Piles

(hemorrhoids)

Introduction.

This folder gives information on the treatment of piles. One should realise that  individually  the situation can be different.

Position and function of piles

Piles (hemorroïds) are protruded venous bodys that close the anus. The venous bodies are a spongy network of bloodvessels, covered by a mucous membrane within the sfincter of the anus. Piles are located at the inside of the anus and when they are close to each other, they close the anus leaktight.

Cause and complaints of piles

When there exists a lot of pressure on the piles, they stretch and as a result they may protrude, even to the outside and bulge. That may create an uncomfortable or painful feeling. Thereby the blood in the piles can increase, as a result of which piles bleed easily. Also a bloodclot can form itself in the veins in the skin around the anus. That is externally tangible and painful. It is called a trombosed haemorrhoïd.

Especially a lack of feeding fibres in our food makes the stool thick and dry. This ensures pressure on the piles during evacuation. Also much sitting, insufficient physical exercise and high bodyweight can contribute  to this end.

The prevention of complaints

Complaints can be prevented by keeping the stools soft , as a result of which the stools will evacuate easier. For that, eating sufficient feeding fibres  (brown bread etc.) and drinking much water (1½ - 2 litres per day) is necessary. Also control of the toilet visit is important. Thus you do not have to postpone the toilet visit at insistence too long. When you try to introduce a sort of schedule, you prevent that you must stop unchoking at inconvenient moments too long.

Try some more physical  exercise and if necessary lose some weight! Most of the patients with pile complaints profit from these measures and rules of life. When nevertheless the complaints  continue, further treatment is necessary.

Diagnosis and research

The complaints piles can give, are also seen at other diseases of the rectum or the anus. For this reason examination is conducted of the anus, the anal canal and the beginning of the rectum. The doctor will do the examination of the patiënt in  the knee/elbow position or side position, an attitude inelegant for the patient. Thereby he looks at the surroundings of the anus and the anus itself and he also will conduct  an internal examination of the anus and the lower part of the rectum with his finger.
If necessary additional examination is done, for example an endoscopy of the large bowel or a radiography. This will be particularly done at patients above forty or fifty years, because the chance that other diseases than hemorroids are the cause of the complaints is then more likely . In general it is sufficient to do only the examination of the anus and the anal canal  in younger patients  .

The treatment possibilities

A logical treatment is bringing back the piles at their initial place. Protruding has then been  remedied and the piles can give thus no more complaints.

• The protruded and therefore redundant mucous membrane can be ligatured using rubber band. The redundant mucous membrane dies within seven up to ten days and leaves the body with the rubber band while having stool .
• Also the pile can be made to shrink by injecting an irritating fluid under the mucous membrane.
• A third treatment possibility is sealing the piles with infra-red light.
• Also combinations of the mentioned treatments can be carried out.

The treatment happens in the outdoor patiënt department. You are lying on a special examinationtable, and then a small tube is placed in the anus . Via this the treatment is carried out. It lasts approximately 10 minutes.

Generally already a good result can be expected after the first treatment at more than half of the patiënts. Sometimes a second or third treatment is necessary. An operation with hospitalisation because of piles is but seldom necessary. Only at painful, entirely protruded and serious trombosed piles (click on photograph under) a small operation can be necessary. Thereby the tension of a part of the anal sfincter is interrupted, as a result of which the swelling can lessen. Because of the pain this operation generally takes place under general anaesthesia or by puncture in the back (spinal anesthesia).

Possible complications

No surgical intervention is entirely without dangers. Thus at the surgical treatment for piles also the normal chance on complications of any operation exists.

• Bleeding is possible after action in this area that is rich of vessels. If you use anticoagulant medecines, you must communicate this to your doctor. These medecines give an increased risk on bleeding and therefore must be stopped temporarily if your doctor tells you so.
• When a rubber band leaves the rectum it is possible there is also some blood loss. When blood loss seems more than a cup full, you must get in touch with the hospital.
• After a surgical treatment for piles mictionproblems can occur. When you really can not go to the bathroom you must  contact  the hospital.
• As a result of inflammation on the injectionsite there may appear a short-term small temperature increase.
• Little burnwounds that are made at the infra-red treatment, may cause some fluidproduction for some days.
• Cutting a part of the sfincter has hardly influence on stopping unchoking. In the beginning it is possible to experience a minimal loss of control of the sfincter, particularly on winds. Generally this is of temporarily. Unfortunately however there can be some loss of this control permanently in a small number of cases. One must  master  the continence then more consciously.

At the outdoorclinic treatment no anaesthesia is necessary. Still it is possible after the treatment with rubberbands, injection or infra-redtherapy to experience an unpleasant and painful feeling  during two up to three days. The seriousness of the complaints depends on the size of the treated piles. At pain you can use pain-killers such as paracetamol. These you can buy at the pharmacy or general storekeeper. Also a hot bath can relieve the pain.

After the surgical treatment in the hospital you should judiciously keep the anal area clean, particularly after stools, but also in between. Two times per day are generally sufficient. With the shower you can rinse the area easily. After an outdoor treatment you can generally resume your activities within one or two days.

After hospitalisation and treatment under general anesthesia you must take into account a long-termer absence. After the piles treatment, stools will have to be kept soft. Generally you get  a recipe for medecines for that purpose. To prevent the comeback of complaints you should undertake judiciously as many aforesaid measures as possible and observe rules of life.

Questions

If you still have questions, ask them your treating doctor or general practitioner.
At urgent questions or problems before treatment has taken place you should contact  the department  where the treatment will take place. When problems arise at home after the operation, get in touch with the general practitioner or the hospital.
Finally, if you believe that certain information is lacking or unclear, please let us know.

 

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