Piles

Piles
Piles (clinically known as hemorrhoids) basically, is the swelling of blood vessels near the anal opening and a sliding down of the lining of the anal canal. Piles are lumps that from inside the back passage and on the surface of the anus. The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. We understand that piles may not be a subject you feel comfortable talking about, but there is no need to suffer in silence. If you have got piles, you are not alone. Piles will affect one in two of us.
1. Internal – it is a prolapsed hemorrhoids which is a result of swollen blood vessels that has been pushed out of the anus.
2. External – they are less common than internal piles and show without any pain or symptoms. These develop around the outside edge of the anus.
  1. 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.
  2. Hard stool – when hardened stools come in contact with swollen vessels, the friction between the two causes the vessels to rupture and bleeding ensures.
  3. Habits related with toilet – spending too much time on the toilet, holding it when you have to go.
  4. Being overweight – carrying around extra body weight may lead to piles.
  5. Lifting heavy loads – this leads to straining the lower body which may result into damage of the tissue and blood vessels of the back passage.
  6. Family history – if your parents ever suffered from piles, then you may have chance of getting piles.
  7. Pregnancy and child birth – a growing fetus, as well as exertion of labour, can put extra pressure on the back passage.
  1. Itching sensation at anal region
  2. Feeling of heaviness at anal region
  3. Painful and hard stool
  4. Recurrent per rectum bleeding
  5. Sliding down of the anal parts
  6. A dragging sensation in back passage
  7. A bulging feeling just inside back passage

    8. It usually starts with itching sensation in the area and feeling of heaviness. Later, bleeding from the anal opening and pain during or after defecation make their appearance. It is at this stage of the disease when patient begin to panic.
    Depending upon swelling and progression piles may divide in to 4 stages
      Grade I -symptoms are mild pain, itching sensation, heaviness. Grade II, III – Symptoms are painful defecation, recurrent bleeding, itching sensation, burning sensation, dragging sensation, feeling of prolapse. Grade IV – symptoms worsen
As the disease advances, a systematic clinical examination and diagnosis from a specialized doctor is of utmost importance. Treatment options includes:
  1. Medical: Grade I and early stage of Grade II can be treated with the help of medicines and dietary modification.
  2. Surgical: One of the most advance Minimally Invasive Procedure for hemorrhoids (MIPH) is STAPLER Surgery.
After years of surgical research, the 21st century saw the invention of Stapler Surgery (Minimally Invasive Procedure for Haemorrhoids). Stapler surgery is one of the best option treatment of piles as it is associated with minimal pain and faster recovery (can join on duty from 3rd day)
Procedure
It is minimally invasive procedure that reduces the prolapsed of haemorrhoidal tissue. A unique stapling technique is used to push the swollen blood vessels back into their normal position. It is a day care procedure.

1) Preparation: Requires nil mouth for about 6 hrs prior to the surgery.
2) Surgery: It takes only 15 to 45 minutes. It is usually done under spinal anaethesia. It is done through natural opening, with the help of use and throw transparent device known as Stapler. In this surgery there is no any cut outside and no stitches so there is no need of dressing after surgery.
3) Post operative after care: Patient can have his full diet 4 hrs after operation. Patient can walk around, after 5 -6 hrs Patient can be discharged within 24 hrs On discharge antibiotics and painkiller for 3 to 5 days are advised.

For this surgery a hospital stay of 24 hours is required where the patient is immediately discharged within 24 hours. He can also rejoin work from the 3rd day depending on his recovery time. But there are a few points that need to be considered and followed after getting discharged for complete relief from the problem of piles. They are as follows:
  • Have plenty of fluids, a fibre rich diet i.e green leafy vegetables fruits etc and eat less spicy and oily food.
  • Do not sit for long hours on the toilet unless the need for defecation.
  • Do not strain while defecation.
  • Defecate only when the need arises and don’t make it a routine habit.
  • Avoid sitting for long hours in one place like work station i.e for more than 45 minutes. Give mobility to your body.
  • Avoid excessive driving and exercise in the first month. The patient can start with mild exercises like walking after one week and get back to the normal routine after 2-3 weeks depending on the recovery time and under the doctor’s advice.
After operation sometimes there might be slight discomfort and mild pain in the anal region accompanied by little bleeding too. But this symptom is common in some post operative patients for the first 1-2 weeks. Routine follow up of the doctor is a must.
Comparison between Stapler Surgery and Conventional (Traditional) Surgery for Piles

Concerns Stapler Surgery Conventional Surgery
Post operative pain Less More
Surgery time Less More
Post operative bleeding Less More
Recovery time Less (3-5 Days) More (10-15 Days)
Hospital Stay Less (24 hours) More (3-5 Days)
Recurrence chances Negligible More
Patient’s satisfaction More Less
Relief from Constipation rectal yes to some extent as it also improves internal rectal prolapsed No cure for internal rectal prolapse