Piles Surgery

What is Piles?

Piles are often feared as the tumor of the anus. Actually, piles are not cancerous and not dangerous. It is simply some enlarged/ engorged blood vessel(s) of the anus. It is also called hemorrhoids in medical terminology. It is the dilatation (varicosity) of the hemorrhoidal plexus (veins of anus). It appears as bluish or purple colored swelling due to stagnated blood. Piles may cause symptoms like bleeding, itching, pain, and lump feeling in the anus.

When there is obstruction, resistance, sluggish or reduced or back flow of blood, valveless-ness, etc., blood vessels suffers with varicosity, resulting in Piles. Varicosity is often noticed in the legs of pregnant women, 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 part of the body, where the gravitational force constantly creates 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 anastomosing (joining) systemic & portal (liver) circulation. These blood vessels have no valves to avoid back flow and are more prone to varicosity.

Piles patients mostly suffer silently due to shyness to explain or show it 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 are often misspelled for all anal complaints (fissures, fistulas, rectal tumors, prolapsed anus, etc.) Every complaint should be clearly analyzed by examination and investigation before being diagnosed and treated.

Incidences of Piles are 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 are more common in persons who deviate more from nature in diet, living style and sitting habits. These people are most susceptible to have piles:

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

Anal architecture is designed in such a manner to control even the release of air (flatus) and watery stools i.e., airtight and leak-proof. It is well-formed with internal sphincter and external sphincter muscles. Anal canal is anatomically divided into two parts (namely upper part and lower part) by Hilton’s line (bluish pink ring). This upper anal part originates from the endoderm and is covered with mucous membranes. The nerves in the upper part are supplied from the autonomic nervous system which doesn’t have any pain sensitive nerve fibers. The lower part of the anal canal originates from ectoderm and is covered by skin. Unlike the upper part, it is supplied by spinal nerves which have pain sensitive nerve fibers. The blood supply to upper part of the anus is supplied by superior hemorrhoidal plexus and the lower part is supplied with inferior hemorrhoidal plexus. The occurrence of swelling/ varicosity in the anus (piles) is more common in 3 O’ clock, 7 O’ clock & 11 O’ clock position of anus which are all supposed to be weak points of the anus.

Types of Piles

Piles are classified in two categories

Internal piles

Internal piles lies inside the anus. Usually internal piles originate from superior hemorrhoidal plexus of the upper part of anal canal and lies above the Hilton’s line. This type usually will not be painful, since it lies in the upper part of anal canal, which lacks pain-sensitive nerve innervations.

  • Primary piles: Occurs due to hereditary reason without any causative factor or obstruction.
  • Secondary piles: Occurs in continuation with other diseases or obstruction to portal circulation like liver disorders, portal hypertension due to obstruction, rectal or pelvic tumors, cancer, splenomegaly, etc.

Prolapsed piles

Prolapsed piles are the piles which gets descend from the place of origin, i.e. internal piles descends to get visualized as external piles. This prolapsed piles should be cared for in the initial period itself or otherwise it may get strangulated and develop into gangrene. In the initial period, the protrusion gets inside or recedes without any assistance after passing stool, but in due course, the protruded mass will not recede even with the assistance of fingers.

Commonly suspected causes for development of piles and pressure in the blood vessels may be due to:

Obstruction

  • Physiological – Pregnancy and delivery can cause temporary increase of venous pressure and thus piles can occur.
  • Pathological – Liver and portal vein disorders, pelvic or rectal tumors, cancer, etc., can cause obstruction and lead to piles.
  • Erect postures of man – Animals are flat, but humans had become erect by evolution. This has been considered a major factor for development of piles.
  • Hereditary – piles is often found to run in families.
  • Physical strain – pressure exerted while passing stool, coughing continuously for a prolonged time, weight lifting, etc., can also cause piles & tendency to prolapse and relapse.
  • Foods – Low fiber diet, more Spices, alcohol, lesser intake of water can produce hard stool, which may need of more strain in defecation and thus lead to piles.
  • Defecation – Both constipation and diarrhea can cause piles. The strain for passing the stool is the main reason for the development of piles in both cases.
  • Habits of alcohol, sedentary life and drugs can also cause piles Worries and mental strain can also cause havoc to the intestines and anus.

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