What Are The Types and Grades Of Piles?
Piles can be classified into the following based on their location and characteristics:
Internal Piles
Internal piles develop inside the rectum above the dentate line. They are not visible from the outside
and are categorized into different grades based on their severity and prolapse.
- Grade 1: Grade 1 piles are the mildest form of internal piles. They are small and
found in the
lining of the
rectum. They do not protrude out of the anus and usually do not cause any symptoms. Treatment
for
Grade 1 piles often begins with conservative measures, like lifestyle modifications, sitz baths,
topical creams or ointments, etc.
- Grade 2: Grade 2 piles are larger than Grade 1 and may protrude during bowel movements.
They
protrude from the anus but spontaneously retract back into the rectum after the bowel movement.
Treatment options for Grade 2 piles may include non-surgical interventions like rubber band
ligation, infrared coagulation, and sclerotherapy.
- Grade 3: Grade 3 piles also prolapse during bowel movements but do not retract
independently.
They need to be manually pushed back into the rectum. They may cause significant discomfort,
pain, itching, bleeding, and difficulty maintaining proper hygiene. Treatment options for Grade
3 piles may include rubber band ligation, infrared coagulation, and sclerotherapy.
- Grade 4: Grade 4 piles are the most severe and advanced stage. They remain prolapsed
and
cannot be manually repositioned. These piles are large, inflamed, and highly sensitive. Grade 4
piles can cause intense pain, bleeding, and hygiene difficulties. In addition, they may also be
associated with complications such as thrombosis (blood clots) or strangulation. Surgical
intervention may be necessary for Grade 4 piles, and options may include laser surgery and
stapled hemorrhoidectomy.
External Piles
External piles form around the external opening of the anus and can be seen or felt as lumps or bumps.
They are found below the dentate line and may induce pain, itching, and discomfort. External piles can
be treated using conservative methods
Conservative treatment options for external piles include sitz baths, topical creams or ointments, pain
medications, etc. However, surgery like laser surgery and stapled hemorrhoidectomy may be recommended
for external piles if conservative treatments fail to provide relief or if the condition becomes severe.
Surgical intervention is usually considered when external piles become thrombosed, causing severe pain
and discomfort.
How Can Piles Be Diagnosed?
A proctologist or an anorectal surgeon can diagnose piles through medical history, physical examination,
and diagnostic tests if required. Here is an overview of the diagnostic process for piles:
Medical History: Your healthcare provider will start by asking about your symptoms,
including any pain, itching, bleeding, or changes in bowel movements. They will also ask about
your medical history and any previous occurrences of piles.
Physical Examination: A physical examination of the anal region will be conducted to
evaluate for external and internal piles. The healthcare provider may visually inspect the area
and gently examine the anus and rectum using gloved fingers to check for abnormalities,
swelling, or lumps.
Digital Rectal Examination (DRE): In some cases, a digital rectal examination may be
performed. It involves the insertion of a lubricated, gloved finger into the rectum to assess
the internal piles and check for any other rectal abnormalities. The procedure is typically fast
and involves less pain.
Anoscopy or Proctoscopy: These procedures involve using a small, lighted tube called
an anoscope or proctoscope to examine the anal canal and rectum more closely. Anoscopy and
proctoscopy directly visualize the anal canal and rectum, allowing for a more detailed
examination of piles and other rectal disorders. These procedures can help determine the
location, size, and severity of the piles, guiding the healthcare provider in developing an
appropriate treatment plan.
Sigmoidoscopy: In this procedure, the healthcare provider uses a sigmoidoscope (lighted
tube with a camera) to view the lower part of the colon and rectum. Procedure types include
flexible sigmoidoscopy and rigid sigmoidoscopy. Flexible and rigid sigmoidoscopy allows
healthcare providers to directly visualize the rectum and lower sigmoid colon, aiding in
identifying various conditions, including piles.
Colonoscopy: Colonoscopy helps examine the colon or the large intestine to check the
abnormalities inside it. A colonoscopy evaluates rectal bleeding due to piles or other causes
and rules out more serious problems so the doctor can suggest the most appropriate treatment for
piles.
