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faq_headA peek in the toilet bowl after “the grand finale” and before flushing is always a good idea. Why?

Blood in stools is a fairly common symptom which may be caused by many conditions- ranging from piles or internal haemorrhoids, anal fissure, fistulae to intestinal infections/inflammations and bowel cancers. However, many people incorrectly refer to any symptom occurring around the anal-rectal area as “haemorrhoids”. Serious causes of the symptoms should always be ruled out and therefore, a prompt visit to Surgeon’s office is recommended.

Well, Whenever there is a problem, there are two ways to deal with it- One, face it, accept it, choose the best possible option and get over it! The other option, of course, is to ignore it until you land up in some kind of big trouble. Plus choosing to ignore blood in stools may also affect the overall treatment outcome.

How do I know I have piles?

Initially there may be just painless bleeding while passing stools. Anal symptoms, for example soreness, itching or prolapse, occur often with piles (internal haemorrhoids). There may be localized pain, discomfort or tense swelling around the anal margin which one can feel especially after passing motion. Frequently, there is a constant awareness that something is not right near anal region. This may or may not be associated with anal fissure which is a painful condition. There may or may not be constipation.

I think I am suffering from something like this. But I am too embarrassed to discuss it. What should I do?

The answer is simple. Visit your Surgeon who will ask you certain questions and perform general as well as systemic examination along with a per rectal examination and Proctoscopy. ( A small lubricated metal or plastic tube gently inserted through the anus and is used to see the anal canal and lower part of rectum). This takes less than a minute. These are simple office procedures and will only cause mild discomfort. Based on that, your Surgeon may come up with a diagnosis or may ask for some more tests.

What causes them? How can one prevent them in the first place?

The exact cause of symptomatic haemorrhoids is unknown. A number of factors are believed to play a role including: irregular bowel habits (constipation or diarrhoea), a lack of exercise, nutritional factors (low-fibre diets), increased intra-abdominal pressure (prolonged straining, ascitis, an intra-abdominal mass, or pregnancy), genetics, an absence of valves within the haemorrhoidal veins, and aging. Other factors that are believed to increase the risk include obesity, prolonged sitting, a chronic cough and pelvic floor dysfunction. Evidence for these associations, however, is poor.

During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the haemorrhoidal vessels to enlarge. Delivery also leads to increased intra-abdominal pressures. Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery.

It is not always possible to prevent getting haemorrhoids (piles), but a high-fibre diet will keep your stools soft and reduce your risk of becoming constipated. Also habit of reading newspaper while sitting on a toilet seat for longer periods should also be avoided.

What is the treatment for piles?

Internal haemorrhoids treatment depends greatly on the extent or degree of the condition. They can be classified into 4 grades-

  • Grade I: No prolapse. Just prominent blood vessels.
  • Grade II: Prolapse upon bearing down but spontaneously reduces.
  • Grade III: Prolapse upon bearing down and requires manual reduction with fingers.
  • Grade IV: Prolapsed and cannot be manually reduced

Initially, it can be managed with dietary modifications, conservative measures and other office procedures like rubber band ligation/ injecting a chemical locally, infra red/ laser cauterization albeit the recurrence rate is high. However if these fails or disease is already advanced, surgery is recommended.

What is Stapler haemorrhoidectomy?

Stapled haemorrhoidectomy, also known as stapled hemorrhoidopexy or MIPH (Minimally Invasive Procedure for Piles), is a procedure that involves the removal of much of the abnormally enlarged mucosal tissue, followed by a repositioning of the remaining haemorrhoidal tissue back to its normal anatomic position. The procedure is done under anaesthesia and takes about 15-20 minutes to perform. Post operative pain is significantly less and is associated with faster healing compared to conventional surgery. Most of my patients are discharged same day or within 24 hours and resume normal activities in 2-3 days.

Dr Anshuman Kaushal, Senior Consultant Minimal Access & Bariatric Surgeon, Columbia Asia Hospital, Palam Vihar, Gurgaon 122017 India.

Landline +91 124 398 9896

Kaushal.anshuman@gmail.com  Mobile- 00 91 9910481350