Pile (hemorrhoid) can best be described as, swellings that develop inside and around the back passage, that is, anal canal(Anus). There is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged(filled) with more blood than usual. The engorged veins and the overlying tissue may then form into one or more swellings (pile).

Types of pile:

Pile can be divided into either internal or external pile. Some people develop internal and external piles at the same time.

Internal piles are deeper and initially form above a point 2-3 cm inside the back passage (anal canal) in the upper part of the anal canal.

External piles start off nearer the surface, below a point 2-3 cm inside the back passage.

Despite the name, external piles aren’t always seen outside of the opening of the back passage (anus). Equally confusing, internal piles can enlarge and drop down (prolapse), so that they hang outside of the anus.

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Grades of Pile:

Pile can also be graded by their size and severity.

Grade 1 are small swellings on the inside lining of the anal canal. They cannot be seen or felt from outside the opening of the back passage (anus). Grade 1 piles are common. In some people they enlarge further to grade 2 or more.

Grade 2 are larger. They may be partly pushed out from the anus when you go to the toilet, but quickly spring back inside again.

Grade 3 hang out from the anus when you go to the toilet. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.

Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.

Symptoms of Pile:

Sometimes there are no symptoms and you may not realize that you have any piles.

The most common symptom is bleeding after going to the toilet to pass stools (faeces). The blood is usually bright red and may be noticed on the toilet tissue, in the toilet pan or coating the stools.

A pile can hang down, that is protrude (prolapse) and can be felt outside the back passage. Often, it can be pushed back up after you have been to the toilet. However, more severe piles remain permanently prolapsed and cannot be pushed back up inside.

Small internal piles are usually painless. Larger piles may cause a mucous discharge, some pain, irritation and itch. The discharge may irritate the skin around the anus. You may have a sense of fullness in the anus, or a feeling of not fully emptying your back passage when you go to the toilet.

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What are the complications of piles?

A possible complication of piles that hang down is that they can ‘strangulate’. This means that the blood supply to the pile has been cut off. A blood clot (thrombosis) can form within the pile. This causes really severe pain if it occurs.

What causes piles?

The lining of the back passage (anal canal) contains many blood vessels (veins). There seem to be certain changes in the veins within the lining of the back passage that cause the pile(s) to develop. The lining of the back passage and the veins become much larger and this can then cause a swelling and develop into a pile.

However, some piles seem to develop for no apparent reason. But, when there is an increased pressure in and around the opening of the back passage (anus), this condition can be a major factor in causing haemorrhoids in many cases. If you delay going to the toilet and need to strain when on the toilet then this can increase the pressure and so makes it more likely that a pile will develop.

There are certain situations that increase the chances of developing pile, such as:

Constipation, passing large stools (faeces), and straining at the toilet. These increase the pressure in and around the veins in the anus and seem to be a common reason for piles to develop.

Bacteria infection leading to gastrointestinal tracts disorder can also create strain within the anal region. This can put more pressure on the veins in and around the anus and this pressure would give rise to the swellings of these veins which can then trigger pile.

Being overweight . This increases your risk of developing piles.

Pregnancy. Piles are common during pregnancy. This is probably due to pressure effects of the baby lying above the rectum and anus, and also the effect that the change in hormones during pregnancy can have on the veins. Piles occurring during pregnancy often go away after the birth of the child.

Ageing . The tissues in the lining of the anus may become less supportive as we become older.

Hereditary factors . Some people may inherit a weakness of the wall of the veins in the anal region.

Other possible causes of piles include heavy lifting or a persistent (chronic) cough.

How are piles treated and managed?

In addition to medication, pile patients are advised to take these precautionary measures:

Avoid constipation and straining at the toilet. Keep the stools (faeces) soft, and don’t strain on the toilet.

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 They can do this by:

Eating plenty of fibre (for example, fruit, vegetables, and cereals). Hard food like plantain, and any other foods that could cause their faeces to be hard should avoided

Drink a lot of water. Most sorts of drink will do but too much alcohol, sugar and caffeine should be avoided.

Fibre supplements. If a high-fibre diet is not helping, they can take fibre supplements.

Avoid painkillers that contain codeine. However, simple painkillers such as paracetamol may help.

Toileting . Go to the toilet as soon as possible after feeling the need. Do not strain on the toilet.

Regular exercise helps to reduce constipation.

These measures will often ease symptoms such as bleeding and discomfort. It may be all that they need to treat small and non-prolapsing piles (grade 1). Small grade 1 piles often settle down over time.

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