The lining of the anus contains three clumps (cushions) of soft and spongy paddings that help to act as an extra seal to keep the anus closed to prevent leakage of mucus . The mucus lubricates the faeces so that it can be passed out easily. These spongy pads (piles) are supported in the anus by connecting tissues and contain tiny blood vessels. Piles become problematic when connecting structures no longer hold the piles in place and the piles begin to slip down the anal canal. The blood vessels also become engorged and the piles swell up. In more severe cases, these pads may be pushed further downwards during defecation until it comes out of the anal canal. This is also known as prolapsed piles.
Classification of piles
First-degree piles are pads that remain in the anal canal. These piles are usually painless.
Second-degree piles are pads that are pushed downwards during defecation but return to its internal positions spontaneously.
Third-degree piles are pushed downwards but will usually require fingers to push them back in.
Fourth-degree piles are prolapsed (extrernal) pads that are unable to be reduced into the anal canal. These are usually painful, uncomfortable and bleeding is common.
Factors contributing to piles
The precise cause is still unknown but contributing factors include:
- Chronic constipation or diarrhoea
- Repetitive or prolonged straining during bowel movements
- Spending long periods of time (eg reading) on the toilet
- Prolong squatting or heavy lifting
The symptoms of piles usually come and go but you could have piles if you notice any of the following symptoms:
- Bleeding, with bright red blood, during bowel movement
- Anal swelling during bowel movement
- Itching in the anal region
- Aching pain and discomfort
- Sensitive lump(s)
- Soiling of underwear with mucus or faeces
For mild symptoms you can help by doing the following:
- Wash area gently with lukewarm water to wash away the leaked mucus or faeces
- Take plenty of fiber(vegetables, fruits, breads and cereals) and fluids
- Avoid excessive straining during bowel movement or heavy lifting
- Avoid constipation
- Avoid spending long period of time in toilet
These measures will usually relieve mild symptoms of pain and swelling. If these symptoms persists or worsens, do consult your doctor. You may require special treatment.
- Ligation or banding of piles – Effective for first and second degree piles. This procedure is simple to do and can be performed in the clinic. A small rubber band is placed over the pile, cutting off its blood supply. The pile and the band will then fall off in a few days and the wound wound heal in 1-2 weeks.
- Conventional haemorrhoidectomy – This surgery is the most complete method for treating third and fourth degree piles. This is done under general anaesthesia and usually does not require hospitalization. This procedure removes piles by cutting them off resulting in open wounds that may require 4-6 weeks to heal. Post operatively, pain and bleeding are the main side effects
- Stapling haemorrhoidectomy – This new technique uses a special device to remove a cuff of tissue just above the piles and pull the external piles into their normal position. This method also disrupt the blood supply to the piles causing them to shrink and stop bleeding. This is generally more painful than rubber band ligation but less painful than conventional surgery.
- THD – This is the newest method in treating piles. This technique uses an ultrasound probe in locating the blood vessel feeding into the pile. These vessels are then closed off using sutures. This method is increasingly popular because it does not involve cutting and therefore pain is minimal and even less than stapling haemorrhoidectomy. The recovery is fast and patient can return to normal activity in a very short time.
Do piles lead to cancer ?
- NO. There is no link between piles and cancer. However, the symptoms of piles , especially bleeding, are similar to those of colorectal cancer. Therefore, it is important that all symptoms are investigated by your doctor and that everyone 50 years or older undergo screening tests for colorectal cancer preferably colonoscopy. See a colorectal surgeon first so that your symptoms can be properly evaluated and effective treatment prescribed.