Piles
Pales or haemorrhoids is one of the commonest diseases in Bangladesh. They are blood filled anal
cushions. We are all born with piles, which are needed for continence or to prevent leakage of stool
from anal canal.

Who has piles?
Piles can happen at any age but are most common in young adults. Rare in infants and children.

Who has haemorrhoids?

Haemorrhoids is common in-
 People who are overweight
 During pregnancy.
 People who eat a low-fibre diet.
 People who have long term constipation or diarrhoea.
 People who lift heavy objects.
 People who sit in the toilet for a long time.
 People who strain during defecation.

What are the types of haemorrhoids?
 External- swelled skin around the anal canal. Do not bleed but may become painful called
thrombosed haemorrhoids. Usually no treatment is required.
 Internal – Swellings coming out of the anal canal. Usually bleeds. Requires treatment.

Symptoms of internal haemorrhoids
– Fresh painless bleeding, usually drop by drop.
– An external swelling may be felt, which may or may not reduce.
– Sometimes itching or discomfort
Investigations
– Digital rectal examination
– Proctoscopy
– Colonoscopy
Treatment
– Lifestyle modifications
o Drink more water.

o Ispagula husk
o Increase fibre containing diet- fruits and vegetables.
o Loose weight
o Regular exercise
o Do not sit in toilet for long periods.

– Medications
o Diosmin + hesperidin
o Tropical ointments.
o Stool softners
– Surgery- when conservative treatment and medications fail
o Open haemorrhoidectomy
o Rubber ring ligations
o Longo operations
o Laser operations