Piles is a common health condition that can be cured with medication and simple outpatient procedures. You should consult a doctor to determine which type of piles you have to start the best suitable treatment. The types, symptoms, and treatments of piles are interlinked, and the doctor decides your care plan on the basis of symptoms associated with different types of piles. Keep reading to learn more about the condition.
- What is piles?
- How many types of piles are there?
- Internal haemorrhoids
- External haemorrhoids
- Thrombosed haemorrhoids
- Likely causes of piles
- Treatment options for piles
What is Piles?
Commonly referred to as piles, haemorrhoids (or hemorrhoids) are swollen veins in and around your rectum and anus. Usually, haemorrhoids are caused by excessive pressure and strain in the intra-abdominal region. It is a fairly common health condition that affects about 1 in every 20 people in India.
People don’t often notice it because the haemorrhoids heal on their own. Painless rectal bleeding during or after a bowel movement is usually the most common symptom of piles.
What are the Different Types of Piles?
Based on the location, size, and nature of haemorrhoids, they are majorly categorised into two types—internal and external. Your doctor will perform a physical or digital examination of the rectum (sometimes they may also perform a colonoscopy) to determine the best course of action to treat you. Here are the different haemorrhoid types:
These haemorrhoids develop inside the rectum and are usually not visible. The size of these internal haemorrhoids may vary from person to person and the stage of the disease. Internal haemorrhoids are further categorised into four grades:
- Grade I
These are usually small in size and do not cause any noticeable symptoms. Often enough, grade I piles will heal on its own if the patient changes their lifestyle, dietary, or excretion habits. But if blood is seen in the toilet bowel or the tissue paper after passing waste, consult a doctor as rectal bleeding is the only symptom of this stage. Treatment for grade I piles is medication.
- Grade II
If you have had piles for some time without knowing and you continue living the same way, chances are the haemorrhoids increased in size. Grade II haemorrhoids are slightly bigger in size than grade I haemorrhoids; they prolapse (fall out of the rectum) when you apply pressure and recede when you relax.
People with grade II haemorrhoids notice rectal bleeding and might also feel a lump in their rectum. Upon consulting with the doctor, you will learn the likely causes of your piles and the doctor will prescribe some medicines and dietary changes to treat you.
- Grade III
Haemorrhoids that prolapse during bowel movements or at other times and require you to push them back in are classified as grade III piles. You may experience discomfort due to these, in addition to the rectal bleeding. Most suitable treatment options for grade III piles usually involve a minimally invasive surgery along with dietary changes and medicines.
- Grade IV
This is an advanced stage, which requires the doctor to treat it immediately with the help of surgery. Grade IV haemorrhoids cannot be pushed back inside after prolapsing and need to be surgically removed. These haemorrhoids may become strangulated and cause intense pain suddenly. Thus, it is important to consult a doctor as soon as possible.
As the name suggests, external haemorrhoids occur outside the rectum near the anus. People often think of external haemorrhoids when they are diagnosed with piles, as these are visible and palpable and internal haemorrhoids can’t be seen.
This type of haemorrhoids can cause severe pain and discomfort, disrupting day-to-day activities of the patient including sitting. Treatments for external haemorrhoids focus on alleviating pain and discomfort and changing the lifestyle of the person as they can heal on their own. For large haemorrhoids that are excessively painful, the doctor might recommend a haemorrhoidectomy surgery to remove them.
There is another type of haemorrhoid based on the severity of the condition—thrombosed haemorrhoids. These are extremely painful due to the formation of blood clots in the haemorrhoid. Although it is not life-threatening, it requires immediate medical attention to avoid complications. Thrombosed haemorrhoids, usually purple in appearance and very tender to touch, require surgical intervention to be removed and for the patient to heal.
Both internal and external haemorrhoids can become thrombosed. The doctor will confirm the diagnosis with the help of a digital rectal examination if you present them with extreme piles symptoms—intense pain, itching, burning, and swelling.
