hemorrhoids (Piles)

Popularly known as jedi jedi in the Yoruba language, piles (hemorrhoids) have been falsely indicted as a cause of many symptoms. In this article, I will outline all you need to know about piles.

Imagine that you finish using the restroom and as you wipe or turn to flush the toilet you see unmistakable bright red blood and it’s happening for the 1st time in your life. What will be your 1st reaction? Let me guess. You will panic. Alarm bells would go off in your head as you think of many possibilities and immediately reach out to a medic to lay your complaints. 

What is a pile?

Piles or enlarged hemorrhoids are one of the most common causes of blood in the stool. Hemorrhoids are a part of your body that provides support for your anus (that is the lowest part of your bowels that ends in your ass hole). It is like a support cushion that helps to keep things in place. The support is lost when the cushion begins to fall apart due to the amount of load placed on it. 

This area is sensitive as it has many blood vessels passing through it, hence a little pressure or injury can cause swelling with so much bleeding and/or pain. When it becomes enlarged, it’s called a pile.

Types of pile

Not everyone with piles experiences symptoms. Even those who have symptoms do not all experience the same symptoms. 

External haemorrhoids can be easily seen and felt like a fleshy protrusion from your anus. 

External haemorrhoids are closer to the tip of the anal canal, therefore once they get swollen, they protrude out of the anus. 

hemorrhoids
hemorrhoids/Shutterstock/New Africa

Symptoms of external hemorrhoids are

-Anal protrusion

-Anal pain

-Painless anal Bleeding

Internal hemorrhoids as the name implies are high up inside your rectum so you normally cannot feel them. However, if it becomes enlarged, it can occasionally be displaced so much as to be felt just at the tip of the anal canal. When this happens, you can easily push it back into your anus without pain. However, It will only become painful if it remains outside your anus without being pushed back into the hole. The pressure around your ass hole traps and compresses it causing pain.

They can become so swollen and displaced from their normal position downward, such that they remain can become protrusions felt at the tip of the anal hole (prolapse). A prolapsed internal hemorrhoid is one reason you have soiled underwear which causes itching. In extreme cases, it is trapped in by pressure (strangulations) and becomes painful. 

Symptoms of internal hemorrhoids are:

-Anal bleeding

-Itching of the anus

-Pain in the anus is absent except in cases of prolapsed internal haemorrhoids. 

Causes of Piles

Developing pile is attributed to excessive pressure on the anal tissues that act as cushions. There are many factors that put an individual at risk.

You are at risk of developing piles of you are:

  1. Consuming only foods low in fiber: this makes your stool less bulky such that you have to strain to defecate. The pressure from straining then causes a pile. 
  2. Pregnant: This is due to hormonal changes and pressure from the uterus on the recriminations and anus. 
  3. Sitting in the toilet for long: This reduces blood supply to the haemorrhoids eventually causing enlarged haemorrhoids or piles.
  4. Ageing : Ageing causes weakening of muscles that provide support.
  5. Straining often either due to a chronic cough or straining all the time to pass stool. 
  6. Often Constipated 
  7. Having Diarrhea lasting over 2-4 weeks
  8. Obese
  9. Having anal intercourse
  10. Having a loose ass hole due to spinal cord injury, surgery in your rectum or episiotomy.

Diagnosis

Your doctor will have to examine you to confirm diagnosis after asking you questions about your symptoms and risk factors. 

The examination involves looking at the anus and sometimes putting a lubricated finger into your anal hole. Your Doctor will use a gel containing local anaesthetic to reduce discomfort from examination of your anus. This is imperative to classify the piles as each type has a specific treatment plan.

Piles are graded based on the location as shown in the picture above. 

Grade II : Here, the haemorrhoids protrude only when you strain and return on their own.

Grade I : These internal haemorrhoids mostly have no symptoms other than occasional bleeding which is usually minimal.

Grade III : Here, the haemorrhoids protrude our of the anal canal and must be pushed back in before they return into the anal canal. 

stages of hemorrhoids
stages of hemorrhoids /Shutterstock/New Africa

Grade IV: Remains outside the anal canal and cannot be pushed back in.

Treatment of piles

Treatment is aimed at relieving pain, discomfort and reducing symptoms.

Treatment is initially conservative with medications, lifestyle changes and procedures to provide relief. Piles can be treated without surgery.

Medications for treating piles come in different formulations. An individual can buy them over the counter.

 The different formulations include:

-Suppositories: These are soft pellet-like drug formulations that you can insert into your anus for relief of swelling and discomfort . 

-Ointments: These are oily creams that you can apply to the haemorrhoids and your anus.

-Pads: These are soothing and can be applied to the anus. 

-Oral analgesics are also helpful.

Other measures you can take for relief from symptoms are:

  1. Sitz bath: This involves sitting in a bowl of warm water (not hot water). This helps cleanse the anal area, reduce irritation, increase blood flow to piles and promote healing.
  2. Ice packs: wrapping ice packs in a towel and applying to the anal gives some relief from pain and itching.
  3. Fiber supplements such as psyllium husk can help reduce constipation. 

For higher grades or those with troublesome symptoms in spite of conservative treatments, your doctor may suggest surgical treatments.  

Surgery

Surgical treatments are considered if the above mentioned treatments do not work. The surgical procedures are done in the theatre after you are injected with drug that will make you sleep.They include either cutting off the haemorrhoids completely, or attaching them back into your anus

Prevention 

  1. Avoid constipation by feeding on a high fiber diet with vegetables and fruits. Take smoothies instead of fruit juices to get the fiber in the fruits and vegetables. Drink 3 liters of water daily.
  2. Avoid postponing the trip to the restroom. Empty your bowel soon after you had the urge to do so. That way you can avoid having hard stools. 
  3. Use a damp tissue paper or wet wipes to wipe your bottom. (Use flushable wet wipes for this). Wipe your bottom gently.
  4. Avoid straining when passing stoolAvoid drugs that may cause constipation such as opioids.
  5. Avoid prolonged sitting particularly on the toilet seat. Do not go to the toilet with any of your electronic devices. The tendency to get carried away and sit for a longer time than you planned is always there.
  6. Exercise regularly 
  7. Loose some weight 

Many things can happen that may put you at risk, some you can control (like diet and avoiding sitting in the toilet for a long time), while others (such as aging and pregnancy) you can not. If you already have it, dietary and lifestyle changes, in addition to treatments can help you live a pain free life.

About the author

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Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.