Too much pressure on the veins in the pelvic and rectal area causes hemorrhoids/piles. Normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch. This can cause hemorrhoids/piles. Diarrhea or constipation also may lead to straining and can increase pressure on veins in the anal canal. Being overweight can also lead to hemorrhoids/piles. Pregnant women can get hemorrhoids/piles during the last 6 months of pregnancy. This is because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids/piles worse.
The most common symptoms of both internal and external hemorrhoids/piles include: Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement. Itching.
Rectal pain. It may be painful to clean the anal area.
With internal hemorrhoids/piles, you may see bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may see blood on the surface of the stool.
Internal hemorrhoids/piles often are small, swollen veins in the wall of the anal canal. But they can be large, sagging veins that bulge out of the anus all the time. They can be painful if they bulge out and are squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off. If hemorrhoids/piles bulge out, you also may see mucus on the toilet paper or stool.
External hemorrhoids/piles can get irritated and clot under the skin, causing a hard painful lump. This is called a thrombosed, or clotted, hemorrhoid.
A number of surgical techniques may be used if conservative management and simple procedures fail. All surgical treatments are associated with some degree of complications including bleeding, infection, anal strictures and urinary retention, due to the close proximity of the rectum to the nerves that supply the bladder. There may also be a small risk of fecal incontinence, particularly of liquid, with rates reported between 0% and 28%.Mucosal ectropion is another condition which may occur after hemorrhoidectomy (often together with anal stenosis).This is where the anal mucosa becomes everted from the anus, similar to a very mild form of rectal prolapse.
DGHAL + RAR (Doppler Guided Haemorrhoidal Artery Ligation + Recto Anal Repair :
DGHAL or HALO is performed under general anaesthetic. This operation is designed to eradicate piles without the need for cutting. The operation uses a miniature ultrasound device to locate the blood vessels supplying the haemorrhoids. The aim of the operation is to cut off the blood supply to the haemorrhoids. This is achieved by placing a stitch around each blood vessel. Over the following few weeks to months, the piles shrink away and the symptoms resolve. Some pain is to be expected for several days after the operation and this is usual.
Occasionally, for bigger haemorrhoids the surgeon may suggest a modification of the HALO procedure called RAR (Rectoanal repair). This is where further stitches are used to draw up larger haemorrhoids which may prolapse or hang down through the anal canal. These stitches are then tied to the original stitch, thereby hitching the haemorrhoid back into position and thereby encouraging it to shrink and hold back into position up inside the anus. While this procedure works well, the hitched stitches do cause some pain in the aftermath of the operation and normally we would advise you to have two weeks off work. The pain is still usually a bit less and with a quicker recovery than the alternative, which is a conventional open operation.
Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid used primarily only in severe cases. It is associated with significant post-operative pain and usually requires 2–4 weeks for recovery. However, there is greater long term benefit in those with grade 3 hemorrhoids (Prolapse upon bearing down and requires manual reduction) as compared to rubber band ligation. It is the recommended treatment in those with a thrombosed external hemorrhoid if carried out within 24–72 hours. Glyceryl trinitrate ointment post procedure, helps both with pain and healing.
Stapled hemorrhoidectomy also known as stapled hemorrhoidopexy, is a procedure that involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids. However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorroidectomy and thus it is typically only recommended for grade 2 (Prolapse upon bearing down but spontaneously reduce) or 3 (Prolapse upon bearing down and requires manual reduction) disease.