Piles are called Haemorrhoids in medical terminology. They are swellings within the rectum or around the anus that consist of enlarged and swollen blood vessels.

Piles in majority of cases are mild and most people are unaware of their existence. Severe cases however may manifest as bleeding bright red blood after passing stools, downward movement of the lump or the pile that may have to be pushed back in and itching around the anus.

Piles are common but the exact prevalence of this condition is unknown as many people do not consult their doctor for piles due to embarrassment. It is estimated that almost half of the population over the age of 50 years suffers from piles and nearly half will experience at least one haemorrhoidal episode at some point during their lives. 1-5

Types of haemorrhoids

The piles may be of two types depending on location:

• Internal haemorrhoids – These are present just inside the anus and at the beginning of the rectum

• External haemorrhoids – These are present at the anal opening and often hang outside the anus.

Causes and risk factors of piles

The exact cause of piles is not known but it is known that long term constipation may raise the risk of piles. Due to constant straining while passing bowels there is a pressure on the blood vessels in and around the anus and within the rectum that may cause them to swell. In addition, those who are obese or overweight, pregnant or over the age of 50 are at a heightened risk of developing piles.

Piles often run in families and can be made worse by pregnancy in susceptible individuals.

Other risk factors include:

• those who need to sit for long periods of time

• those with liver cirrhosis

• those who lift heavy weights

• have long term cough

• have anal intercourse

• those with infections around their anus

Diagnosis and treatment of piles

Piles are mostly without troublesome symptoms and they may clear up on their own or with the treatment available over-the-counter at pharmacies. Pain or bleeding however must be evaluated and examined by a medical professional.

Diagnosis involves physical examination, examination of the piles and some imaging studies like sigmoidoscopy, anoscopy, colonoscopy etc. to rule out other causes of bleeding like colon cancer.

Treatment of piles may be with creams and ointments to reduce any itching or discomfort. Some other procedures like banding that involves placing a band at the base of the piles to prevent blood supply to the lump. The haemorrhoid usually falls off within seven days. For large lesions hemorrhoidectomy or surgical removal of the piles may be undertaken.

Prevention

Prevention of piles includes lifestyle changes like avoidance of constipation and keeping the like stools soft and regular. This can be done by eating a healthy balanced diet with cereals, whole grains, fruits and vegetables that provide fiber in diet.

Regular exercise, bowel training and good bowel habits, adequate intake of water and use of stool-softener medications when needed are other preventive measures of piles.