(Piles) are varicose (swollen) veins in the lining of the ANUS. They are very common, affecting nearly half of the UK population at some time in their lives.
They are classified into first-, second- and third-degree, depending on how far they prolapse through the anal canal. First-degree ones do not protrude; second-degree piles protrude during defaecation; third-degree ones are trapped outside the anal margin, although they can be pushed back.
The veins in the anus tend to become distended because they have no valves; because they form the lowest part of the PORTAL SYSTEM; because they are apt to become overfilled when there is the slightest interference with the circulation through the portal vein; and partly because the muscular arrangements for keeping the rectum closed interfere with the circulation through the haemorrhoidal veins. Lack of fibre in Western diets is probably the most important cause. The result is that people often strain to defecate hard stools, thus raising intra-abdominal pressure which slows the rate of venous return to the heart and engorges the network of veins in the anal mucosa. Pregnancy is an important contributory factor in women developing haemorrhoids. In some people, haemorrhoids are a symptom of disease higher up in the portal system (see LIVER), causing interference with the circulation. They are common in heart disease, liver complaints such as cirrhosis or congestion, and any disease affecting the bowels.
Piles cause itching, pain, and often bleeding, which may occur either occasionally or whenever the patient defecates. The patient may complain of aching discomfort and piles may PROLAPSE permanently or intermittently.
Prevention is important; a high-fibre diet will help in this, and is also necessary after piles have developed. Patients should not spend a long time straining on the lavatory. Itching can be lessened if the PERINEUM is properly washed, dried and powdered. Prolapsed piles can be replaced with the finger. Local anaesthetic and steroid ointments can help to relieve symptoms when they are relatively mild, but do not remedy the underlying disorder. With prolapsing piles or non-prolapsing piles when the above measures do not work, persons may seek surgical referral. First- and second-degree piles are usually treated by rubber band ligation or by injecting them with oily phenol (with suitable pain control, of course). Third-degree piles can also be dealt with by techniques, such as stapling or Doppler guided resection.