PILES ( Mulvyadh/Bavasir ) ( clinically known as hemorrhoids ) basically, is the swelling of blood vessels near the anal opening and a sliding down of the lining of the anal canal. The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell.
Conventional piles surgery includes cutting the piles from its root and stitching the wound.
Stapler surgery is an advanced technique using the Ethicon stapler equipment. The equipment appears to look like a gun that takes in the loose anal mucosa (inner lining) and cuts a piece in the shape of a doughnut around its periphery. It simultaneously stitches the raw cut edges of the anal mucosa and fixes the pile in its normal position. This action is similar to a stapler; hence it is commonly called stapler surgery. In medical terms it is called MIPH (Minimally Invasive Procedure for Haemorrhoids).
- Constipation – this is the most common cause
- Hard stool/Strain during bowwel movement
- Faulty toilet habits
- Lifting heavy loads
- Pregnancy and child birth
- Painless bleeding while passing stools
- Feeling a lump outside the anus
- Pruritus ani or itching around the anus
- Fecal soiling of undergarments
- If a blood clot forms in the hemorrhoid (Thrombosed hemorrhoid ) it leads to a severely painful swelling which worsens with bowel movement and sitting.
Piles or haemorrhoids are caused due to increased pressure or straining while passing stools or due to weak muscles around the anus. This leads to bulging and swollen blood vessels that often protrude and lumps while passing stools. These may bleed or may lead to discomfort, pain and itching around the anus.
There are several lifestyle changes that may be adopted to reduce the symptoms of piles and reduce episodes of aggravated piles in susceptible individuals. These include consuming fibre in your diet, practising good bowel habits and so forth. 1-5
Fibre in diet and prevention of piles
Inclusion of at least 25 to 30 grams of insoluble fibres in diet per day: this can be taken in normal diet in form of high fibre foods like fruits, vegetables, whole grains, cereals, etc.
These fibres cause absorption of water in the stools within the colon. This makes the stools softer and increases the volume. This reduces the straining and pressure on the anal blood vessels.
People with risk of haemorrhoids should choose high fiber breakfast cereals. Products with five grams of fiber per serving should be chosen. There are also over the counter high-fiber supplements that are available for these at-risk individuals.
Diet should be low in fat and red meat since these predispose to constipation. Other foods like peas, beans and lentils should be included.
Good bowel habits and prevention of piles
Good bowel habits should be practised. All at-risk individuals are advised to go to the bathroom as soon as they feel the urge. Waiting may harden stools.
They are advised not to sit on the toilet for more than five minutes and avoid straining. If there is not urge the person is asked to get up.
Other ways to prevent piles
Other changes that may reduce the symptoms of piles include:
- All people who are at risk need to take at least six to eight glasses of water daily to keep the stools lubricated.
- Alcohol and caffeine containing drinks (tea, coffee and colas) should be avoided as these predispose to constipation.
- Vigorous wiping especially with a dry toilet paper should be avoided as it irritates the skin around the anus.
- Weight should be reduced since obesity and being overweight is a risk factor for piles.
- Regular physical exercise is important since this helps in weight reduction and also helps in regular bowel movements and avoids constipation.
- Stool softeners are medications that may be used in people with constipation to correct constipation before it can predispose to piles.
- Some medications may lead to risk of constipation. These should be avoided. These include cough syrups with codeine.
- Other conditions that predispose to piles include chronic cough, ascitis and liver disease. These conditions need treatment.
Treatment of Piles by Dr. Dinesh Jain
- Injection Sclerotherapy : A Sclerosant solution (Sodium tetradecyl, polydoconol, etc) is injected just above the base of the haemorrhoid that causes submucosal fibrosis. This leads to shrinkage of pile tissue and stoppage of bleeding. Usually done for grade 1 and 2 piles. It is an outpatient procedure and causes no or minimum pain.
- Rubber Banding of Piles : A medical grade rubberband is used to ligate (to tie) the pile base eventually leading to fibrosis of blood vessels supplying the pile tissue. Done for Grade 2 piles.
- Digital Haemorrhoidal Artery Ligation (DHAL) : Doppler guided ligation of pile tissue. A special equipment with Doppler ultrasound helps in identifying the blood vessel supplying the pile tissue. The haemorrhoidal artery is then ligated. Used mainly for grade 2 piles.
- Surgical ligation and excision (Traditional Haemorrhoidectomy) : This method is used for the treatment of large pile mass for grade 3 and grade 4 piles. In this the pile mass is actually cut and the remnant tissue is stitched back.
- Stapler Haemorrhoidectomy : This is alternative method to surgical excision and ligation. It is generally used for large piles (grade 3 or 4) with mucosal prolapse. The mucosa above the pile mass is lifted up and cut and ligated simultaneously with the help of a disposable stapler equipment. Since the surgery is done in nonsensitive are of anal canal, there is no or minimal pain, least hospital stay and fast healing and recovery.
- LASER Surgery for piles : LASER surgery is commonly done for grade 2 or 3 piles using Diode LASER. Laser beam is used submucosally to coagulate the pile mass to shrink and later cause fibrosis.
Advantages of stapler surgery over conventional piles surgery are :
- Minimal Pain
- Minimal medication
- Fast recovery
- Minimal hospital stay
- Minimal chances of recurrence
- Early return to work