Is it Piles or Fissure?

A common complaint that warrant a gastro consult is blood in stool. Sometimes there may be pain and many a time itching in the anus. When a medical article appears either online or in the papers about blood in stool, the general consensus is to call it an article about piles. It is important to differentiate between these two conditions as the management may be different.

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In piles or hemorrhoids, blood may be present in stool without any pain.

Piles are just congested blood vessels and often bleed when there is pressure on it as in constipation. Sometimes an external piles mass may have a mass outside the anus. Very rarely there is pain in these areas unless there is an irreducible pile mass which refuses to go back inside. Itching may be present.

Anal fissure, though is something that is slightly different in its presentation.

In anal fissure, there is a crack in the mucosa of the anus which widens with time to become a fissure. As the fissure is in direct path of the stool that the patient evacuates daily, there is bleeding accompanied by intense pain.

The pain is so severe that the anal muscle (sphincter) cramps up and refuses to relax. Subsequent bowel movements become very painful.

What causes piles?

The exact cause of haemorrhoids is unclear, but the causes are associated with increased pressure in the blood vessels in and around your anus. The pressure can cause the blood vessels in your rectum passage to become more swollen and inflamed.

Many cases deal with prolonged constipation which causes piles by too much straining on the toilet, which is often due to the lack of fibre in a person’s diet. Chronic diarrhoea can also be one of the causes and can make you vulnerable to piles/haemorrhoids. 

Other factors that might increase your risk of developing piles in the future may include

  • Being overweight or obese
  • Age- plays an important factor, as you get older your supporting tissues get weaker
  • Being pregnant – the increased pressure in your pelvic blood vessels, causes them to enlarge
  • Having a family history of piles
  • Regular heavy lifting of objects
  • Persistent cough or repeated vomiting
  • Sitting down for long periods of time

How do I know if I have piles?

You can diagnose yourself if you think you have piles based on the following symptoms, but it is always advisable to consult your General Physician if you are doubtful

  • Bleeding after passing a stool
  • Itchy anus
  • Mucus discharge
  • Soreness, redness and swelling around your anus
  • If you still feel the need to pass a stool after going to the toilet
  • Lumps and pain around your anus

Some of the serious symptoms that denote a severe condition include:

  • Excessive anal bleeding, leading to anemia
  • Infection
  • Inability to control bowel movements
  • Anal fistula
  • A strangulated haemorrhoid

Treatment for piles

Sometimes piles can be treated at home, but in most cases, you need to go to a piles treating speciality hospital and see a good gastroenterologist.

The treatments provided in the hospital can be with or without surgery, you should discuss with your doctor about the best treatment for you. Note that treatment does not always prevent piles from coming back. Treatment of piles may involve watchful waiting and a course of medicines before laser treatment.

As these are daycare procedures with minimal pain, it is always wise to get them done at the earliest rather than suffering.

Non-surgical treatment

  • Rubber band litigation: a band is placed around your piles to make them drop off
  • Sclerotherapy: a liquid is injected into your piles to make them shrink
  • Electrotherapy: a gentle electric current is applied to make them shrink
  • Infrared coagulation: an infrared light is used to cut the blood supply to make them shrink.

You will be awake for the treatment, but a local anaesthetic will be applied to the area. You should be able to go home the same day. If these methods do not work you may need surgery to remove your piles.

Surgical treatments

  • Haemorrhoidectomy
  • Stapled Haemorrhoidopexy
  • Haemorrhoidal artery ligation.

You’ll be under anaesthesia for this type of treatment and may need to stay overnight in the hospital.

Post-surgery care

The recovery period is usually around 2-3 weeks.

  • Pain can be expected after surgery. Prescribed medicines y your general physician can help ease the pain. Ask your doctor what over-the-counter medicines are safe for you.
  • Some bleeding is normal, especially with the first bowel movement after surgery
  • Stay hydrated and eat a bland diet. Then you can return to your regular foods and gradually increase the amount of fibre in your diet
  • You may apply numbing medicines before and after bowel movements to relieve paints
  • Ice packs can be used to reduce swelling and pain
  • Frequent soaks in warm baths may help relieve pain and muscle spasms
  • Sometimes antibiotics can be recommended to prevent infections and reduce pain
  • Follow up exams with the surgeons are done 2-3 weeks after the surgery to check for problems

Some steps to prevent haemorrhoids include

In the less serious cases, haemorrhoids often settle down after a few days without needing treatments Some of the lifestyle changes to reduce the strain on the blood vessels include

  • Gradually increasing the amount of fibre in your diet
  • Drinking plenty of fluid
  • Not delaying going to the toilet
  • Avoiding medication that causes constipation
  • Losing weight
  • Exercising regularly.

These measures can help in preventing haemorrhoids from returning or developing in the first place.

Always remember to visit a good piles specialist in your city for a proper cure or solution to the problem. Piles require active medical management at the earliest, so do not delay your treatment. Visit your nearest doctor today!

Reference

  1. https://www.bupa.co.uk/health-information/directory/a/anal-fissure

Dr. Karthik Gunasekaran

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