Cause and treatment of piles

What exactly are piles?

Hemorrhoids are blood vessels located under the mucous membrane between the rectum and anal canal and have a network-like structure. All people have hemorrhoids because they help securely seal the bowel externally by ensuring fine continence (sealing of air and fluid in the rectum). The blood vessels can cause complaints for various reasons. Hemorrhoids can become inflamed, bleed, swell, tear, burst, or prolapse outward. In this case, doctors speak of hemorrhoidal disease.

What are the most common causes of hemorrhoidal ailments?

The most important cause of hemorrhoids is strong straining with increased pressure in the abdominal cavity (high intra-abdominal pressure) as well as pushing after bowel movements. Thus, bowel problems such as diarrhea or constipation can negatively affect the normal sphincter function of the rectum. Frequent bowel movements – for example, during prolonged diarrhea – can irritate the hemorrhoidal plexus. Therefore, increases in abdominal pressure from various causes, such as persistent coughing or overweight, can lead to hemorrhoidal disease. Sports activities like weightlifting or abdominal muscle training can also increase intra-abdominal pressure. Pregnancies can trigger hemorrhoidal complaints due to increased abdominal pressure combined with loosening of the pelvic floor tissue. Accompanying pelvic floor training is therefore an important countermeasure.

Connective tissue loses firmness due to aging. That is why hemorrhoid problems increase with advancing age. A low-fiber diet, lack of exercise, and insufficient drinking promote the development of hemorrhoidal conditions. Furthermore, there are genetic predispositions for hemorrhoidal complaints. A predisposition for this disease is therefore already familial in some people.

What are the signs of piles?

Depending on their severity, hemorrhoids cause annoying moisture, itching, burning, or bleeding after bowel movements. In the later stages of the disease, there is a foreign body sensation due to prolapse and fine continence disorders which can manifest. Usually, patients' symptoms have been present for a long time during proctological examinations and are sometimes only diagnosed through routine check-ups, such as with a urologist or dermatologist. Men are often affected because, for example, out of fear of devaluation, they seek medical advice later. As with all diseases, it is important to positively influence the course of the disease as quickly as possible.

What stages of hemorrhoid disease are there?

Stage 1:

Internal hemorrhoids, which do not become externally visible even when straining, can cause annoying moisture, itching, burning, or painless bleeding after bowel movements. Therefore, any abnormalities such as blood in the stool or frequent itching should be taken seriously here as well, even if no pain has yet occurred.

Stage 2:

An external prolapse of the hemorrhoids that only occurs during straining and is spontaneously reversible at rest defines the second stage of hemorrhoidal disease. 

Stage 3:

A permanently present prolapse of the hemorrhoids protruding from the anal canal, which can be corrected by manipulation, e.g., finger pressure, along with accompanying symptoms such as a foreign body sensation and frequent bleeding, moisture, and inflammation combined with anal minor incontinence are typical for the third stage. 

Stage 4:

The hemorrhoidal prolapse can no longer be manually repositioned. Medical interventions are essential here.

How are hemorrhoids diagnosed?

The symptoms already indicate the disease. Through targeted physical examination and a colonoscopy, the specialist can make a definitive diagnosis. Severely pronounced hemorrhoids (e.g., prolapse) can be seen with the naked eye. Other changes in the rectal area as well as other diseases such as tumors, polyps, an enlarged prostate, or abscesses are ruled out by the extended examination. 

What can you do against hemorrhoids?

Prevention is the best aftercare. A healthy, fiber-rich diet and plenty of fluids support normal digestion and are the most efficient way to avoid hard stools (up to constipation) and thus unnecessary straining during bowel movements. Only go to the toilet when you really need to. Avoid excessive straining and try to relax. Ensure regular bowel movements and allow enough time. Regular physical activity and meals help with this. If hemorrhoidal symptoms still develop, do not despair. For mild hemorrhoidal complaints, lukewarm sitz baths with the addition of chamomile or oak bark as well as rest can already provide sufficient relief. Relaxation measures reduce the increased tension of the sphincter muscle (sphincter tone) because stress also plays a role in the development of hemorrhoidal complaints. 

Mild symptoms such as moisture and itching can be treated with anti-inflammatory Suppositories and ointments from the pharmacy are used. These measures relieve symptoms temporarily. However, investigating the cause and, if necessary, adapting your lifestyle is strongly recommended to prevent chronic deterioration. Ask your doctor or pharmacist about this.

What should I do if the hemorrhoidal symptoms worsen?

Even then, the doctor has various procedures available for therapy to specifically treat enlarged hemorrhoids. Which one is individually best suited for you is decided by the treating medical professionals. It is important that you consult a doctor you trust and do not hesitate to openly discuss your health problems out of fear or shame.