Treatment of piles using Sclerotherapy by Dr. Karun Verma

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What are piles (hemorrhoids)?

Piles (hemorrhoids) are swellings or mass of swollen veins that develop inside and around the back passage (anus). Symptoms of piles include bleeding from anus while passing stools, feeling of anal mass and sometimes if pile mass gets swollen it may also cause pain in anal region.

The anal canal is the last part of the large intestine and is about 4 cm long. At the lower end of the anal canal is the opening to the outside (usually referred to as the anus), through which feces pass. At the upper end, the anal canal connects with the rectum (also part of the large intestine).

There is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged with more blood than usual along with the swelling of overlying tissue and then form into one or more small swellings called piles.

What are the different types of piles (hemorrhoids)?

Internal piles : are those that form above a point 2-3 cm inside the back passage (anus) in the upper part of the anal canal. Internal piles are usually painless because the upper anal canal has no pain nerve fibers.

External piles : are those that form below that point, in the lower part of the anal canal. External piles may be painful because the lower part of the anal canal has lots of pain nerve fibers.

Some people develop internal and external piles at the same time.

What are the stages of piles?

Internal piles can be classified into grades 1 to 4 according to their severity and size:

Grade 1 are small swellings on the inside lining of the anal canal. They cannot be seen or felt from outside the anus. Grade 1 piles are common. In some people they enlarge further to grade 2 or more.
Grade 2 are larger. They may be partly pushed out from the anus when you go to the toilet, but quickly spring back inside again.
Grade 3 hang out from the anus when you go to the toilet. You may feel one or more as small, soft lumps that hang from the anus but you can push them back inside the anus with a finger.
Grade 4 permanently hang down from within the anus, and you cannot push them back inside.

What causes piles (hemorrhoids)?

Constipation, is probably the most common cause. These increase the pressure in and around the veins in the anus and seem to be a common reason for piles to develop.
Pregnancy. Piles are common during pregnancy. This is probably due to pressure effects of the baby lying above the rectum and anus.
Ageing. The tissues in the lining of the anus may become less supportive as we get older.
Hereditary factors. Some people may inherit a weakness of the wall of the veins in the anal region.

Diagnosis Of Piles

If you think that you may have piles (hemorrhoids), or have bleeding or pain from your back passage (anus), you should visit your doctor as bleeding from anal region can be a sign of some serious problem like Cancer or Ulcers in large intestine.

Piles are diagnosed by doctor by doing physical examination and if required Video Proctoscopy and sigmoidoscopy can be done.

TREATMENT OF PILES

Following treatment modalities are being used for the treatment of piles:

Sclerotherapy – Phenol in oil is injected into the tissues at the base of the piles using a special type of syringe and needle. This causes a scarring (fibrotic) reaction which obliterates the blood vessels going to the piles. The piles then die and drop off. This technique is usually used by a doctor during an OPD.

Band Ligation: In this technique a rubber band is put over a pile mass and it cuts off the blood supply to the pile mass which dies and drops off. This technique can also be performed during a routine OPD visit of the patient.

Infrared coagulation/photocoagulation – this method uses infrared energy to burn and cut off the circulation to the hemorrhoid, which causes it to shrink in size. It seems to be as effective as banding treatment and injection sclerotherapy for first- and second-degree piles.

At our Centre we have been treating patients with combination of Sclerotherapy and Band Ligation and the results of technique are phenomenal. The benefits of this technique are that the patient can return to the work same day after the procedure with minimal or no pain. There is no need for any admission and bed rest. Moreover no tissue is cut during the procedure and thereby reducing the side effects which usually result from the surgery. Compared to the surgery the cost of this procedure is also very less.

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