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PILES HAEMORRHOIDS SURGERY IN INDIA

Piles, or haemorrhoids, are areas in the anal canal where the tissue, which contains lots of blood vessels, has become swollen. They can be internal, occurring inside the anus, or external, when they can be seen and felt on the outside of the anus. When visible they look like round pink swellings, the size of a pea or a grape. Piles are common in pregnant women, but are rare in children.

Blood vessels are supposed to suffer with varicosity, when there is obstruction or resistance/ sluggish or reduced or back flow of blood / valvelessness, etc. Varicosity is often noticed in the legs of pregnant women or policemen or in persons whose job/habit is to stand continuously for a prolonged period. Veins of the legs are most commonly affected with varicosity, since it is the most dependent part of the body, where the gravitational force constantly gives pressure with stagnation. Other than varicosity of legs, the next commonest spot of varicosity is the anus since it has a cluster of loosely supported blood vessels anastamosing (joining) systemic & portal (liver) circulation. These blood vessels have no valves to avoid back flow and is more prone to varicosity.

Piles patients mostly suffer silently with their complaints due to shyness to explain or show the thing to the doctor. They bear the pain and complaints as far as possible and go for treatment only in unbearable conditions, which usually leads them directly to the surgeon’s table. Every complaint should be treated then and there, for easy cure and to avoid progress of the disease into complications. Also, nowadays piles is often misspelled for all anal complaints (fissures, fistulas, rectal tumours, prolapsed anus, etc.) Every complaint should be clearly analysed by examination and investigation before being diagnosed and treated.

Incidences – Piles is very commonly seen nowadays. Women have higher incidence than men. The reason behind it is not clearly known. It is more commonly seen in adolescent age group and aged persons who all seem to be more tensed. There must be a relation between piles and tension/psychological factors. Its incidences is more common in persons who deviate more from nature in diet, living style and sitting habits. Sufferers are mostly

• Long sitting travellers
• Sedentary workers
• Alcoholics and those who suffer from liver disorders
• One who suffers often from constipation or diarrhoea

Causes And Types

Piles and their symptoms, which are one of the most common afflictions in the Western world, are also seen commonly in India. Not many people like to talk about it hence true statistics in India are not available. In the west over half the population over the age of 50 suffer from it. However they can occur at any age and can affect both women and men.

Because the presence of pile tissue is normal, it acts as a compressible lining which allows the anus to close completely. Disease should be thought of as pile tissue that causes significant symptoms. Unfortunately, piles tend to get worse over time, and disease should be treated as soon as it occurs.

Proposed causative factors include : –

1. constipation,
2. prolonged straining,
3. derangement of the internal anal muscle, and
4. pregnancy

Piles may be caused by more than one factor. Piles can be either internal or external, and patients may have both types. External piles occur below the dentate line and are generally painful. When inflamed they become red and painful, and if they become clotted, they can cause severe pain and be felt as a painful mass in the anal area. Internal piles are located above the dentate line and are usually painless. Dentate line is a line seen in the anal canal that demarcates the area with pain sensation from that without it.

Treatment Options Surgery in India

The best treatment is prevention. A diet high in fibre and bulk can prevent constipation. If the diet cannot be modified in this way, adding bulk laxatives may be necessary; they can prevent worsening of the condition. There are numerous creams and suppositories that can relieve anal irritation and pain, but they rarely provide long term benefit.

The treatment choices for piles include : –

1. injection sclerotherapy,
2. cryosurgery (cold probe),
3. rubber band ligation,
4. infrared coagulation,
5. radiofrequency coagulation,
6. direct current coagulation,
7. anal stretch
8. scalpel (standard) surgery,
9. laser surgery and
10. stapled surgery.

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