Wednesday, 18 September 2013

Diagnosis and Treatment of Piles (hemorrhoids)

Diagnosis

Most individuals who have hemorrhoids discover them in one several ways. They either feel the lump of an external hemorrhoid when they wipe themselves after a bowl movement, note drops of blood in the toilet bowl or on the toilet paper, or feel  a prolapsing hemorrhoid after bowel movements. Several anal pain may occur when an external hemorrhoid thromboses, or a prolapsing internal hemorrhoid becomes gangrenous. Symptoms of anal discomfort as well as itching may occur, but anal conditions other than hemorrhoids are more likely to cause these symptoms than hemorrhoids. Hemorrhoids get a "bum rap" for such symptoms since both hemorrhoids and other anal conditions are common and may occur together. For example, up to 20 percent of individual with hemorrhoids also have anal fissures.

Now by the history of the symptoms, the physician can suspect that hemorrhoids are present or not. Although the physician should try his or her best to identify the hemorrhoids, it is  perhaps more important to exclude other causes of hemorrhoid-like symptoms that require different treatment. These other causes - anal fissures, fistulae, perianal (around the anus) skin diseases, infections, and tumors - can be diagnosed on the basis of a careful examination of the anus and anal canal. If necessary, scrapings of the anus to diagnose infections and biopsies of the perianal  skin to diagnose skin diseases can be done.

External hemorrhoids appear as a bump or dark area surrounding the anus. If the lump is tender, it suggests that the hemorrhoid is thrombosed. Any lumps need to be carefully followed, however, and should not be assumed to be a hemorrhoid since there  are rare cancers of the perianal area that may masquerade as external hemorrhoids

The diagnosis of an internal hemorrhoid is easy if the hemorrhoid protrudes from the anus. Although a rectal examination with a gloved finger may uncover an internal hemorrhoid high in the anal canal, the rectal examination is more helpful in excluding rare cancers that begin in the anal canal and adjacent rectum. A more through examination for internal hemorrhoids is done visually using an anoscope . An anoscope is a three-inch long, tapering, metal or clear plastic hollow tube approximately one inch in diameter at its viewing end. The anoscope is lubricated and inserted into the anus, through the anal canal, and into the rectum. As the anoscope is withdrawn, the area of the internal hemorrhoid(s) is well seen. Straining by the patient, as if they are having a bowel movement, can make hemorrhoid(s) more prominent. Anoscopy is a very good way to diagnose anal fissures.

At times, indirect anoscopy can be helpful. Indirect anoscopy uses a special mirror for visualizing a patient's anus while the patient is seated and straining on a toilet. Indirect anoscopy allows the doctor to see the effects of gravity and straining on the anus. For example, the physician can be able to determine if what is prolapsing is a hemorrhoid, rectal lining, a rectal polyp, or the rectum itself [a condition called procidentia in which the rectum turns inside out and protrudes from the anus]. Whether or not hemorrhoids are found, if there has been bleeding, the colon above the rectum needs to be examined to exclude important causes of bleeding other than hemorrhoids. Other causes include, for example, colon cancer, polyps, and colitis ( inflammation of the rectum and/or colon). This examination can be accomplished by either flexible sigmoidoscopy or colonoscopy, procedures that allow the doctor  to examine approximately one-third or the entire colon, respectively.

Treatment options for the piles

In the majority of cases, piles resolve on their own without the need for any treatment. Treatment can help significantly reduce the discomfort and itching that may patients experience. A good doctor will initially recommend some lifestyle changes.

Body weight: If the patients is obese, losing weight may help reduce the incidence and severity of hemorrhoids.

Diet: Piles may be caused by too much straining when doing bowel movements, which is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber fruits and vegetables, or even switching your cereal breakfast to bran. Water is the best drink, and the patient may be advised to increase her/his water consumption. Some expert say too much caffeine isn't good.

Surgery: Surgery is used for particularly large piles, or Grades 3 or 4 hemorrhoids. Generally, surgery is used if other procedures were not effective. Sometimes surgery is done on an outpatient basis - the patient goes home after the procedure, or he/she may have to spend the night in hospital. 


3 comments:

  1. Wow! Thanks for sharing this valuable blog with us. I would like to share something useful with you regarding ayurvedic medicine for piles I hope this will help you as an inspiration for your next upcoming blogs.

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