#hemorroid #piles #fissures
What are piles?
Piles are technically referred to as haemorrhoids . Piles are naturally occurring tissues in the anus, it is basically to cushion the anal region and prevent any injury when hard motion passes through the anus.
Can piles be left untreated?
When somebody comes to know that they have got piles, because they have undergone a test, or a colonoscopy for some other reason, and the report says grade I haemorrhoids or grade II haemorrhoids, small piles seen, They start panicking and ask do I need treatment for this? What will happen if I don’t treat the piles?
All piles do not require treatement, if one doesn’t have the following symptoms:
No constipation’
No excessive straining involved
No bleeding in the motion
Pile masses do not project out of the anus and cause discomfort.
Then the piles do not need any treatment like medicine or surgery, the only precaution they need to take is, make sure to have adequate fluid intake, they need not worry that they have piles and it may lead to other complications.
Can Piles turn into cancer?
Many people come with the fear that their piles can turn into cancer if untreated. This is a myth, haemorrhoids cannot turn into cancer, but haemorrhoids can be the first symptom of an underlying colonic cancer. So, if anyone has piles for 10 years it won’t turn into cancer, But when patients come with piles, we make sure to test for other tumors, or a mass , or a cancer, in the last 20-30 cm of the colon which can cause pressure on the blood vessels of the colon and thereby it can present as piles.
What are the complications of piles?
When the piles start causing symptoms like bleeding on and off in two three months,a bulge outside the anus and itching, many of these piles can be treated by:
preventing constipation,
use of a hot water tub,
local cream application,
a small rubber band or injection is given into piles to shrink it.
Small piles can be treated with these procedures itself, without any major procedure.
Do all piles need surgery, and can piles be cured without surgery?
Piles which have grown much larger in size, we have a grading of piles, grade I to IV , Large piles, like grade III or IV piles have grown much larger in size, such large pile masses which cause:
-frequent bleeding during motions,
-hanging out of the anus,
-itching,
-pain when they sit and work for long hours,
these are the piles which need more than medicines, using a laser beam the piles masses are shrunk and the piles problems are cured. Majority of piles cases are treated without surgery.
What are Fissures?
Sometimes patients confuse piles and fissures.
Fissures are an injury to the anus in the form of a small cut, since the anus is a sensitive area there will be a lot of pain for even small cuts, due to this pain the anus goes into spasm or a complete tight closed state. When the anus continues to be in a closed tight state for prolonged periods it causes the muscles to fatigue and there is constant pain sensation for the patient. In this case when the person tries to pass motion it becomes more and more difficult thus worsening the cut and thereby increasing the pain.
When surgery is needed for fissure?
Surgery is needed for a very small group of people with fissures, like 15% to 20%. The basic premise of the surgery is to relieve the anal spasm, the muscles of the anal region go into extreme tight state where the anal region is closed continuously for long time. If prolonged spasm when it fails to cure by simple medicines, in such cases a surgery where a small cut is made at the anal sphincter and released partially, thus the tightness comes down, the anal relaxes and the fissure gets chance to heal, nowadays this is done using laser rather than a knife, it is punctured using a laser and the pain is less or very minimal and the patients get released by end of the day, the pain relief is immediate.
The fissure patients come with extreme pain in the morning, when they undergo a laser sphincterotomy, by evening they are absolutely pain free.The pain relief is instantaneous, but this surgery is needed only in a small group of people with fissures.Majority of fissure patients cure with medications alone.
Do fissures come back after surgery?
The fear of repetitive fissures if one undergoes surgery for fissure is like saying if one gets operated for a fracture the fear of having another fracture is higher or lower, but in reality it’s the same. Fissures is not a disease it is a wound and once cured it may or may not repeat depending upon your lifestyle and eating habits. If one suffers from prolonged constipation and passes very hard stools they are at risk for fissures.
by
Dr. G. Parthasarathy
Sr. Consultant, Surgical Gastroenterology, Laparoscopic & Hepato-Pancreaticobiliary Surgery
@KIMS Hospitals Secunderabad