Haemorrhoidectomy (Piles)

Haemorrhoids popularly called Piles, are swollen veins in your anus and lower rectum, which are similar to varicose veins. Piles can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids).

Nearly three out of four adults will have Piles from time to time. Piles have a number of causes which include lifestyle and hereditary factors. Fortunately, effective medicine and surgery options are available to treat piles. Many people get relief with medical treatment and lifestyle changes in the early stages.

Signs and symptoms of Piles usually depend on the type of haemorrhoid, i.e., Internal Haemorrhoid, External Haemorrhoid or Thrombosed Haemorrhoid.

If bleeding during bowel movements is seen or it’s a known case of piles that don’t improve after a week of home care, it is advisable to consult the doctor. Being mindful of the symptoms helps the doctors and the patients. Some of the common symptoms are:

Bleeding during and after passing stool
Large swellings (piles) in the anal area causing significant discomfort
Painful internal swelling or piles that make it difficult to sit
Sore and itchy anal region making it difficult to keep the area clean
Seek emergency medical care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

As you age, your risk of piles increases. That’s because the tissues that support the veins in the rectum and anus can weaken and stretch.

The veins around anus tend to stretch under pressure and may bulge or swell. This leads to the formation of Haemorrhoids. This can further develop from:

increased pressure in the lower rectum due to extra-strain during bowel movements
sitting for long periods of time on the toilet
having chronic diarrhea or constipation
obesity and pregnancy
having anal intercourse
eating a low-fiber diet
regular heavy lifting
Piles can become life-threatening if not treated early and some people are more at risk for developing haemorrhoids without the right lifestyle choices or precautionary measures.

It is important to treat haemorrhoids (Piles) at an early stage, or it may lead to massive bleeding and could require blood transfusions. It may also lead to cases of thrombosis of piles or prolapsed piles, leading to severe pain and ulcers. Medical complications arising from untreated haemorrhoids are rare but include:

Anemia
Chronic blood loss from haemorrhoids may cause anemia, in which you don’t have enough healthy red blood cells to carry oxygen to your cells.
Strangulated hemorrhoid
If the blood supply to an internal haemorrhoid is cut off, it may be “strangulated,” which can cause extreme pain.
Blood clot
Occasionally, a clot can form in a haemorrhoid (thrombosed haemorrhoid). Although not dangerous, it can be extremely painful and sometimes needs to be lanced and drained.

Some haemorrhoids can’t be managed with home-care and medicine-based treatments alone, either because symptoms persist or because an internal haemorrhoid has prolapsed.

Fortunately, a number of minimally invasive haemorrhoid (Piles) treatments are available that are less painful than traditional haemorrhoid removal (haemorrhoidectomy) and allow a quicker recovery:

Rubber Band Ligation: The most commonly used haemorrhoid treatment is rubber band ligation, in which a small elastic band is placed around the base of a haemorrhoid. The band causes the haemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the haemorrhoid in place. It takes two to four procedures, the number of procedures required depends upon number of piles in an individual, done six to eight weeks apart, to completely eliminate the haemorrhoid. Complications, which are rare, include mild pain or tightness, bleeding, and infection.
Other procedures: Other standard procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. Side effects and recurrence vary with the procedure, so consult your surgeon about what’s best for your situation.
One may need surgery if they have large protruding haemorrhoids, persistently symptomatic external haemorrhoids, or internal haemorrhoids that return despite rubber band ligation.

Traditional Haemorrhoidectomy: A narrow incision is made around both external and internal haemorrhoid tissue and the offending blood vessels are removed. This procedure cures 95% of cases and has a low complication rate. The procedure requires general anesthesia, but patients can go home the same day. Patients can usually return to work after 7–10 days.
An alternative to traditional haemorrhoidectomy is called stapled haemorrhoidopexy. This procedure treats bleeding or prolapsed internal haemorrhoids.

Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH).

It is appropriate when you have:

Very large internal haemorrhoids (Piles)
Internal haemorrhoids that still cause symptoms after nonsurgical treatment
Bleeding during or after the defecation
Large external haemorrhoids that cause significant discomfort and make it difficult to keep the anal area clean
Both internal and external haemorrhoids

Stapled haemorrhoidectomy employs a unique circular stapler which reduces the degree of prolapse by excising a circumferential strip of mucosa from the proximal anal canal. This has the effect of pulling the haemorrhoidal cushions back up into their normal anatomical position. Usually the patient will be under general anaesthetic, but only for around 30 minutes.

Due to the low level of post-operative pain and reduced analgesic use, patients will usually be discharged either the same day or on the day following surgery. Most patients can resume normal activities after a few days when they should be fit for work. The first bowel motion is usually on day two and should not cause any great discomfort. Staples may be passed from time to time during defecation. This is normal and should not be a cause for concern.

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