TRYING to find out what piles means to an average Nigerian is usually an interesting experience. If one asks the question: “What is pile?” the answers one gets can be as varied as the number of people asked. To most Nigerians, pile is anything ranging from diarrhoea, constipation, bleeding from the anus, prolapse of the rectum, to other diverse symptoms like low back pain, reduced libido, failure of ejaculation in males and many other symptoms of lower intestinal tract disorder.
What really is “Pile”?
In a strict use of the word, pile refers to haemorrhoids, which is a dilation of certain blood vessels in the rectum. The rectum is the lowermost part of the alimentary canal from where we defaecate through the anus.
However before going further, one must hasten to say that depending on the age, there can be several other causes of bleeding from the anus which must be eliminated before labelling the bleeding as haemorrhoids or piles. They include:
(i) Fissures in the anus
(ii) Tumours of the rectum or colon
(iii) Ulceration of the colon
(iv) Injury to the anus
(v) Massive bleeding from the upper parts of the alimentary canal e.g. bleeding duodenal ulcer.
In children, the rectum may be prolapsed in cases of malnutrition or severe electrolyte inbalance.
Therefore “piles” or “haemorrhoid” should only be used to describe either the passage of bright red blood per rectum or the prolapsed of the rectum during defaecation. Haemorrhoid is certainly not caused by eating sweet things, and those myriads of symptoms like diarrhoea, low back pain, reduced libido etc, which are usually attributed to piles, should really be examined on their own merits.
Haemorrhoids are classified into three stages and people who have experienced this condition before would agree that the stages are quite distinct.
Stage 1 or first degree haemorrhoids:
This is earliest stage. The affected person usually notices that his/her faeces is blood stained or quite commonly he/she notices that after defaecation he or she notices that after defaecation he or she passes some bright red blood too and attempts to clean up result in several lengths of toilet paper being stained with blood. There is no prolapsed noticed at this state.
Second degree haemorrhoids: In this stage, the rectum prolapses during defaecation but in either reduces spontaneously on its own or later it may have to be pushed in by the affected person. There is usually no pain experienced in this stage.
Third degree haemorrhoid: In this stage, the prolapsed rectum cannot be reduced by the patient and it remains prolapsed. Both stage II and III may be accompanied by bleeding which may be profuse in some cases.
As mentioned above, the two usual presenting symptoms are rectal bleeding and/or prolapsed. Pain is not a usual symptom and when this occurs, it shows that certain complications have set in.
Complications of haemorrhoids
Haemorrhoids can remain in the first degree stage for many years coming on and off before the patients start to notice prolapsed during defaecation. The two common complications of haemorrhoids are Anaemia and strangulation of the pile.
1. Anaemia: The frequent rectal bleeding that occurs in haemorrhoids even where the bleeding appears to be minimal may be sufficient to deplete the patient’s store of iron and he presents with features of anaemia. In some exceptional cases there may be episodes of bleeding that may be severe enough to warrant the patient being transfused.
2. Strangulation: in a few instances a haemorrhoid in stage 2 or 3 may become gripped by the anal
Sphincters so much that blood flow will be obstructed. When this happens the haemorrhoid is said
to be strangulated and it is usually accompanied by excruciating pain. Such a case should be taken to
the hospital as an emergency.
There are several approaches to the treatment of piles, depending on the stage of presentation and
other accompanying circumstances.
1. Use of suppositories: In the early stages the use of suppositories containing steroids may be sufficient to reduce inflammation and change a second degree haemorrhoid to a first degree type.
II. Surgical treatment:
Contrary to the beliefs of many haemorrhoid patients that surgical treatment means cutting off their rectum, there are several surgical approaches that can be made. These include:
(a) Identification and excision of the dilated vessels
(b) Use of electrocoagulation of the vessels
(c) Use of a very cold solution (liquefied carbon dioxide) to freeze out the offending vessels or
(d) Simply tying off the dilated haemorrhoidal vessels.
The surgeon is the person to decide on which method to use.
-By Dr. Wale Shobowale