Piles (or haemorrhoids) refers to swollen and inflamed blood vessel in the anorectal area.
It usually presents as painless bleeding (blood in the pan) in the initial stages and later becomes painful with discomfort. Piles may also present as itching and or swelling at the anal area.
It’s best to consult a general surgeon so that he or she can examine you and advise treatment. This is important as the surgeon can confirm the diagnosis, classify the degree of haemorrhoids and plan treatment.
The surgeon can also do a sigmoidoscopy or a colonoscopy to assess if there is any other reason for the haemorrhoid to occur(etiology).
Haemorrhoids (piles) are classified based on the degrees
I degree : the pile is internal and presents as painless bleeding with no swelling noticeable outside the anal canal. Diagnosed best with a proctoscope instrument.
II degree : the pile begins to prolapse out of the anal canal but reduces spontaneously after moving bowel.
III degree : the pile which comes out while moving bowel needs to be manually reduced post defecation and will begin to cause discomfort if not reduced.
IV degree : (also external haemorrhoid) the pile remains outside at all times and will cause pain or discomfort.
V degree (thrombosed pile) : here, the pile becomes extremely painful.
All degrees may present with bleeding or itching or mucus discharge
Once a correct diagnosis is made the surgeon will advise you the appropriate treatment plan.
I & II degree piles are usually treated with medication ( such as MPFF & topical applications) and more importantly lifestyle changes such as high fibre diet and good fluid intake to prevent passage of hard stools or constipation. Toilet habits like sitting on the comode for long periods are to be avoided.
Most I and II degree piles will resolve with these precautions.
If a I or II degree haemorrhoid fails medical treatment then surgery or outpatient procedure is recommended.
Typically III and IV degree haemorrhoids are treated with surgery. Many types of surgeries are available and the surgeon will advise the most appropriate method as per his expertise and depending on the degree of haemorrhoids.
V degree haemorrhoids or thrombosed are first treated with medications till the inflammation settles and then surgery may be required.