Causes, Symptoms & Treatment of Internal Hemorrhoids (Internal Piles)

How can I treat my Internal hemorrhoids?

The term ‘piles' or 'haemorrhoids' refers to the enlarged vascular tissues in the anus or the rectum. Most piles (haemorrhoids) form as a result of increased pressure in the lower part of the rectum, which may be due to rough sitting, breastfeeding constipation, or straining while trying to pass a stool.

To diagnose piles, a doctor has to do a thorough assessment, which includes some physical examinations. At times, other diagnostic tests may be suggested to eliminate other diagnoses. The recommended treatment for haemorrhoids may vary depending on the severity of the condition.

For more information, continue reading!

What are Hemorrhoids?

Hemorrhoids (also called piles) are swollen and inflamed vascular cushions located in the anus and lower rectum. These cushions are a normal part of human anatomy, but they become a medical problem when they cause symptoms. There are two types of Hemorrhoids:

External Hemorrhoids: These form under the skin around the outside of the anus. They are often the most painful type because the overlying skin has many pain-sensing nerves.

Internal Hemorrhoids: These form inside the rectum, above a point called the dentate line. Because this area has few pain-sensing nerves, they are usually not painful. Their most common symptom is bright red blood on toilet paper or in the toilet bowl. They can be graded from I to IV based on their severity and whether they prolapse (protrude) from the anus.

What Causes Hemorrhoids?

Common causes of hemorrhoids include:

• Straining during bowel movement
• A low-fiber diet intake
• Chronic constipation
• Often lifting heavy objects
• Pregnancy
• Sitting on Toilet for long period of time

What is the Treatment of Hemorrhoids?

Many hemorrhoids can be effectively managed with at-home care and lifestyle modifications. The primary goals are to reduce straining, soften stools, and relieve symptoms.

You can mostly treat your hemorrhoids at home by:

• Eating Fiber-enriched food
• Drinking plenty of water or other non-alcoholic liquids each day as advised by your healthcare professional
• Avoid straining during bowel movement
• Not sitting on the toilet for a long period of time
• Sit in a tub of warm water or sitz bath, several times in a day to help in pain relief.
• Take a stool softener or fiber supplements as prescribed by your health professional

Symptoms of Internal Hemorrhoids

In case, you have internal hemorrhoids or internal piles you may have experience:

• Bleeding from your rectum that is characterised by bright red blood on stool, on toilet paper or in the bowl after bowel movement
• A hemorrhoid that has directed through your anal opening known as prolapse
• Internal piles that are not prolapsed mostly are not painful. Prolapsed internal piles may be painful and cause discomfort.

What are Some of the Effective Treatments for Internal Piles?

The treatment of haemorrhoids can involve a variety of techniques, including self-care and other necessary medical procedures and surgeries. Check out the detailed list below: 

Conservative Treatments  

It is recommended that all patients, regardless of the severity of their condition, attempt conservative treatments first to manage their symptoms. They may include the following:  

i. Home Treatments  

• Sitz Baths: A warm bath with Epsom salt soaks reduces inflammation, itch, and pain, causing discomfort by lowering anal pressure. It helps to maintain hygiene at the anus and improves blood supply to the anal region, thus eliminating stagnation and swelling. 
• Ice Packs: Ice packs are recommended for reducing inflammatory swellings.  
• Clock Toilet Training: It involves establishing a definite pattern for timing activities associated with bowel movements.
   

ii. Lifestyle Adjustments

All patients are likely to receive some lifestyle changes or suggestions from the healthcare staff, as these are considered the first line of therapy.

• Lifestyle Alterations: Dietary adjustments, which include high fibre intake, adequate hydration, and regular physical activity.
   

iii. Medical Therapy

Using a softening laxative in conjunction with regular doses of fibre-rich foods is the first stage in sustaining stool softening and reducing straining as part of medical therapy. The following alternatives may be offered:  

• Oral Medication: Oral treatment is important to patients with active haemorrhoids as either early prophylactic treatment in lesser degrees or use for blunt harm control until more advanced interventions like surgical procedures are performed at the hospital.  
• Creams, Ointments, and Suppositories: Discomfort may be treated with bland emollient products containing corticosteroids, vasoconstrictors, local anaesthetics, antiseptics, and astringents. Oral medications can also be used.

iv. Surgical Techniques  

To shrink or remove haemorrhoids, surgery may be required in certain cases. Below are some of the surgical procedures that can be performed to resolve such issues:  

• Hemorrhoidectomy: The haemorrhoid removal process is recommended for patients with large internal or external haemorrhoids who have not had success with therapeutic measures. As these patients may require permanent removal, a healthcare professional will first confirm the location, size, and severity of the haemorrhoids. Less than 10% will get symptomatic haemorrhoids surgically removed.  
• Rubber Band Ligation: Unlike traditional surgery, where the haemorrhoid is removed, this technique forces the haemorrhoid to fall off naturally by placing a band around it and inhibiting blood flow to the swollen mass. It usually takes between 5 and 7 days, and the patient may experience mild discomfort or pressure.  
• Sclerotherapy: The patient’s swollen mass is injected with chemicals meant to shrink it. While the procedure is painless, it usually needs several treatment sessions.
• Infrared Photocoagulation: This method is mostly pain-free and uses infrared light (heat energy) to shrink and remove hemorrhoidal tissue. As the symptoms do not go away immediately, several procedures are needed to help alleviate the condition.
• Radiofrequency Coagulation and Excision: For this specific technique, a professional applies radio waves of frequencies 5.0 to 6.0 MHz using a radiofrequency electrode to meticulously remove haemorrhoids without applying high temperatures.
• Embolization: Under local anaesthesia, 2 to 3-mm coils are introduced into the vessels supplying blood to the haemorrhoids, constricting the vascular supply and minimizing blood flow to the tissues to relieve symptoms.

Can Surgery Be Avoided When Treating Internal Piles?  

Yes, internal piles, particularly in their initial stages (grades 1 and 2), can usually be successfully treated without surgical intervention through conservative treatment methods, including dietary adjustments. Other non-invasive techniques can also be used, including rubber band ligation, sclerotherapy, and infrared photocoagulation.

Non-surgical methods are suitable for many patients suffering from internal piles, especially patients experiencing mild or moderate symptoms. In any case, it is crucial to consult a healthcare specialist to develop the most effective treatment plan tailored to the severity of your condition.

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