Heammorrhoid(pile): its causes and medical management

Pile which is medically referred to as heamorriod are vascular structures on the anal canal that that serve as cushions that help with stool control. They become problematic when they are inflamed or swollen.


Causes:

The main cause is unknown.

Risk factors:

1. Constipation
2. Diarrhoea
3. Cough (coughing severely)
4. Pregnancy (laxation of muscles,and pressure from the fetus)
5. Sitting too long in the loo (toilet)
6. Straining while stooling
7. Obesity
8. Pelvic floor muscle dysfunction

Types: 

There are two main types

1) Internal heamorriod
2) External heamorriod


 Internal heamorriod: the swelling is painless,bleeding from the rectum iß bright red which can be seen on the stool and on tissue paper.

Classificationon internal heamorriod

• Grade 1: no  prolapse, just prominent blood vessels 
• Grade 2: prolapse is present upon bearing down but there is spontaneous reduction 
• Grade 3: prolapse upon bearing down but requires manual reduction 
• Grade 4: prolapse is present and there is inability to reduce it manually. 

  External heamorriod: there is pain and swelling around the anus.

Management

• Dietary fibre increase
• Increase fruits and fluid intake 
• Antiinflammatory drugs(only prescribed by a physician)
• Sitz bath
• Vaso constrictors (only prescribed by a physician) 

Treatment

It could be treated surgically or non-surgically

Non surgical treatment

1. Rubber band ligation can be done in grade one through grade three. It is a procedure where an elastic is applied onto the internal hemorriod of at least cm above the pectinate line to cut off blood supply within five to seven days,the hemorriod falls off.

2. Sclerotherapy: here an injection of sclerosing agent is done such as phenol, into the site of hemorriod. This causes the vein walls to collapse and the hemmoriod  is shed off. 

3. Cauterization is done as a last resort non-surgically when all methods have failed. 

Surgical treatment

• Excised hemorriodectomy

• Doppler guided transanal hemorriod dematerialization 

• stapled hemorriodectomy it stapled hemmoriodopexy

Prevention of hemorriod

• Increase in fibre intake
• Avoid straining during stools
• Avoid constipation and diarrhea
• Enough exercise
• Avoid sitting too long in the toilet
• Lose weight if obesed 
• Avoid lifting heavy weight .

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