Understanding Piles

A surprisingly large number of the population suffer from the inconvenience and pain of haemorrhoids, otherwise known as Piles. Find out more about it in this article written by Prof Eu Kong Weng, Colorectal Surgeon.

What are the symptoms of this condition?

The symptoms can range from discomfort and itching to debilitating pain, making it difficult to walk. Piles are normally-occurring submucosal vascular cushions that are found in the anal canal. They are formed from arteriovenous communications between the superior haemorrhoidal arteries and the terminal branches of the superior rectal artery. They are usually present at 4, 7, and 11 o’clock positions, but can occur all around the anal canal. They are thought to be essential in maintaining continence to faeces and flatus, contributing to about 20 per cent of resting anal pressure.
Although we often associate piles with spicy or hot food, there is no scientific evidence linking piles with spices in the diet. However, some patients do notice a worsening of the symptoms of piles after a spicy meal. The symptoms experienced by patients with piles include painless fresh rectal bleeding, perianal discomfort or pruritus, faecal soiling, or a painful anal swelling. Of these, painless bleeding is the most common presenting symptom. Many factors contribute to piles.

Any condition that is associated with a raised intra-abdominal pressure can contribute to causing piles. This includes straining, constipation, diarrhoea, prolonged sitting on the lavatory, inadequate fibre intake, pregnancy, ascites and pelvic-space-occupying lesions. Piles may also occur as a result of collagen disease.
Simple steps can be taken to avoid bouts of piles. For example, patients who spend prolonged periods straining with their stools in the lavatory or who have inadequate amounts of fibre in their diet, are more prone to piles. Women are also more prone to piles after pregnancy.

What can be done to improve the condition?

Lifestyle modifications such as increasing your intake of dietary fibre and fluids, improving anal hygiene and toilet habits and avoiding the extremes of constipation and diarrhoea are important in the treatment and prevention of piles, as well reducing the risk of disease recurrence after surgical treatment.

A high fibre diet may also help to alleviate pain, bleeding and prolapse.

Is piles a dangerous condition?

Piles in themselves do not lead to more serious illnesses, but can cause significant pain and distress in the acute setting, if they become thrombosed and ulcerated. Patients often complain of a painful perianal mass, and surgical excision in the early phase can provide rapid relief of symptoms. However, piles can also coexist with, and mimic, other conditions such as infections and fissures, as well as colorectal cancer.

It is for this reason that any patient with symptoms attributable to piles, be fully evaluated by a colorectal surgeon, with colonoscopy.

Can you tell us about the treatment for piles?

The treatment for piles depends on the symptoms and severity of the piles. Small bleeding piles can be treated with oral medications, topical suppositories inserted into the anus, or rubber band ligation in the outpatient clinic. Larger piles presenting with bleeding can be treated with transanal haemorrhoidal dearterialization (THD), which is a painless procedure involving ultrasound-guided, targeted suture ligation of the vessels contributing to the haemorrhoids. Even larger piles that prolapse out of the anus and require patients to push them back after defecation can be effectively treated with excisional surgery, such as stapled haemorrhoidectomy, or a conventional haemorrhoidectomy.

This article was written by Prof Eu Kong Weng, Colorectal Surgeon at Colorectal Surgeons Inc., Mount Elizabeth Novena Specialist Centre and was published in This Quarterly magazine. For queries and consultation with Prof Eu Kong Weng, head to GetDoc.

Tags

• haemarrhoids
• hemarrhoids
• piles