Likely Causes of Piles
Piles are associated with increased pressure in the tissue and blood vessels in and around the anus and rectum, which can cause swelling and inflammation. Here is a list of potential causes of piles:
- Constipation is the most common cause of piles as people who have constipation usually strain more during their bowel movements.
- Obesity can also increase the pressure in the rectal area among other things, which can lead to piles.
- Pregnancy and childbirth also cause increased pressure in the rectum.
- A fibre-deficit diet will make the stool harder to pass through and the person to strain more, thereby causing piles.
- People with a family history of piles are more likely to have piles.
- Strenuous physical activities such as intense workout or physical labour are also related to increased pressure in the rectal area.
Other likely causes include anal intercourse, ageing, inflammatory bowel disease, and chronic diarrhoea.
Treatment Options for Piles
Your doctor will create a care plan for you based on the multiple factors—age, overall health, severity of the condition, type of haemorrhoids, prognosis, and your response to different treatment methods. If the piles type and symptoms are not severe, the doctor will start with mild treatment options, such as the following:
- Haemorrhoid creams and other medicines to reduce pain and/or discomfort
- Ice packs to reduce swelling
- Sitting in warm water baths for a few minutes several times a day
- Adding more fibre in your diet and/or laxatives (stool softeners)
- Increasing your fluid intake
Many patients see their symptoms relieving in some times. For those who don’t see any improvement, the doctor might suggest any of the following treatments:
- Rubber band litigation
A process of tying the base of the haemorrhoid using a rubber band to cut off its blood supply. This causes the haemorrhoid to shrink and fall of on its own in a while.
- Electrical coagulation (infrared photo coagulation)
Using a beam of infrared light, the doctor burns haemorrhoid tissue, and then, it can fall on its on in some time. Sometimes, people may refer to this as laser treatment.
Doctors inject a chemical solution (usually phenol oil) directly into the haemorrhoid that causes the haemorrhoid to shrink.
A surgical procedure to permanently remove the haemorrhoids. This does not guarantee that your haemorrhoids won’t return.
The type of piles disease can determine your treatment plan and the prognosis (how the disease will progress). Since piles is a common condition, many over-the-counter (OTC) medicines including, topical creams, are available for people to self-medicate.
Although these OTC medicines can be helpful in alleviating symptoms, they might not be enough to cure piles. Sometimes, piles-likes symptoms can mask other health problems such as anal fissures or fistulas and cancer in worst cases.
Thus, it is important that you get yourself checked by a doctor to confirm the diagnosis and have suitable treatment. You can also try changing your eating habits—increasing fibre and fluid intake—to minimise the risk of getting piles again after being cured.
Which type of piles is painful?
Thrombosed haemorrhoids are the most painful types of piles; these are tender purple haemorrhoids that have a blood clot inside them and need immediate medical attention. Apart from thrombosed haemorrhoids, grade III and IV internal piles and external haemorrhoids cause the most discomfort and pain.
How do I know what kind of haemorrhoid I have?
If the only symptom you have is blood on the toilet paper or in the bowl, you likely have grade I haemorrhoids or piles. Grade II piles also cause rectal bleeding and prolapse when you apply pressure. However, patients with grade III piles may have to push the prolapsed haemorrhoid in the rectum after their bowel movements in addition to experiencing rectal bleeding. If you have grade IV piles the prolapsed haemorrhoid doesn’t go inside even after pushing, it can only be removed surgically by a doctor.
Please note that it is best to consult a doctor if you suspect you have piles to eliminate other possibilities including rectal cancer.
What are different types of piles?
Based on the location of haemorrhoids, piles can be of two types—internal and external. Internal haemorrhoids are further categorised into four grades from I to IV on the basis of their size and whether they are prolapsing or not. There is another category of haemorrhoids—thrombosed haemorrhoids—which causes extreme pain and occurs due to a blood clot in the haemorrhoid.
Which is the most common type of piles?
Internal haemorrhoids is one of the most common types of piles; people with this condition have usually no prominent symptoms other than rectal bleeding. Piles is a common disease that about 1/20 people in India can have due to several risk factors.