Hemorrhoids (AmE), haemorrhoids (BrE), emerods or piles are varicosities or swelling and inflammation of veins in the rectum and anus. Hemorrhoids are actually the anatomical term for "’cushions of tissue filled with blood vessels at the junction of the rectum and the anus." However, the term has come into common usage to indicate the condition described herein. Perianal hematoma are sometimes misdiagnosed and mislabeled as hemorrhoids, when in fact they have different causes and treatments.

Piles are tissue of the anus rich in blood vessels. Piles are incredibly common; at least 50 percent of people suffer with them at some time. In the USA, the prevalence is about 4.4%. These may be associated with pain, bleeding, itching and feeling as if a lump or bump is hanging down your backside. Piles look like round pink swellings, the size of a pea or a grape. Sometimes they are of a blue color.

Basic Treatment of Hemorrhoids

Medical treatment of piles is aimed initially at relieving symptoms. Over-the-counter corticosteroid creams can reduce pain and swelling. Other treatments, on the other hand, involve more prevention on the part of the patient than cures. For example, one should always avoid toilet tissue with colors or perfume, eat more leafy green vegetables (which will make stools bulkier and softer to relieve) and drink more liquids.

When thrombosis, pain and tenderness occur, a ten to twenty minute hot tub bath two to four times daily brings heat to the area, provides relief from the pain and promotes healing. This is called a hot Sitz bath treatment. With that in mind, a piles sufferer should always keep the anus safe by practicing good personal hygiene; that is, keep the anal area clean and avoid using rough toilet paper.

Surgical/Non-Medicinal Treatments for Hemorrhoids

Some people require the following medical treatments below for chronic or severe hemorrhoids; indeed, if the case of piles has become quite serious, then drastic measures such as laser treatment and surgery may be implemented.

• Rubber band ligation: Sometimes called Baron ligation. Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.
• Hemorrhoidolysis/Galvanic Electrotherapy: Desiccation of the hemorrhoid by electrical current.
• Sclerotherapy (injection therapy): Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
• Cryosurgery: A frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues. Rarely used anymore because of its side effects.
• Laser, infrared or BICAP coagulation: laser, Infrared beam or electricity is used to cauterize the affected tissues. Lasers are now much less popular. Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to Grade III. These are the most readily available non-surgical procedures in the US.
• Hemorrhoidectomy: A true surgical procedure to excise and remove hemorrhoids. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason is often now recommended only for severe (Grade IV) hemorrhoids.
• Stapled Hemorrhoidectomy: Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It’s meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.
• Enema: This practice is used to clean the rectum. While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor. In an enema, water is injected into the rectum and then flushed out, cleaning the area.
• Doppler-Guided Hemorrhoidal Artery Ligation: The only evidence-based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately.
• HAL-RAR: To date, Doppler Guided Hemorrhoidal Artery Ligation was indicated in management of Grade II & Grade III Hemorrhoids but with the availability of HAL Recto Anal Repair (HAL-RAR) Management, prolapsing hemorrhoids without excision has also become possible.
• Transanal Hemorrhoidal De-Arterialization (THD): Similar to HAL, but more standardized and therefore safer, less painful and has a shorter recovery time.

Prevention of Hemorrhoids

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber (such as fiber supplements, fruits, vegetables and cereals high in fiber), exercising, practicing better posture and reducing bowel movement strain and time.

• Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight underwear.
• Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking extra dietary fiber and fluids a couple days prior to that time. Fluids emitted by the intestinal tract may contain irritants that can increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.
• Kegel exercises for the pelvic floor may also prove helpful. Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily) and small changes in a person’s daily diet can help tremendously in both prevention and treatment of hemorrhoids.
• Based on their very low incidence in the developing world—where people squat for bodily functions—hemorrhoids have been attributed to the use of the unnatural "sitting" toilet. In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets.

Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. No follow up studies have ever been published. The American Society of Colon & Rectal Surgeons is silent regarding the therapeutic value of squatting.

Causes of Hemorrhoids

Piles can be internal, inside the anus, or external and also be seen and felt on the outside of the anus. You can have internal and external piles at the same time. It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the world’s population will be affected by hemorrhoids at some time in their life.

• The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements and too much pressure on the rectal veins due to poor muscle tone or poor posture. It is thus a common condition due to constipation being caused by water retention in women experiencing premenstrual syndrome or menstruation.
• Hypertension, particularly portal hypertension, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall—known as portocaval anastomoses.
• Obesity can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause hemorrhoids. Poor muscle tone or poor posture can also result in too much pressure on the rectal veins.
• Pregnancy causes hypertension, which in turn and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy. Also, anal sex without sufficient lubricant can also cause excessive strain to rectal veins and is in fact one of the most common causes of hemorrhoids amongst otherwise healthy young adults.
• Excessive consumption of alcohol or caffeine can cause hemorrhoids, because both drinks can cause diarrhea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension.

Symptoms of Hemorrhoids

Hemorrhoid prevalence peaks between forty-five and sixty-five years of age. The most common symptoms are fistulae, abscesses, irritation and itching (pruritus ani) and painful bleeding. People whose parents had piles may be more likely to get them. Pregnant women often get piles because of the strain from carrying the baby and from giving birth.

Other symptoms of external piles may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as thrombosed external piles. In addition, excessive straining, rubbing or cleaning around the anus may cause irritation with bleeding and/or itching, which may also produce a vicious cycle of other symptoms. Draining mucus may also cause itching.

There is some overlap with symptoms of rectal and anal carcinoma; always consult a doctor. In any case, people with hemorrhoids may experience the following common symptoms:

• Pruritis Ani (itchiness around the anal canal).
• Bleeding, usually bright red, ranging from light staining of toilet paper to profuse hemorrhaging.
• Mucous discharge.
• Pain, mainly in thrombosed hemorrhoids.
• Palpable lump/mass in prolapsed hemorrhoids.