SHORT FEATURE
SMITHA NAIK AND DINESH RAO B.
When piles persist for a long duration and
are accompanied by bleeding, surgical
treatment is the only alternative.
I
T was a severe case of bleeding piles
that kept the French emperor Napoleon
off his horse during the Waterloo battle…
this delayed the battle and led to his
eventual defeat in the war. Many people
suffer from this dirty bleeding disease
silently.
Haemorrhoids (Greek for ‘veins
likely to bleed’), is the medical term for
the disease commonly known as piles’
(Latin pila for ‘a ball’). Piles is caused
due to permanently distended, enlarged,
dilated veins in the distal rectum or anus
region. Thus, piles appear as abnormally
swollen cushions of tissues in the anorectal walls, which may protrude through
the anus. This painful condition may
sometimes become complicated by
localized inflammation, bleeding and
thrombosis.
Piles have now become a common
problem, especially in people who
often suffer from bowel disorders and
prolonged constipation. More than 40%
of the developed world silently suffers
from this painful disorder, especially
during old age. It occurs mainly due to
the consequences of low residual ‘western
diet’, lack of dietary fiber, obesity and
modern sedentary lifestyle.
The earliest symptom of piles is bright
red coloured bleeding during defecation.
Sometimes severe bleeding may lead to
anemia. Less common symptoms include
itching, discomfort, leaking of mucus,
heavy feeling in the rectum region, etc.
If there is regular inflamed ulceration,
thrombosis or prolapsed conditions,
it leads to complications. A thorough
medical examination of all cases of piles
must be made to rule out cancer of the
rectum.
Types of Haemorrhoids
Piles arising above the internal sphincter
are classified as ‘internal piles’, and
those emerging outside the sphincter as
‘external piles’. The external piles do not
typically bleed, or cause much pain, but
internal piles become constricted and
may be very painful and may bleed, when
they enlarge and extrude from the anus.
Piles can also be classified into, first,
second and third degree piles. The firstdegree piles never appear at the anus
and bleeding at the end of defecation
will be the only symptom. Second
degree piles protrude beyond the anus
as uncomfortable swellings, but return
spontaneously back. The third degree
piles remain outside the anus and need
to be returned by pressure. It may often
require surgery, especially when they
become strangulated, producing severe
pain and further enlargement.
Causes of Haemorrhoids
Piles are a vascular complex disorder
due to varicose veins of the anal region,
showing
multi-factorial
inheritance.
Many scientists consider this disease as
an offshoot of human evolution from
the trees, and the predominance of
bipedality. Some scientists try to find fault
in the human body’s basic design. Years
of inevitable pressure and hereditary
predisposition in some people are the
root causes for the development of piles
in humans.
Haemorrhoids
develop
in
persons who inherit the harmful
“right” combination of mutated genes
(polygenes), and is triggered by the
interaction of certain genetic factors with
environmental factors like nutrition,
obesity, sedentary life, etc. With the use
of modern molecular genetics, detailed
family studies like pedigree analysis and
twin studies may help the scientists unlock
the secret of the origin and development
of piles.
FACTORS TRIGGERING PILES
SCIENCE REPORTER, SEPTEMBER 2013
46
•
Chronic conspaon
•
Neglect of anal hygiene
•
Ano-rectal infecons
•
Tumors in the rectum
•
Alcoholism
•
Venous stasis of pregnancy
•
Enlarged prostate glands in men
•
Cardiac failure
•
Congeson in the veins of the
haemorrhoid plexus, due to portal
hypertension.
SHORT FEATURE
Isabgol is useful in controlling constipation
and to avoid piles formation
Drink plenty of fluids
Piles are rarely seen among the rural native Africans, but in urban Africans, it has become
endemic over recent years due to the shift of diet to Western dietary customs.
Piles occur equally in both men and
women. In men with enlarged prostate
gland, straining to pass urine may lead to
the development of piles. In pregnancy,
venous stasis (when the pregnant uterus
compresses the rectal vein) results in
piles.
Piles appear to be rare in children,
and tend to develop after the age of 20
years. Hence, piles is an “adult onset
disorder”. It generally develops after the
age of 50 years, in many elderly people,
due to genetic predisposition and due
to persistent elevated venous pressure
near the anal canal. Jobs involving heavy
lifting or sitting for long periods; obesity;
and modern sedentary lifestyle influence
the formation of piles. It can become
severe in people who do not maintain
normal anal-hygienic condition regularly.
