THROMBOSED PILES(PROLAPSED PILES)
Piles are small lumps that develop on the edge of the anal opening.They are vascular structures along with connective tissue and seen as piles or pile mass or haemorrhoids.
External piles cause mild to moderate pain and usually get better with pain killers ,creams,laxatives and antibiotics in 7-10 days.
If the pain is severe ,there may be blood clot in it,this is called thrombosed piles.The patient needs admission in this case for definitive management.He is advised surgical excision of the thrombosed pile mass called haemorrhoidectomy under anaesthesia.
Internal piles usually present with painless rectal bleeding usually bright red in colour and associated with normal coloured stool.The exact cause of piles is still not known but chronic constipation is an important precipitating factor for piles.Many people have combination of both external and internal piles.Most of the patients feel embarassed especially women for early consultation regarding piles and its symptoms.They are most of the times not aware of the seriousness because of inaccesibility to visualise the exact nature of problem in anal region.
Among other factors that have been associated with piles ,there are obesity,prolonged sitting posture,lack of exercise,lack of fiber in diet,genetic factors, chronic cough,sometimes pregnancy where there is increased abdominal pressure, etc.
Haemorrhoidal cushions are normal sinusoids seen in anal canal in three fixed locations.These cushions are responsible for 20% of anal continence remaining 80%is done by the anal sphincter.The piles increase in size and prolapse due to increased abdominal pressure and closed anal sphincter in chronic constipation.
Diagnosis is made most of the times by direct examination of peri anal and rectal region using proctoscope with local anaesthetic jelly by a physician/surgeon.This can further be confirmed by colonoscopy for any other colonic diseases.
There are four grades as follows:
Piles are small lumps that develop on the edge of the anal opening.They are vascular structures along with connective tissue and seen as piles or pile mass or haemorrhoids.
External piles cause mild to moderate pain and usually get better with pain killers ,creams,laxatives and antibiotics in 7-10 days.
If the pain is severe ,there may be blood clot in it,this is called thrombosed piles.The patient needs admission in this case for definitive management.He is advised surgical excision of the thrombosed pile mass called haemorrhoidectomy under anaesthesia.
Internal piles usually present with painless rectal bleeding usually bright red in colour and associated with normal coloured stool.The exact cause of piles is still not known but chronic constipation is an important precipitating factor for piles.Many people have combination of both external and internal piles.Most of the patients feel embarassed especially women for early consultation regarding piles and its symptoms.They are most of the times not aware of the seriousness because of inaccesibility to visualise the exact nature of problem in anal region.
Among other factors that have been associated with piles ,there are obesity,prolonged sitting posture,lack of exercise,lack of fiber in diet,genetic factors, chronic cough,sometimes pregnancy where there is increased abdominal pressure, etc.
Haemorrhoidal cushions are normal sinusoids seen in anal canal in three fixed locations.These cushions are responsible for 20% of anal continence remaining 80%is done by the anal sphincter.The piles increase in size and prolapse due to increased abdominal pressure and closed anal sphincter in chronic constipation.
Diagnosis is made most of the times by direct examination of peri anal and rectal region using proctoscope with local anaesthetic jelly by a physician/surgeon.This can further be confirmed by colonoscopy for any other colonic diseases.
There are four grades as follows:
- Grade I: No prolapse. Just prominent blood vessels.
- Grade II: Prolapse upon bearing down but spontaneously reduce.
- Grade III: Prolapse upon bearing down and requires manual reduction.
- Grade IV: Prolapsed and cannot be manually reduced.
We need to keep the following diseases in mind-fissure,fistula,abscess,cancer,rectal varices as seen in portal hypertension,colitis etc.There may be minor diseases like skin tags,anal warts,rectal prolapse,polyps,etc
Reducing weight, high fiber diet,avoid /treat constipation,disciplined life style regarding diet and bowel habits,maintain good hydration.
Band ligation,cryo surgery,sclerotherapy are first line of management of initial stages of piles.
Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid used only in severe cases.
- Stapled hemorrhoidectomy, is a procedure that involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids. However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorroidectomy and thus it is typically only recommended for grade 2 or 3 disease.
- After surgery one can return to play again quipping "...my problems are all behind me "
- more in blog
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