Dr Deepak Varma Gastro Surgeon Cochin

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Piles ( Haemorrhoids )

One of the most common of anal pathologies ishaemorrhoids. They are swollen blood vessels appearing in the lower rectum. Normal haemorrhoids are venous cushions present in the anorectum. These are referred to as piles ( haemorrhoids) when they begin to develop symptoms. The arteriovenous plexuses dilate causing abnormal swelling of the anal cushions. The suspensory muscles are stretched thus leading to the eventual prolapse of the rectal tissue. Significant mucous discharge is seen as a predisposing factor to strangulation and incarceration.


Causes And Risk Factors

  • Low fibre diets: lead to straining during defaecation resulting in increased pressure and engorgement of the haemorrhoids
  • Straining and constipation: when the anal canal resting tone is higher than normal
  • Pregnancy: pregnancy poses as a risk factor for the development of haemorrhoids in women
  • Anorectalvarices: patients experiencing portal hypertension present with anorectalvarices in the midrectum
  • Poor posture: lack of erect posture
  • Family history and trend
  • Hepatic disease
  • Malignancy of the colon
  • Chronic diarrhoea
  • Obesity
  • Elevated resting pressure in the anus
  • Spinal cord trauma and injury
  • Loss of rectal muscle tone

Signs And Symptoms

  • Painful bowel movements in advanced stages
  • Rectal bleeding: bright red blood
  • Presence of protrusion
  • Streaks of blood on the tissue after a bowel movement
  • Faecal leakage
  • Pain and irritation at the anus
  • Extreme anal itching


  • Physical examination: Digital assessment of the anal canal indicates indurated areas along with tenderness, masses, discharge of blood or mucous and rectal tone
  • Anoscopyandflexiblesigmoidoscopy: for internal view of the haemorrhoids; to exclude proximal diseases
  • Colonoscopy: to check for colonic malignancies; full evaluation of the large bowel
  • Hematologic studies: CBC to mark infection; haematocrit testing for excessive bleeding and concomitant anaemia
  • Treatment

Acute thrombosis of the external haemorrhoids is an emergency and is resected within 48 hours to 72 hours of onset of symptoms.

Most of the haemorrhoids can be managed with dietary modifications and fiber supplements. Grade I and II haemorrhoids can be effectively treated with outpatient procedures like sclerotherapy and banding, which are inexpensive and do not require hospital admission.

Surgical haemorrhoidectomy is indicated when all conservative treatments fail; there is a presence of Grade III and IV haemorrhoids with severe symptoms; and the presence of associated anorectal symptoms.

PPH or procedure for prolapsing haemorrhoids also known as stapled haemorrhoid surgery is done for the treatment of internal haemorrhoids.

Doppler-guided transanal haemorrhoid aldearterialization or THD Doppler is effective for the treatment of prolapsed haemorrhoids.

Our team grade the haemorrhoids according to Banov et al to analyze the degree of prolapse of the anal canal prior to surgery. We are well equipped with the instruments for out-patient treatment of haemorrhoids.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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