What are piles?
Piles can be of various sizes and may be internal (inside the anus) or external ones (outside the anus). Typically, internal piles occur from 2 to 4cm above the opening of the anus. External piles (perianal hematoma) occur on the outside edge of the anus. The internal ones are much more common.
According to the US National Institutes of Health (NIH), symptomatic hemorrhoids affect at least half the American population at some time in their lives before the age of 50.
In the majority of cases, piles are effectively treated with over-the-counter medications, a good fluid intake, and by following a diet high in fiber. In severe cases, the piles may have to be surgically removed. About 10% of patients who go and see their doctor about piles eventually require surgical intervention.
Symptoms of piles
In most cases piles are not serious and go away on their own after a few days.
An individual with piles may experience the following symptoms:
- A hard lump may be felt around the anus. It consists of coagulated blood, called a thrombosed external hemorrhoid. This can be painful
- After going to the toilet, a feeling that the bowels are still full
- Bright red blood after a bowel movement
- Itchiness around the anus
- Mucus discharge when emptying the bowels
- Pain while defecating
- The area around the anus may be red and sore.
Internal hemorrhoids are classified into four grades:
- Grade 1 - there are small inflammations, usually inside the lining of the anus. They are not visible
- Grade 2 - larger than grade 1 hemorrhoids, but also inside the anus. When passing a stool, they may get pushed out, but return unaided
- Grade 3 - often called 'prolapsed hemorrhoids'; these appear outside the anus. The patient may feel them hanging out. They can be pushed back in if the patient presses with their finger
- Grade 4 - these cannot be pushed back in and need to be treated by a doctor. They are large and stay outside the anus all the time.
External hemorrhoids are called perianal hematoma. These are small lumps that are located on the outside edge of the anus. They are very itchy and can be painful if a blood clot forms inside (thrombosed external hemorrhoid). Thrombosed external hemorrhoid requires medical treatment straight away.
Why do piles occur?
The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge. Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to:
- Chronic constipation
- Chronic diarrhea
- Lifting heavy weights
- Pregnancy
- Straining when passing a stool.
The tendency to develop hemorrhoids may also be inherited. The risk of developing piles grows with age.
Diagnosing piles
A doctor can usually diagnose piles after carrying out a physical examination, examining the patient's anus.
The doctor may ask the following questions:
- Do any close relatives (parents, siblings) have piles?
- Has there been any blood on the stools?
- Has there been any mucus on the stools?
- Has there been any recent weight loss?
- Have bowel movements changed recently?
- What color are the stools?
For internal hemorrhoids, the doctor may perform a digital rectal examination (DRE) or use a proctoscope - a hollow tube fitted with a light. The proctoscope allows the doctor to see the anal canal and take a small tissue sample from inside the rectum, which can be sent to the lab for analysis.
If the physician is presented with signs and symptoms which may suggest another digestive system disease, risk factors for colorectal cancer, and some other factors, he/she may recommend ordering an examination of the colon using colonoscopy.