Tuesday, February 17, 2009

A messy pile

A messy pile
Wed, Feb 18, 2009
The Star/Asia News Network

[Top: Piles are often categorised as external or internal.]

PILES, otherwise known as haemorrhoids, are swollen vascular cushions within the anal canal . As it is perceived as an embarrassing topic, sufferers often live in extreme discomfort due to the pain and itching. As a result, sufferers are unable to lead a comfortable life as it interferes with their daily routines.

Piles is actually a common condition and affects all racial groups in Malaysia. Doctors estimate that about one in three adults will suffer from symptoms attributable to piles during their lifetime.

Piles usually occur in adulthood and sufferers can be from any age group, ranging from late teens to retirement age. Males and females are equally susceptible to the condition.

Piles are often categorised as external or internal. Beneath the mucous membrane lining, the anal canal is a network of vascular cushions. A portion of this is inside the rectum, which causes internal piles when they become swollen with blood. The other is under the skin around the anus, giving rise to external piles when they are swollen.

The severity of the condition ranges from first degree (mild) to fourth degree (severe).

Internal piles (piles that occur in the anal canal)

1. First degree piles bleed but do not prolapse (protrude out of the anal canal).

2. Second degree piles prolapse during bowel movement but reduce spontaneously afterwards.

3. Third degree piles prolapse during bowel movement, but only return inside the anal canal when pushed back physically.

4. Fourth degree piles have a blood clot within them, which cause severe pain and difficulty in passing motion. They prolapse permanently outside the anus.

External piles (piles that occur around the anal opening)

1. External piles form a soft lump around the anal opening. They frequently co-exist with internal piles. When a blood clot develops and the lump becomes hard, the condition is known as thrombosed haemorrhoids.

What causes the disease?

The exact cause for piles is unknown, but it may be linked to excess pressure in the anus and lower rectum. Some factors which may contribute to the formation of piles include:

-Excessive straining during bowel movement, or when constipated

-Chronic diarrhoea

-Lack of adequate fibre in the diet.

-Pregnancy and childbirth

-Family history

-Cancer or growths in the pelvis or bowel

-Age, which causes the anal cushions' supporting ligaments to lax

Symptoms of the disease

The following symptoms could indicate the presence of piles:

-Bleeding and/or discomfort during bowel movement/strain

-Protrusion during bowel movement

-Pain or itching in the anal area

-Anal lumps

Prevention of the disease

Piles can actually be prevented in the following ways:

-Improving and regularising bowel habit

-Increasing the amount of fibre intake and fluid

-Eliminating excessive straining during bowel movement

-Exercise regularly

-Avoid becoming overweight

Treatment of the disease

Depending on the severity of piles, the condition can be treated in a variety of ways.

First-degree piles:

-Improving and regularising bowel habit

-Increasing the amount of fibre intake and fluid

-Eliminating excessive straining during bowel movement

-Local and general medication


-Infrared coagulation

Second-degree piles:


-Infrared coagulation

-Rubber band ligation

-Stapler haemorrhoidopexy, also known as the Longo Technique or Procedure for Prolapse and Haemorrhoids (PPH)

Third-degree piles:

-Rubber band ligation

-Conventional haemorrhoidectomy

-Procedure for prolapsed haemorrhoids (PPH)

Fourth-degree piles:

-Conventional haemorrhoidectomy


Here, we will discuss on the differences between the treatments mentioned:


Sclerotherapy is essentially an injection of sclerosant which will shrink dilated vessels.

Infrared coagulation

Infrared coagulation uses heat energy by means of infra red technology to burn the vessels and make them shrivel.

Rubber band ligation

Rubber band ligation is the application of a tight rubber band around the vascular pedicles of the haemorrhoids.

All three treatments may be performed as outpatient treatments for early, non-prolapsing haemorrhoids at surgical clinics and are also known as office treatments for haemorrhoids. However, one must remember that these techniques are only for 1st or 2nd degree haemorrhoids.

Procedure for prolapsed haemorrhoids (PPH)

Stapler haemorrhoidopexy, also known as the Longo Technique or Procedure for Prolapse and Haemorrhoids (PPH) is a new method of surgery that aims to minimise the pain associated with haemorrhoidectomy.

PPH was conceived in 1993 by Dr Antonio Longo of the Department of Surgery at the University of Palermo, Italy. Used to treat prolapsed piles, PPH works by pulling the displaced piles back to their normal positions, while cutting and stapling off their blood supply, causing the swollen piles to shrink. The procedure is done using a specially designed circular stapler.

Done under anaesthesia, the procedure is done in the rectum, where there are very few sensory nerves, thereby causing minimal pain to the patient.

With PPH, there are no external skin wounds which take time to heal. Studies show that the wound after stapler haemorrhoidopexy usually heals within an average of five days.

PPH was launched in Europe in 1995 and introduced in the United States in 1998. In Malaysia, it was made available in the year 2000, and to date, 8,900 patients have undergone the procedure successfully.

The operation is performed under local, regional or general anaesthesia, hence the patient will not feel any pain. In addition, the procedure is done above the piles, in a region where there are no sensory nerve endings. This means that the patient feels minimal pain during and after the operation.

After the operation, the patient may feel some pain at the anal area, which subsides within two or three days for 80 per cent of patients. There is also low risk of damage to or infection of the rectal wall.

How does PPH compare to conventional haemorrhoidectomy?

Conventional haemorrhoidectomy usually takes a longer time as compared to PPH, which only takes 15-20 minutes. Conventional surgical methods involve the physical removal of the piles and skin tissue around the peri-anal region, which has abundant sensory nerve cells. This leaves a raw, open wound, which causes considerable post-operative pain, especially during bowel movement. The open wound also requires careful care to prevent infection.

The wound may take six to eight weeks to heal completely, and requires medication and often dilution to prevent stenosis (closure). Additionally, the pain is usually experienced for one to two weeks.

Side-effects include pain and bleeding in the post-operation period, which may lead to constipation. Patients may also find difficulty in passing urine.

Ismail Sagap, a consultant general and colorectal surgeon added, "Most patients who have underwent PPH have received a high success rate based on the immediate symptomatic relief they encounter after the surgery. The rate of recovery is also much faster as patients can go home the next day after surgery and resume normal activity within five days."

"Overall, PPH has been well accepted due to its convenience, shorter hospital stay and faster recovery rate. Moreover, surgeons in Malaysia have long accepted PPH as one of the most convenient techniques in treating prolapsing haemorrhoids."

This story was first published in The Star.

1 comment:

David said...

Itching and pain be gone! I found a solution in the bathroom bidet sprayers they use in Thailand. Every doctor will tell you that you need to clean but the key is you need to do it without irritating the skin. Difficult to accomplish when you have an itch that is just begging to be scratched. But cleaning with a water spray does just that and it is easy, convenient and no one need know that this is what you are using it for. I bought mine at http://www.bathroomsprayers.com and installed it myself. Best thing I ever did.