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Piles or haemorrhoids are one of the most common ailments known in both men and women, but many suffer in silence rather than discuss hemorrhoid treatment with their doctor. Often one gets into trouble by resorting to self-medication or falling into the hands of a quack.

The American Society of Colon and Rectal Surgeons reports that 50 percent of all Americans will have hemorrhoids in their lifetime. One reason people do not talk about hemorrhoid problems with their doctor is because they anticipate a painful, traditional hemorrhoid surgery. But the things have changed!

A minimally invasive surgical approach now available called Minimal Invasive Procedure for haemorrhoids MIPH), may help patients recover from haemorrhoid surgery faster with less pain when compared to conventional hemorrhoidectomy procedures.

Clinical trial results comparing this procedure to conventional hemorrhoid surgery have shown that patients who have the MIPH procedure may experience: less pain, a quicker recovery period, less overall complications and need for less postoperative pain medication.

Since the MIPH procedure was first introduced in Italy in 1997, it has become a common procedure around the world for the surgical treatment of hemorrhoids.

Using a haemorrhoidal circular stapler device, the MIPHprocedure essentially "lifts up," or repositions the mucosa, or anal canal tissue, and reduces blood flow to the internal hemorrhoids. These internal hemorrhoids then typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional hemorrhoidectomy procedures because it is performed above the "pain" line, or dentate line inside the anal canal. The advantage is that this hemorrhoid treatment method affects few nerve endings, while traditional hemorrhoidectomy procedures are performed below the dentate line, affecting many sensitive nerve endings.

MIPH is indicated for patients with
• Second degree hemorrhoids after failure of conservative treatment
• Third and fourth degree hemorrhoids
• Rectal mucosal prolapse

As with any surgical procedure, there are risks that accompany MIPH:
1. If too much muscle tissue is drawn into the device, it can result in damage to the rectal wall
    resulting in inflammation or infection.
2.The internal muscles of the sphincter may be damaged, resulting in short-term or long-term
   dysfunction, such as severe pain or incontinence.
However in expert hands these complications are less.

 

Dr.H.V.Shivaram, consultant surgeon at Columbia Asia Hospital, Bangalore
answers some of the commonly asked questions about piles:

What is a hemorrhoid?
Each of us has veins, or hemorrhoids, within the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. It is believed these veins exist to protect and cushion the anal canal. When these veins swell and descend into the anal canal, they are considered “prolapsed.” One set of veins is inside the rectum (internal hemorrhoids) and another is under the skin around the anus (external hemorrhoids).

Why does hemorrhoidal tissue prolapse?
A number of factors contribute to hemorrhoidal issues — constipation with prolonged straining and pregnancy are two of the most common causes. With aging, the muscles and other anatomic structures that support the tissue weaken and help contribute to the prolapse of the hemorrhoid.

What are the types of hemorrhoids?
There are two types — internal and external.

Internal hemorrhoids usually are not painful, but may bleed. Sometimes, an internal hemorrhoid may stretch until it bulges outside the anus. This is called a prolapsed hemorrhoid. A prolapsed hemorrhoid can go back inside the rectum on its own over time, or it can be gently pushed back inside. If the prolapsed hemorrhoid cannot be pushed back inside, consultation with a surgeon about surgical treatment options is necessary.

External hemorrhoids involve the veins around the anus. They can be itchy or painful and can sometimes crack and bleed. If a blood clot forms, one may feel a tender lump on the edge of the anus, and see bright red blood on toilet paper or in the toilet after a bowel movement.

What are the symptoms of hemorrhoids?
Symptoms of hemorrhoids, both external and internal, include:
• Aching after a bowel movement
• Anal or rectal itching
• Bright red blood on toilet tissue or in toilet bowl
• Appearance of anal tissue pads or sensitive lumps

Consult your surgeon if you experience any of these hemorrhoid symptoms.

Who gets hemorrhoids?
Hemorrhoids are one of the most common ailments for men and women alike — affecting more than half the population at some point in their lives. Onset commonly occurs after the age of 30, but hemorrhoids are reported in people of all ages.

What are the chances that I will have hemorrhoids?
Hemorrhoids can affect men and women alike; however an individual may be more likely to get hemorrhoids as they age or if their parents had them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. For most women, such hemorrhoids are a temporary problem. Obesity, straining during bowel movements, sitting too long on the toilet, or standing or lifting too much can make hemorrhoids worse. Constipation is the main cause of hemorrhoids.

How can I prevent getting swollen or prolapsed hemorrhoids?
The following are tips for hemorrhoid prevention:

• Include more fiber in your diet. Fresh fruits, leafy vegetables, and whole-grain breads and cereals
   are good sources of fiber.
• Drink plenty of fluids (except alcohol). Eight glasses of water each day is ideal.
• Do not read on the toilet. Sitting and straining too long encourages swelling.
• Exercise regularly.
• Avoid laxatives, except bulk-forming laxatives, Other types of laxatives can lead to diarrhea, which
  can worsen hemorrhoids.
• When you feel the need to have a bowel movement, don’t wait for long periods before using the
  bathroom.

How can I reduce my hemorrhoidal pain?
• Take warm soaks three or four times a day.
• Clean your anus after each bowel movement by patting gently with moist toilet paper or moistened
   pads, such as baby wipes.
• Use ice packs to relieve swelling.
• Use acetaminophen (paracetamol) to help relieve pain.
• Apply a cream that contains numbing agent like lignocaine. Creams that contain hydrocortisone can be
   used for itching or pain.

What do I do if I think I have hemorrhoids?
If you find you are struggling with hemorrhoid symptoms, it is important to visit your surgeon to correctly identify the problem. The physical evaluation to confirm a diagnosis of hemorrhoids should include observation, palpation, and anoscopic examination.