Patient's Complete Guide to Bawaseer (Piles)

Overview of Bawaseer (Piles)

Piles (بواسیر/Bawaseer) also termed as Hemorrhoids are the collection of swollen veins and tissues in the rectum area. These piles can be internal (inside the rectum) or external (outside the rectum). Piles can occur due to various reasons but the exact cause is unknown. Approximately, 3 out of 4 adults may suffer from piles. Most of the time, people get relief with home remedies and lifestyle changes.

As per a study, conducted in 2017, usually men and women above 50 years of age mostly develop piles in their lifetime.

Signs and Symptoms of Bawaseer (Piles)

Each type of pile has different signs and symptoms such as: 

External Piles:

In external piles you may experience:

  • Itching or irritation in your anal region
  • Pain or discomfort
  • Bleeding
  • Swelling around your anus

Internal Piles:

Symptoms of internal piles can be:

  • Bleeding without any pain during bowel movements. 
  • Pain and irritation while pushing a pile through the anus

Thrombosed Piles:

Some common signs and symptoms of thrombosed piles are:

  • Severe pain
  • Inflammation
  • Swelling
  • A hard lump near your anus

Types of Bawaseer (Piles)

Depending upon the severity of the piles, it is divided into the following types:

  • Internal Piles: These piles are developed inside the rectum and cannot be seen from the outside. These piles are painless but bleeding occurs during bowel movements.
  • External Piles: These piles are formed on the external lining of the rectum. They are extremely painful and irritating. These piles can be either tiny or in the form of large lumps.
  • Thrombosed Piles: These piles are in the form of swollen bulges around the anus. Thrombosed piles are blood clots in the veins around the rectal area. These piles can lead to complications due to insufficient blood supply to the anal tissues.

Causes of Bawaseer (Piles)

Due to the pressure, the veins around the rectum swell and bulge. This can lead to piles development. The pressure on the rectum area can be increased due to: 

  • Straining during bowel movements
  • Having chronic diarrhoea or constipation
  • Sitting for long periods of time on the toilet
  • Being pregnant 
  • Being obese
  • Eating a low-fibre diet
  • Having anal intercourse
  • Regular heavy lifting

Risk Factors of Bawaseer (Piles)

There are two main risk factors that contribute to piles development such as:

  • Age: With the risk of developing piles is increased. Because the tissues that support the rectum veins become weak and lose their elasticity. 
  • Pregnancy: Pregnancy is another risk factor of piles. It is because during pregnancy the pressure on rectum veins is increased due to the baby's weight. 

Health Complications of Piles

Piles rarely cause other complications such as: 

  • Blood Clot: Sometimes, a clot is formed in a pile. This clot is not dangerous but causes irritation and pain. Therefore, it needs to be lanced and drained.
  • Anemia: Anemia is a condition caused by excessive blood loss. Piles rarely cause anemia if blood loss is chronic.
  • Strangulated Piles: Strangulated piles occur if blood supply to the internal piles is blocked. This complication can cause extreme pain.

Prevention

The risk of piles is greatly reduced once the stools are kept soft. This can be done in the following ways:

  • Avoid over-straining: While using the toilet, don't put strain. Straining can cause damage to the veins of the rectum because of the built pressure.
  • Fiber Rich Nutrition: Eat foods that are rich in fiber. Consume a diet that contains fruits and vegetables. Adding whole grains to the diet will always keep the stool soft.
  • Go to the washroom when needed: You should not be waiting to go to the toilet when you have the urge. Waiting for longer periods of time can make the stool drier.
  • Physical Activity: Sitting or standing for longer lengths can put unnecessary pressure on the veins. Physical activity can make the bowel movements regular. This results in passing out the stool in a smooth manner.

Diagnosis

External piles can be diagnosed easily just by looking. However, diagnosis of internal piles may require examination of the anal canal and rectum.

  • Digital Examination: In this examination, the doctor may insert a gloved finger inside the rectum to feel unusual growths.
  • Sigmoidoscopy/Anoscopy: If through digital examination, internal piles cannot be detected another technique such as sigmoidoscopy can be used. In this procedure, an anoscope is inserted inside the rectum and a detailed image of the lower rectum is obtained.
  • Colonoscopy: It is a procedure in which the entire colon is examined by using a colonoscopy. 

Treatment of Bawaseer (Piles) | When to Consult a Doctor

Depending upon the severity of the condition, piles can be treated in the following ways:

Home Remedies

With home treatments, you can relieve the mild symptoms of piles. These remedies include:

  • Stay Hydrated: Drink caffeine-free fluids because excessive alcohol and caffeine can cause dehydration. 
  • Eat Fiber-rich Diet: Constipation can be avoided by adding 20-35 grams of fibre to an everyday diet. Later, you can gradually increase the amount of fibre by using a diet containing: 
  • Wheat bran
  • Oat bran
  • Peas and beans
  • Prunes and prune juice
  • Whole grains, including brown rice, oatmeal, and whole-grain pasta, cereals, and bread
  • Citrus fruits
  • Fibre Supplements: Try to use fibre supplements if you can’t get enough fibre from food. Fibres can make your stools soft and more regular. These supplements also help to reduce gas and cramping.
  • Over-the-counter Laxatives: If fibre supplements don’t help, try to use over-the-counter laxatives as per the doctor’s suggestion. 
  • Avoid the use of irritating scented soaps or bubble baths for cleaning.

With these home treatments, piles symptoms often subside within a few days. However, if your symptoms get severe and you notice bleeding seek medical care immediately.

Medications

If your pile’s symptoms are mild, use OTC medicines as per the doctor’s recommendation. These products consist of ingredients such as witch hazel, or hydrocortisone and that momentarily relieve discomfort and pain.

External Piles Thrombectomy

This procedure is used to remove blood clots in external piles. This procedure is performed under anaesthesia and typically takes 72 hours to complete.

Minimally Invasive Procedures

These procedures are used for persistent bleeding or painful piles. These treatments can be done without anaesthesia. The invasive procedures include:

  • Rubber Band Ligation: To cut off the circulation, rubber bands are placed on the internal piles. The pile’s withers and fall off after a few days. This procedure can cause severe complications.
  • Injection (sclerotherapy): In this procedure, piles of tissues are shrunk by injecting a chemical solution. Injections can cause mild pain.
  • Coagulation (infrared, laser or bipolar): In this technique, laser or infrared light is used to coagulate the piles. Through this approach, internal piles are hardened. It has fewer side effects as compared to other techniques. 

Surgical Procedures

Only a few people have to undergo surgery for piles removal. Surgery is required if the piles are larger and difficult to remove. Usually, the following surgical approaches are used to remove piles.

Piles Removal (Phlebectomy)

This technique is used to remove excessive pile tissues that cause bleeding. This is the most effective approach to treat the server and recurring piles.  

Piles Stapling

This procedure is used for internal piles. Also termed as stapled piles opexy. It blocks the blood flow to pilesal tissue. Stapling caused less pain and you can return to your daily activities earlier. However, this technique can cause some complications such as:

  • Bleeding
  • Life-threatening blood infection (sepsis)
  • Urinary retention and pain

Seek medical care if your piles are not recovering with home care and lifestyle changes. Excessive bleeding can also be a sign of some other diseases such as colon cancer.

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