Piles
are swellings of spongy, blood-filled patches in the wall of
the anal canal. These cushion-like areas usually occupy three
places, equidistant, around the circumference of the canal.
What makes these patches swell may vary from individual to individual.
Chronic constipation is a major factor; there is also a family
tendency. Sometimes chronic diarrhoea can cause piles, as can
diseases of the lower intestine. Piles are of three types, first
degree, second degree and third degree. First degree piles (or
internal haemorrhoids) remain inside the anal canal and usually
cause little more trouble than some bleeding at the end of defaecation.
Bleeding is found with all degrees of piles and can be sufficiently
severe as to cause anaemia (see Anaemia), and, although they
frequently itch, there is usually no severe pain. Pain suggests
a split in the anus (an anal fissure) is also present. In second-degree
piles, the piles do protrude to the outside when the person
strains, but go back inside again when the straining stops and
they can be uncomfortable. Third degree piles are outside of
the anus all the time and can only be replaced by being pushed
back in. Even third degree piles do not necessarily cause much
discomfort but the sensitive tissue can be excoriated by clothing
etc. Sometimes the blood supply to third degree piles gets cut
off and the piles become swollen and very painful (stangulated
piles). This condition requires surgical treatment, as do third
degree piles generally. Surgical removal of piles is called
"haemorrhoidecomy". Haemorrhoidectomy is sometimes necessary for second degree piles but generally they, and first-degree piles, can either be treated by the simple removal of constipation, by the use of faecal softeners and fibre-rich diet, or by being shrivelled up with sclerosant fluids or the local application of elastic bands. The most commonly presenting piles to general practitioner, because they are painful, are not true piles at all but perianal haematomas. These are very tender, hard, cherry- like swellings caused by a bleed under the skin, near the opening of the anus. After a few days, they usually settle down, shrivel up and may leave a small, painless skin tag.
The management is, mainly, as above, clearing the constipation, and injection, banding or surgery as necessary. Simple measures involve keeping the skin clean and dry - washing after defaecation - using very soft tissue or cotton wool to clean oneself. Suppositories and ointments are available over the counter that give some relief, mainly to the itch. More potent products are available for the physician. Even if piles are thought to be the cause, all patients with rectal bleeding should see their doctor. |
