Description

🌟 Piles (Hemorrhoids) – Comprehensive Overview Piles, or hemorrhoids, are swollen, inflamed veins in the anal canal or rectum. They can be internal (inside the rectum) or external (under the skin around the anus). They are common and often related to increased pressure in the rectal veins due to straining, pregnancy, or chronic constipation. --- 🔍 Types of Hemorrhoids Type Location Features Internal Above dentate line Painless, may bleed, can prolapse External Below dentate line Painful, especially when thrombosed, can cause swelling and discomfort Mixed Both locations Features of both internal and external hemorrhoids --- 📈 Grades of Internal Hemorrhoids Grade Description I Bulge into canal, no prolapse II Prolapse during defecation but reduce spontaneously III Prolapse requiring manual reduction IV Irreducible prolapse, may strangulate --- ⚠️ Symptoms Rectal bleeding (bright red, on tissue or toilet bowl) Anal itching or irritation Pain (especially with external or thrombosed piles) Prolapse or feeling of fullness in the rectum Swelling/lump at the anal verge --- 🧪 Diagnosis Clinical history and examination Proctoscopy or anoscopy for internal hemorrhoids DRE (Digital Rectal Exam) Rule out other causes of bleeding (e.g., fissure, colorectal cancer) --- 💊 Management 🔹 Conservative (Grade I–II) High-fiber diet, fluids Stool softeners (e.g., lactulose) Sitz baths Topical creams (hydrocortisone, lidocaine) Avoid straining and prolonged sitting --- 🔹 Office-Based Procedures (Grade I–III) 1. Rubber band ligation – most common, effective for Grades I–III 2. Infrared coagulation 3. Sclerotherapy 4. Cryotherapy (less common now) --- 🔹 Surgical Treatment (Grade III–IV or refractory cases) Procedure Description Notes Milligan-Morgan Hemorrhoidectomy Excision of hemorrhoidal tissue (open technique) Most effective, more pain, longer recovery Ferguson Hemorrhoidectomy Closed technique Less postoperative pain Stapled Hemorrhoidopexy (PPH) Circular stapler resects prolapsed mucosa Less pain, shorter recovery, higher recurrence Doppler-guided HAL-RAR Hemorrhoidal artery ligation with mucopexy (for prolapse) Minimally invasive, effective in early grades --- ⚠️ Complications Pain Bleeding Urinary retention Infection Anal stenosis Fecal incontinence (rare) Recurrence --- 🏥 Postoperative Care Pain control (NSAIDs, warm baths) Fiber + hydration Laxatives Wound care and hygiene Avoid straining ---