According to surgeon Dr.
Denis P. Burkitt, piles are rarely seen
among the rural native Africans, but in
urban Africans, it has become endemic
over recent years due to the shift of
diet to Western dietary customs. Rural
Africans consume a high fiber natural
diet containing ample of vegetables,
grains, cereals and fruits. On the other
hand, urban Africans depend too much
on refined foods, which lack dietary
fibre. Dietary fibers and bioflavonoids
(antioxidants) not only helps in
reducing colonic cancers, but also help
in preventing piles, especially if taken at
early stages.
According to Hamish Thomson,
piles are preventable if bran (i.e. husks
of grain sifted from the flour, now eaten
as healthy food) is added to the food
regularly. Wheat bran helps to soften the
stool, reduce the strain, and saves the
irritated strained tissues of the anal-canal
from wear and tear.
Thorough medical examination of
all cases of piles must be made to
rule out cancer of the rectum.
How to prevent Haemorrhoids
Haemorrhoids can be prevented by
following simple changes in lifestyle
habits. Epidemiological evidence indicates
that people who consume a fibrous diet
have a low incidence of constipation,
piles, cancer of the colon, diabetes,
coronary artery diseases, etc. Dietary
fibers work as bulk laxatives and help in
initiating colonic peristalsis by distending
the colon. One should consume adequate
quantity of fresh fruits, vegetables and
whole grain cereals. Plantago lanata
(Isabgol), which is rich in hemicelluloses,
has been used since ages in ancient Indian
medicine for constipation and to avoid
piles formation.
It is advisable to drink plenty of
fluids - at least eight glasses of water per
day. Try to keep weight within normal
limits. Obesity is the common nutritional
disorder of recent years, and is associated
with several diseases. Avoid straining
at the stool while defecation. Also avoid
prolonged sitting and working and
indulge in regular exercises.
Treatments for Haemorrhoids
Non-surgical treatments for piles include
measures to control pain, discomfort,
reduce swellings, irritations, congestion
and bleeding. The treatment is targeted at
the following:
i. Dietary fibers increase bulk of faeces
and play a role in defecation reflux by
distending the rectum. Bowel regulation
is accomplished by eating a high fiber
diet, with fecal softening agents or
medications.
ii. There are many herbal remedies for
47
piles. Ranunculus ficaria, Witch hazel
(Hamamelis virginiana), Horse chestnut
(Aesculus hippocastanum), etc. are used
after crushing into a fine pulp and
combining with petroleum jelly.
iii. Use of water and “warm sitz bath”
etc may help to reduce the swelling and
itching caused due to piles.
iv. Hydrocortisone (ANUSOL) suppositories
may be used for edematous, prolapsed
haemorrhoids, in combination with warm-sitz
baths.
v. Local anaesthetics are used to relieve acute
pain of piles.
When piles persist for a long duration
and are accompanied by bleeding,
surgical treatment is the only alternative.
Here the main aim is to remove the piles
completely or to clot (thrombose) the anal
venous blood vessels, so that they wither
away.
‘Rubber band ligation’, cryosurgery
and sclerotherapy are used to remove the
piles. Haemorhoidectomy is the surgical
operation of removing piles that have not
responded to simple measures. Possible
complications are bleeding, or later anal
stricture (narrowing).
Dr. Smitha Naik is Assistant Professor of Oral
Pathology at the Pacific Dental College and
Hospital, Udaipur. Address: Department of Oral
and Maxillofacial Pathology, Pacific Dental College
and Hospital, Debari, Airport Road Udaipur,
Rajasthan-313 024; Email: smithadineshrao@
yahoo.co.in
Dr. Dinesh Rao B. is Professor of Pediatric
Dentistry at Pacific Dental College and Hospital,
Udaipur. Contact address: Department of Pediatric
Dentistry, Pacific Dental College and Hospital,
Debari, Airport Road, Udaipur, Rajasthan-313024.
Email: pedodinesh2003@yahoo.co.in
SCIENCE REPORTER, SEPTEMBER 2013