Prevalence of piles

Piles or Haemorrhoids has become a common disease in Kashmir now with majority of the patients complaining about the issue. On an average scores of the patients visit to the Out Patients Department in the hospitals complaining about various symptoms that lead to the piles,daily.

The prevalence of symptomatic haemorrhoids is estimated over 4 % Worldwide. And Kashmiris to this diseases are no different considering the change in the life style particularly food habits of the locals here.

Before speaking about the symptoms of the factors that led to piles, let us know what it actually means and how does it occur.

Often a commonly used word by a patients with such complication are “I have something coming out of rectum or I get bleeding while defecation, or even I had painful defecation or an itching.”

While a few patients complain about a single symptom, many tell multiple complications that make their lives uncomfortable.

If we go by its literal definition, Haemorrhoids or piles mean dilated (enlarged) veins in the walls of the anus and sometimes around the rectum, usually caused by untreated constipation.

As per the medical science Piles are enlarged anal cushions in anal area at 3, 7 and 11o clock position corresponding to position of vein(Superior haemorrhoidal vein).

Piles occurring other than these positions are called secondary piles. Any factor leading to straining is putting pressure on these veins leads to their enlargement with no preventive or therapeutic treatment. There occurs graded enlargement of plies from Grade I to Prolapsed piles. With enlargement, bleeding, itching, painful defecation or boggy swelling is felt.

Technically in majority of such patients, constipation will be common most issue or complaint. This etiology (cause) is not restricted to constipation only, but pregnancy, drugs, prolonged sitting (inactive life style) , colon tumours proximal to anal canal etc., are often described as reasons behind this problem.

Sometimes sentinel pile, a tag of skin usually 1 cm or more is usually seen in females especially after pregnancy associated with chronic anal fissure.

Frequent consumption of non-vegetarian diet, intake of less fluids and irregular bowl habits are believed to be major reasons for piles especially in our Kashmir.

What to do and what not to do is pivotal at each stage in this diseases. As said, prevention is better than cure, high fiber diet, plenty of oral fluid and avoidance of food causing constipation is vital preventive measures for all who have and who want to prevent piles.

Most of times, this procedure could be beneficial for initial grades. For all modalities of treatment, prevention and treatment of avoiding straining during passing out stools is of utmost importance.

Traditional treatment is permissible for Grade I to early Grade III.

Likewise, if traditional methods fail, other non -operative methods have a role to play to deal with this diseases.

These include injection therapy with sclerosing agents, Banding, Cryoablation or the Laser Banding and injection.

Therapy is recommended for early grades;Cryoablation and laser are also recommended. Surgery is last resort.

Ligation and excision of piles is commonly used procedure done under spinal anaesthesia.

A nagging pain persists for few days which subsides of its own.

Recently MIPH has evolved for piles, a minimally invasive technique which is less painful and early recovery.

In nutshell treatment for this disease includes changing the diet to prevent constipation and avoid further irritation, the use of topical medication.

Avoiding constipation and straining due to stools is the best option to avoid piles.

(The author is currently deputed as senior doctor and surgeon at Sub District Hospital Pattan)