When the pressure on the veins in the rectal region increases, they swell. These swellings resemble a bag of worm and are referred as Piles or Haemorrhoids. The term Haemorrhoids is more used in the American continent. There are two types of piles, namely, internal piles and external piles. Internal piles are more common than external piles. This write up is about the four grades of internal piles, its management and the surgical options given by piles surgeons.
Types of Piles
When these swelling are present internally within the anus, on the anal lining, they are termed as internal piles. They are formed slightly above a line called dentate line or pectinate line. The entire anal canal is divided into an upper two third portion and a lower one third portion by this dentate or pectinate line. They are precisely formed between 2 and 4 centimeters above the anal opening.
When these swelling are present externally outside the anus, precisely beneath the skin that surrounds the anus, they are termed as external piles.
Causes of Piles
As said earlier piles or haemorrhoids are caused as a result of pressure on the veins in the rectal region. There are several factors that cause pressure on the veins in the rectal region. The various factors that cause this pressure are
(1) Constipation – Generally chronic constipation which has been around for quite few years.
(2) Diarrhea – Chronic in nature
(3) Lifting heavy weights – This becomes a reason when improper lifting techniques are employed while lifting any kind of weights. Gyms are not the only place where weights are lifted. A bucket full of water, LPG cylinder, lifting heavy machineries at work are some of the activities where lifting of weight takes place. Men do most weight lifting in gym and in work place while women lift weights as they perform house hold chores.
(4) Abdominal Exercises – The pressure exerted to the anal region when doing abdominal exercises is high and can lead to piles.
(4) Pregnancy – The growing fetus puts pressure on the abdomen cavity which in turn can cause the veins in the anus to swell. Also women are more prone to constipation due to their pelvic shape. The instance of constipation increases during pregnancy which might also play a role.
(5) Straining while passing stools – This condition is closely tagged to constipation. Straining puts pressure on the veins and hence they are responsible for swelling of the veins in the anal region.
Symptoms of Piles
(1) Spots of blood in the stool
(2) Pain when passing the stool. The pain can range from mild to severe depending on the severity of the piles.
(3) An itchy sensation around the anus.
(4) In severe cases of piles, a hard lump may be found hanging from the anal region. This lump may be hanging externally or it can have its origin internally.
(5) A feeling of incomplete evacuation of stools.
Grades of Internal Piles with Diagnosis, Management and Surgical Option
Grade-1 Internal Piles
The piles condition is fresh and asymptomatic and is present internally above the pectinate line. Pain does not manifest at this budding grade of piles. Just that the veins that are facing the intense pressure are beginning to show symptoms of piles. The patient rarely feels discomfort at this stage.
Diagnosis of Grade-1 Internal Piles
– Usually the diagnosis is not done at this stage as the piles is in its nascent budding stage.
– Some patients might experience itching and discomfort.
– A digital anal examination cannot provide enough clues as the piles surgeon cannot feel anything lumpy
– A proctoscope fitted with light allows the piles surgeon to observe the anal canal and can safely conclude the presence of piles.
Management of Grade-1 Internal Piles
– Reducing the instance of constipation by including more fiber in the diet and performing physical exercises.
– If the patient is overweight or obese, they should start managing their weight by cutting down their carb intake and increasing the fiber content.
– The piles specialist might prescribe over-the-counter laxatives for few days which should be continued.
Grade-2 Internal Piles
The piles condition begins to experience something called “prolapsing”. Prolapse is nothing but the veins becoming weak and beginning to be pushed out of the anal canal. The secondary grade piles condition is painful. The prolapsed veins get pushed up inside or reversed into the anal canal spontaneously.
Diagnosis of Grade-2 Internal Piles
– Usually the diagnosis is done at this stage as the piles as it is beginning to show up conspicuously.
– Patients experience definite itching and discomfort.
– A digital anal examination provides clues to the piles surgeon as the piles specialist can feel something lumpy inside the anus.
– An examination by proctoscope confirms the presence and grade of piles.
– Rarely profuse bleeding is reported in grade-2 internal piles also. Similarly rare instance of thrombosed (a condition of blood clot inside the piles) condition is also reported at this stage.
Management of Grade-2 Internal Piles
– Reducing the instance of constipation by including more fiber in the diet, managing the weight and physical exercises.
– The piles specialist prescribes over-the-counter laxatives which should be taken diligently.
– If the piles shows excess bleeding that if left untreated can cause anemia or if the piles has thrombosed that it becomes unbearably painful, surgery as an option is recommended by the piles surgeon.
– Usually Banding and Sclerotherapy are the surgical options recommended for grade-2 internal piles.
Grade-3 Internal Piles
This condition or grade is when the prolapsed veins becomes more painful and causes more discomfort because the spontaneous reversal or reduction of the prolapsed veins does not happen. However the patient can manually push the prolapsed veins inside the anus.
Diagnosis of Grade-3 Internal Piles
– Patients themselves can feel the lump of veins getting pushed from inside the anus and staying outside. When the prolapsed vein is pushed inside it caused immense pain.
– A digital anal examination by the piles surgeon confirms the presence of piles.
– An examination by proctoscope by the piles surgeon confirms the grade of piles.
– The probability of profuse bleeding is higher in grade-3 internal piles.
Management of Grade-3 Internal Piles
– Since the piles present usually shows bleeding surgery is recommended by the piles surgeon. Banding and Sclerotherapy are the surgical options available for grade-3 internal piles also.
– Even after surgery, the surgeon would recommend to reduce the instance of constipation. As part of this, the piles specialist would recommend including more fiber in the diet, and managing the weight.
– The piles specialist prescribes over-the-counter laxatives which should be taken diligently.
Grade-4 Internal Piles
This grade is where the prolapsed piles cannot be pushed inside the anal canal manually also. The piles hangs outside and causes immense pain and discomfort.
Diagnosis of Grade-4 Internal Piles
– Patients themselves can feel the lump of veins thrombosed and prolapsed outside the anus. They are very uncomfortable and cause excess pain.
– A mere look at the anus by the piles surgeon confirms the final grade of piles.
– Usually in grade-4 internal piles there is excess bleeding.
Management of Grade-4 Internal Piles
– Surgery is the only option available to manage the piles.
– Haemorrhoidectomy is the surgery type recommended for grade-4 piles. At this stage banding or sclerotherapy surgery types do not serve the purpose.
– Constipation has to be reduced. Hence a diet rich in fiber is recommended. Along with that moderate physical activities are recommended to keep the bowel movement healthy. Lifting of heavy weight as part of working out is not recommended at this stage.
– The piles specialist prescribes medications which should be taken diligently.
Dr. Maran, a piles specialist in Chennai performs piles surgery in Chennai on a regular basis. He is of the opinion that only a piles surgeon can ascertain the stage of any piles condition and whether the existing piles needs a surgical management. So let your piles surgeon examine you first and let know the stage.
If you are suffering from severe constipation, you may want to get yourself examined with Dr. Maran, the piles surgeon in Chennai. You can call Springfield Wellness Centre and fix an appointment with the piles specialist