Hemorrhoids and piles are the same thing. There is no difference between piles and hemorrhoids. Sometimes people think that normal anal cushions are called hemorrhoids and swollen anal cushions are called piles. Some say that hemorrhoids are internal, and piles are external. This is not the case. Hemorrhoid is the medical term and pile is the general term. Nevertheless, this article will talk in detail about piles (or hemorrhoids), highlighting their clinical features, symptoms, causes, diagnosis, prognosis, and also the course of treatment/management they require.
What is Hemorrhoids (or Piles) and what are the causes?
There are three anal cushions in human anal canal located at 2, 7 and 11 O’clock positions (when the patient is supine). Hemorrhoids contain sinusoids, smooth muscles, and soft connective tissue. These sinusoids are different from veins because they do not have smooth muscle in their walls. The sinusoid set is known as hemorrhoidal plexus. Anal cushions help maintain continence. They expand in size during straining to keep the anus closed. Hemorrhoids occur when the venous pressure is very high and when the sinusoidal complex comes down. Two types of hemorrhoids occur. Internal hemorrhoids arise due to excessive expansion of superior hemorrhoidal plexus. External hemorrhoids arise from the inferior hemorrhoidal plexus. Exact cause for hemorrhoids is not known; constipation, diarrhea, low fiber diet, sedentary life style, straining, pregnancy, obesity, chronic cough, and pelvic floor abnormalities lead to hemorrhoids.
Clinical features, signs and symptoms, and diagnosis of Hemorrhoids (or Piles)
Diagnosis of hemorrhoids is clinical. Signs of external and internal piles present differently. Many individuals present with both. External piles are very painful if thrombosed. This pain lasts a few days. If not infected they heal spontaneously leaving a skin tag. Internal piles feature painless, fresh bleeding after defecating. Blood covers the stools, drips down into the toilet bowl, or is seen on the toilet paper. Blood is not mixed with stools. Blood is not altered.
Observation of the anal region is adequate to diagnose external piles and grade III and IV internal piles. External piles appear on the pectinate line. Skin covers the outer half, and the anoderm covers the inner half of it. These are very sensitive to pain. Grade III internal piles come down while straining, but go back up with manual reduction. Grade IV piles are already outside and irreducible. Grade II piles come down while straining and spontaneously go back. Grade I piles are just expanded blood vessels without prolapse. Other ano-rectal conditions like fistula, fissure, malignancy, and rectal varicies should be considered before making a definitive diagnosis.
Treatment/Management of Hemorrhoids (or Piles)
Conservative management is indicated for first and second degree hemorrhoids and in pregnancy. It involves high fiber diet, good fluid intake, NSAID, and rest. High fiber diet gives bulk to stools and holds water in the gut to help move bowel well. NSAID should not be used for more than 3 weeks because they cause skin thinning. Surgical procedures are indicated if no resolution seen with conservative methods. Rubber band ligation involves the application of a tight rubber band 1 cm above the dentate line to cut off the blood supply to hemorrhoids. In a few weeks, the hemorrhoid falls off. Sclerotherapy involves injection of a chemical agent to collapse the walls of sinusoids in hemorrhoids. Expanded hemorrhoids can be cauterized with laser, cryo, and electricity. Hemorrhoidectomy is good for severe cases. Trans-anal ultrasound guided hemorrhoidal dearterialization and stapled hemorrhoidectomy are two other common procedures.
Piles vs Hemorrhoids
Although many consider piles and hemorrhoids to be different, they are the same.