What are Piles (Hemorrhoids) ?
- The Veins (Blood Vessels that take back blood to the heart) in the region of the Anus form a complex structure interlinking with each other and is called the Hemorrhoidal Plexus.
- They are also called the Anal Cushions in an ailment free individual and are typically seen at 3’0 clock, 7’0 clock and 11’0 clock positions.
- These veins when they expand, most commonly due to constant straining, they give a cushioning effect to the anal sphincters and the region over all
- When the reason for expansion of these veins keeps happening over and over again, these anal cushions become permanently enlarged and that is what “Piles” for lay-people but “Hemorrhoids” in Medical Terms
- Commonly Seen as Soft swellings from Inside the Anus, may expand upon straining, may disappear upon relaxation and may cause profuse bleeding
What are the most common complaints in Piles (Hemorrhoids)?
- Hemorrhoids or Piles are different from a Fissure in Ano because it is basically a painless condition
- Most common complaint I receive from my patients is Swellings coming out from the Anal Region
- These swellings may appear upon straining and then disappear by themselves automatically in the earlier stages, but remain irreducible at later stages
- Itching may or may not be seen in the skin around Anal region.
- These swellings may be associated with Bleeding, which is typically described to me as a JET of blood upon straining / defecating. (Drops of Blood are seen with Fissure in Ano)
- If Hemorrhoids are associated with Pain then it is more than likely that you also have a co-existing Fissure in Ano disease (Click here) . Fissures and Piles are very commonly seen together
What are the Types of Hemorrhoids?
Mainly the types of Hemorrhoids are:
- Internal Piles
- External Piles
- Mixed Internal and External Hemorrhoids
In simple terms,
- Hemorrhoids originating from above the Pectinate Line (Shown in the Figure) are called Internal Piles or Hemorrhoids
- Hemorrhoids arising from below the Pectinate line are called External Piles or Hemorrhoids
- 60-70% of all Hemorrhoids are Internal Hemorrhoids (1)
However, for those who want to understand deeper scientific causes, it can be classified as:
- Internal Hemorrhoids are the ones that are supplied by the Superior and Middle Rectal Arteries
- External Hemorrhoids are the ones that are supplied by the Inferior Rectal Artery.
What are the Stages of Hemorrhoids / Piles
- There is no classification for External Hemorrhoids
Internal Hemorrhoids / Piles are the most common types of Hemorrhoids seen in clinical practice and they are classified as per Goligher’s Classification:
- Grade I : Where there is only bleeding however no visible swelling from the Anus, can be appreciated on Proctoscopy.
- Grade II : Where there is a visible mass that comes out from the Anus during exertion of pressure (straining) but the it goes back inside by itself without any external push
- Grade III : When the Mass is visible outside the Anus and only goes inside when it is pushed inside manually by self or by a Surgeon
- Grade IV : When Hemorrhoids are always seen outside the Anus and even if it is tried to be reduced, it cannot be reduced and permanently stay outside.
- Prolapse: When the mucosa and the muscles of the intestines start coming out due to the Sustained straining, it is called a Prolapse
What are the causes of Hemorrhoids / Piles
- Causes for Hemorrhoids are mainly related to Straining.
- Sustained Straining may happen due to the following reasons:
1. Hard Stools or Constipation
2. Lack of Exercise
3. Anal Sex
4. Heavy Weight Lifting (Including Gym Exercises)
5. Anal Sex (may it be Homo or Hetero Sexual)
6. Prolonged Squatting.
7. Western Style position for passing stools
8. Sitting for extended durations
9. Pregnancy
10. Obesity
11. Junk Food/ Highly Processed Food in Diet
12. Long Term Intake of medicines like Pain KIllers, Anti Inflammatory Drugs, Steroids, Anti-Hypertensive Drugs etc
12. Previous Anal Region Surgeries
Hemorrhoids / Piles in Pregnancy
- Hemorrhoids are very common in Pregnancy and is nothing to worry about.
- It should infact be considered as a part and parcel of your Journey of Pregnancy as a Mother
- Piles / Hemorrhoids happen mainly because of 2 reasons:
1. Due to increase in circulatory fluid volumes during pregnancy
2. Due to lack of fibre and fluids in diet in addition to the hormonal influence by Progesterone, Constipation is more than likely to occur. - Also, As pregnancy progresses, the constipation increases without any medical intervention, which then causes the need for constant straining