Global Health Asia-Pacific Special Issue - Page 10

You Ask , They Answer

Q

: What are piles and what are its symptoms ?

A

: Piles are actually physiological structures in the human body – and everyone has them ! They are also known as anal cushions and are essentially tissues with lots of blood vessels in them that can swell and decrease in size to help us with fine control of continence .
However , in patients who have increased abdominal pressure — for example , those with constipation , obesity , heavy lifting as part of work or exercise , or who are pregnant or have chronic cough , etc . — these factors tend to cause the blood vessels to swell and , over a prolonged period , can lead to these piles getting larger and developing symptoms .
Symptoms of piles primarily include either bleeding ( usually painless fresh red bleeding after a passing motion ) or prolapse ( a lump that comes out of the anus after straining which may or may not be able to be pushed back ). In some acute cases , the piles can bleed internally , forming a clot which may lead to anal pain .

Q

: Can piles clear up on their own and are there home remedies for them ?

A

: Yes , in fact many times after an acute episode of bleeding or prolapse , after the straining ends , many patients
are relieved of their symptoms , and a reasonable number of patients do not have recurrence of symptoms for a long time .
Home treatments for piles would really depend on the severity of symptoms and how extensive the piles are that need to be treated . Minor piles symptoms can be managed by just avoiding constipation and straining , but the more advanced cases are best managed with the help of a doctor ’ s advice and medications .

Q

: When should people with piles see a doctor and what are the main treatments available ?

A

: As explained earlier , piles are physiological and almost never cause any life threatening issues ! However , the key is that we need to be aware that other potentially life threatening problems may present similarly to piles . For example , colorectal cancer or polyps can present with painless bleeding with motion as well , so our first priority would be to exclude these issues besides the treatment of the symptoms .
Treatment of piles depends on the symptoms exhibited and generally fall within three main categories : 1 . Conservative treatments with oral or topical medications and lifestyle modifications ; 2 . Local treatments such as rubber band ligation or coagulation ; and
3 . Surgery for which there are many techniques , including conventional surgery , laser surgery , haemorrhoidal artery ligation , and stapled haemorrhoidectomy , just to name the more common ones . The type of surgery will depend on the nature of the haemorrhoids as well as the experience of the surgeon .

Q

: Is it possible to prevent or reduce the risk of piles ?

A

: What we can do to reduce the risk of piles becoming symptomatic includes preventing constipation by taking adequate fibre and fluids and avoiding sitting on the toilet for long periods unnecessarily .
More importantly is to check with your doctor if you do have any symptoms of piles as to whether you should get the rest of your colon examined as well – removal of polyps could potentially prevent cancer development and save lives !
Dr Eugene Yeo
Dr Eugene Yeo is a general and colorectal surgeon at Mount Elizabeth Hospital in Singapore .
8 ISSUE 6 | 2022 GlobalHealthAsiaPacific . com