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How does one determine best treatment for piles ?
Last edited on 15 Aug 2016 01:10
Haemorrhoids or piles are dilated blood vessels in the distal anal canal. The reason why there are so many choices is because it really depends on how severe the piles are. Piles exist in 4 grades. Grade I - internal. Grade II - external reducible. Grade III - irreducible. Grade IV - Thrombosed (blood vessels within are clotted).In general if the piles are internal, simpler methods like rubber band ligation will work quite well together with stool softeners to regulate bowels. For example, if prolapse and external tags are the issue, an excisional type of surgery would work best. If bleeding is the problem, then surgery directed at the disconnecting the blood supply is better. Thereafter the procedure is usually tailored to what the predominant symptom is.

However once haemorrhoids are external or prolapsed out of the anal canal methods involve excision or stapling the complex to devascularize the vessels.

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Adjunctive measures are equally important to prevent other anal conditions like anal fissure, mucosal prolapse and ulceration. These conditions are caused by straining at stools or constipation. Ensuring toileting time is kept to a minimum, stool softeners and adequate fibre intake should be borne in mind. Drugs like proctosedyl are topical agents that can reduce engorgement of the mucosa of the piles. Flavinoids like Daflon are very effective in high doses for a short course of time to reduce blood flow into the haemorrhoid complexes.
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