What Are The Different
What Are The Different Treatment Options For Piles?
Piles can be treated using both non-surgical and surgical methods. Here are some common non-surgical and
surgical treatments for piles:
Non-surgical Treatment
Non-surgical treatments for piles include the following:
- Rubber band ligation: Rubber band ligation is a commonly used non-surgical treatment
for internal piles. To do this procedure, a doctor inserts a viewing scope (anoscope) into the
anus. A special instrument called a ligator is used to place a small rubber band at the base of
the piles. The rubber band cuts off the blood supply to the piles, causing it to shrink and
eventually fall off within a few days. The procedure takes about 30 minutes, and you can go home
when it's done. The recovery time after rubber band ligation is typically short, and most
individuals can resume their normal activities within a few days.
- Sclerotherapy: Among the wide range of treatment options for managing piles, a
non-surgical modality is sclerotherapy. During sclerotherapy, a solution (sclerosant) is
injected into the affected vein, causing it to shrink and eventually fade away. It is typically
used for the treatment of internal piles. Since sclerotherapy is a non-surgical procedure, it
generally offers a faster recovery time than surgical interventions.
- Infrared photocoagulation: Infrared photocoagulation is a medical procedure for
treating small and medium-sized piles. This treatment is only for internal piles. During the
procedure, the doctor uses a device that produces an intense beam of infrared light. The heat
from infrared light causes scar tissue, which cuts off the blood supply to the piles. The piles
shrink and eventually fall off, and scar forms on the wall of the anal canal. The scar tissue
holds nearby veins in place so they don't bulge into the anal canal. The recovery time after
infrared photocoagulation is typically short. Most individuals can resume their normal
activities immediately after the procedure.
- Electrocoagulation: This procedure uses an electric current to destroy the piles. In
this procedure, a proctoscope is placed in the anus to locate the piles. A probe is then placed
at the base of the piles, and an electric current is delivered to the piles using a handpiece
connected to the probe. The purpose is to use the electric current to thicken the blood in
vessels and cauterize it at the base. The piles then start to shrink. The recovery time after
electrocoagulation for piles can vary from person to person, and it depends on factors such as
the size and severity of the piles, as well as individual healing capabilities.
Surgical Treatment - Operation for Piles
Surgery is the best and most sure-shot method of piles treatment. Piles need surgery in cases where home
remedies, medications, and other conservative measures have failed to provide relief or when the piles
are severe or persistent. Some common types of piles surgery include:
- Open surgery-Open surgery, or open hemorrhoidectomy, is a traditional surgical
procedure to remove piles. In this procedure, the surgeon makes an incision in the anal region
to locate the piles. The incision is generally made around the anus or in the anal canal,
depending on the location and severity of the piles. The surgeon carefully removes the piles
using surgical instruments, and the technique may involve excising the piles or ligating them
with sutures to restrict their blood supply. The goal is to completely remove or reduce the size
of the piles. The complete recovery time after open surgery for piles can vary from several
weeks to a few months. It depends on factors such as the extent of the surgery, individual
healing abilities, and adherence to post-operative care instructions.
- Stapler surgery-Stapler surgery or stapled hemorrhoidectomy is a surgical method for
treating piles. It utilizes a stapling device to remove piles tissues. Doctors suggest this
treatment procedure for patients whose piles have prolapsed or become abnormally large or who
have shown little or no improvement with nonsurgical treatment. Under stapler surgery, the piles
tissue is lifted into a ring of tissues with sutures, and a stapler removes it, restricting
blood flow to the tissue. As a result, patients who undergo stapler surgery typically experience
less pain than those who undergo traditional piles surgery. They also experience less bleeding,
itching, and swelling around the anus and inside the rectum. Recovery from stapler surgery is
quick and is linked to fewer complications.
- Laser surgery- Laser surgery is the safest and most effective surgical option to treat
piles. This procedure uses laser energy to shrink and coagulate the piles tissue. However, the
surrounding healthy tissues remain unaffected. Laser surgery is a minimally invasive approach
performed on an outpatient basis. It is associated with minimal post-operative pain and a
relatively shorter recovery time.
.jpg)
