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Signs and Symptoms

The exact cause of symptomatic haemorrhoids is unknown. Multiple factors play role in development of piles. These include

• Irregular bowel habits (constipation and diarrhoea)
• Increased intra-abdominal pressure – like in pregnancy, prolonged straining
• Low fibre diet
• Ageing
• Some studies have incriminated genetics as a possible cause
• Other risk factors like – lack of exercise, obesity, smoking, prolonged sitting etc.

Symptoms of Haemorrhoids

• Internal haemorrhoids usually cause painless bright red bleeding during or after defecation. Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus.
• External haemorrhoids can become painful when thrombosed.

Grading of haemorrhoids

• Grade I – No prolapse, only dilated veins.
• Grade II – Haemorrhoids prolapse but reduce spontaneously on its own.
• Grade III – Haemorrhoids prolapse but have to be repositioned manually.
• Grade IV – Haemorrhoid are permanently prolapsed and cannot be repositioned manually.

Treatment

• Conservative – includes high fibre intake, plenty of oral intake, sitz bath/hot fomentation, laxatives and topical agents.
• Rubber Band Ligation – a rubber band is applied to haemorrhoid above the dentate line to cut off its blood.
• Injection Sclerotherapy – an injection of sclerosing agent is given in the internal haemorrhoids which causes veins to collapse leading to shrinking of haemorrhoids.
• Grade IV – Haemorrhoid are permanently prolapsed and cannot be repositioned manually.
• Surgery – Excisional haemorrhoidectomy –is surgical excision of haemorrhoid. It is associated with significant post-operative pain.
• Stapled Haemorrhoidectomy - it is associated with relative less post-operative pain and relative faster recovery than the conventional haemorrhoidectomy.
• Laser Surgery.
• Other procedures like infra-red have been tried with variable success rates.