Pile it On

Piles are engorged blood vessels around the anus resulting from excessive downward pressure over a long time. Common causes include straining at stool, prolonged constipation or diarrhoea, and spending a long time on the toilet bowl. There are two types of piles:

INTERNAL PILES develop from inside the anal canal and may prolapse outside the anus during exertion (for example, straining at stool). Initially, they may return into the anus on their own, but over time, they may protrude further, requiring the patient to push them back into the anus. Since they originate within the anus, treatment measures are more varied and may include rubber band ligation, injection sclerotherapy, THD (transanal haemorrhoidal dearterialisation) or stapled haemorrhoidectomy.

EXTERNAL PILES originate at the anal verge (external anal opening). They are not usually reducible and can cause sudden painful swellings called perianal hematomas. These are essentially blood clots that may be associated with skin tags, which makes cleaning difficult. Treatment may involve topical creams or surgical excision.

PREVENTING PILES Do not strain at stool or spend too long on the toilet bowl. Prevent constipation by increasing fluid intake with moderate fibre intake.

TREATMENT Piles are treatable and there are different ways to do so.

Non-invasive: Medications to reduce blood flow to the swollen piles and fibre supplements to aid in stool passage. Ointments or creams used topically to reduce swelling and soothe irritation

Semi-invasive: Clinical procedures such as rubber band ligation and injection sclerotherapy

Invasive: THD, stapled haemorrhoidectomy or conventional haemorrhoidectomy (open or closed methods)