Piles, or medically known as hemorrhoids, is swollen blood vessels in the anus or rectum. There are two kinds of haemorrhoids. External haemorrhoids happen in the anus. They can be seen and felt, as they protrude out. They are uncomfortable and can become painful when blood clots within them. Internal haemorrhoids cannot be seen as they occur within the rectum. They are not painful, but they cause bleeding through the anal region. Piles is mainly caused due to an increase of pressure on the lower rectum.
- Strenuous bowel movements
- Chronic diarrhoea/ constipation
- Obesity
- Pregnancy
- Low-fibre diet
- Anal coitus or heavy lifting
- Sitting for a long period on the toilet
- Discomfort and pain.
- Swelling in the anal region.
- Itching or irritation
- Bleeding
- Inflammation
- Hard lump near the anus.
- Haemorrhoids require a physical examination.
- External haemorrhoids can be diagnosed with a visual inspection.
- Internal haemorrhoids are diagnosed by inserting a gloved and lubricated finger in the rectum.
- An anoscope or proctoscope may be used for internal haemorrhoids. The instrument visualises the inside of the rectum and colon.
- Painkillers and topical creams
- Suppositories and sitz bath
- Sclerotherapy injections close internal haemorrhoids.
- Banding to close blood supply to the haemorrhoid.
- Coagulation using a laser beam to seal the haemorrhoid’s end
- Haemorrhoidectomy surgery is used for external haemorrhoids that are very uncomfortable or for internal haemorrhoids that are large in size.
- The risk of haemorrhoids increases with age as the tissue supporting the anus and rectum’s veins weakens.
- Pregnancy is another risk factor because the additional weight of the baby puts pressure on the anus.
Anal fissures are common and don’t cause serious issues. They affect people of any age. They are caused when the lining of the lower rectum tears. Acute anal fissures are short-term and heal within a few days or weeks at home. Chronic anal fissures are long-term that last longer than 8 to 12 weeks. They require treatment.
- An injury or trauma to the anal canal
- Hard and large bowel movement
- Constipation
- Strain when passing stool
- Chronic diarrhoea
- Crohn’s disease
- Childbirth
- HIV/ herpes
- Tuberculosis
- Anal cancer/ Syphilis
- Pain when passing stool
- Enduring pain often lasting for hours after passing stool
- Itching around the anus
- Blood spotting during a bowel movement
- Irritation around the anal region
- Cracks, tags and lumps near the anus
- Visual examination is done to diagnose anal fissures, which appear as paper cuts.
- Digital rectal examination in which an endoscope is inserted in the rectum to see tears.
Treatments
- Sitz bath
- weight control
- Stool softeners
- Medication to reduce muscular spasms
- Controlled diet to prevent constipation
- Avoidance of tight clothing
- Avoidance of prolonged sitting
Lateral Internal Sphincterotomy is done to dilate the sphincter and allow stool to pass smoothly and heal the fissure.
Anal fistula form when an anal gland forms an abscess. The pus-filled infection creates a tunnel between the anal canal and the buttocks' skin. This happens because the abscess acts as a breeding ground for bacteria, which slowly break through the skin and the organ.
50% of fistulas happen due to an abscess. Other causes include:
- Crohn’s diseases
- Trauma
- Diverticulitis
- Tuberculosis
- Cancer and STDs
- An anal abscess has a 50% risk of developing into a fistula.
- Conditions of the lower digestive tract like Crohn’s, Colitis, chronic diarrhoea and rectal cancer increase the risk of anal fistula.
- Fever along with chills
- Pain and swelling near the anus
- Soreness, redness and itching
- Pus drainage around the anus
- Tiredness and discomfort
- Medical history, anorectal symptoms and a rectal examination are conducted to diagnose anal fistula.
- MRI, ultrasound or endoscopy is used when the fistula is not visible on the skin.
- A barium contrast CT Scan or X-Ray may be utilised for internal fistula.
- Blood tests and colonoscopy are used for anal fistula caused by digestive conditions like Crohn’s.
- The conventional treatment method is colorectal surgery. Here the surgeon drains the pus and leaves the wound open to heal. It takes a week for the patient to recover. They may be scarring due to stitches.
- Another treatment option is laser fistula surgery. A 360-degree laser is passed through the opening of the fistula. Since it is a pinhole surgery, there are no cuts or stitches. The patient has no scarring and the recovery time is exceptionally quick.
