the best treatment available for hemorrhoids, anal fistula, anal fissure and pilonidal sinus. By this technique, Kshar Sutra is placed right at the root of hemorrhoidal tissue and the whole hemorrhoid is ligated with Kshar Sutra. Blood supply to the existing hemorrhoid is cut off and hemorrhoid will shed off after some days. Kshar Sutra that is placed at the root of hemorrhoid will help to prevent the recurrence of the disease. Surgery : Many kind of surgical techniques are present Sclerotherapy (Injection Therapy): Sclerotherapy is a popular form of hemorrhoid treatment whereby a chemical agent is injected into the hemorrhoid to cause it to shrink and go away. Rubber Band Ligation- A rubber band is placed on the haemorrhoid so as to cut off the blood supply and shedding off the hemorrhoid Infra Red Coagulation- Infra red rays are used to kill hemorrhoids Cryosurgery – Very low temperature is used to shrink the hemorrhoids Surgical Excision – Hemorrhoids are cut off using a knife. Stapler surgery – Used in rectal prolapse And Many more.....Keep in mind that your treatment differ depending on your symptoms and the location of your hemorrhoid.