Piles are swellings in the anus or lower part of the rectum (lowest part of bowel which expels fecal matter of the body). These swellings can be external or internal. There may be pain or pruritis of varying degrees. Technically, “piles”, are known as hemorrhoids because they occur due to swelling of small veins in the lower part of rectum or anus. The hemorrhoids may be situated external or internal to the lumen. At times the swelling or congestion of the veins may be severe enough to cause rupture and bleeding. This is alarming to the person when he sees blood being passed out at time of passing stool. Hemorrhoids can occur at any age but are rare in children or adolescents. They may be mild where they protrude only while straining. But in advanced cases, they remain out permanently causing much discomfort! In adults, they occur due to multiple reasons. Chronic constipation is the most common reason. When one strains to pass a hard stool or impacted stool, pressure is exerted on the group of small veins present at the lower end. As a result they become engorged and rupture. Advanced pregnancy similarly exerts pressure on the veins, forcing them to rupture. If the woman is constipated, this adds to the pressure aggravating piles. Obesity, lack of exercise, sitting for long hours continuously are other risk factors for causing piles.In elderly people, muscular support to the wall of the rectum is reduced due to weakness and this may induce hemorrhoids. Excess coughing, lifting heavy weights, standing for long hours are other risk factors which can precipitate hemorrhoids. Once somebody develops piles, he complains of pain and sensation of swelling in the anal region. The symptoms can be acute or chronic, mild or severe depending on the onset and amount of venous network affected. When the vessels rupture, there will be bleeding which can range from few drops to severe, again depending on the veins affected. With long standing piles there can be dryness and some infection over them. This will aggravate the pain and cause itching. With time, some hemorrhoids wither away and some new ones may be formed. Diagnosing piles is very simple. A simple manual examination of the rectum reveals them.Treatment mainly depends on treating the cause. If the factor inducing piles is persistent, the suffering will continue. One should take adequate amount of water, high fiber food and exercise to prevent constipation. If there is a chronic cough, it should be treated. Somebody suffering from piles should avoid lifting heavy weights. Surgery is the ultimate treatment for hemorrhoids, if they are severe and disabling to the person. But it should be remembered that surgical removal of piles carries all the risks of a major surgery like infection, bleeding e.t.c. Moreover if the reason for causing piles continues e.g., chronic constipation, there is a high risk of relapse of piles with same or greater intensity. Therefore surgery is best avoided. One of the simple treatments which can be done at home is a hot sitz bath. An individual should take a small tub or basin full of tolerably hot water and sit on it for 2 or 3 times every day. This helps the piles to reduce in size and shrivel up. Use of cold compresses is also useful. After passing stool or urine, an individual suffering from piles should clean the perineal region, very well with a wet tissue and try to push the piles inside. This also helps in keeping them reduced. Another conservative technique used by doctors is to tie rubber bands at base of piles. This stops the blood supply and the piles dry up. At times a drug called adrenaline is injected at the lower end of the piles. This also curtails blood supply to the hemorrhoid and helps them to reduce in size and disappear. Ointments are available for local application to treat piles.One should avoid having piles. Still if they come up, one can try all other measures, before going for surgery. –rachna212002@yahoo.co.uk
