A patient suffering from any type of ano-rectal problem, having pain, burning into ano with or without bleeding often comes to a conclusion, (without taking proper advice) that he/she is suffering from piles.

There is a general tendency even amongst the general practitioners to treat the conditions depending upon the symptoms as described by the patients without making a proper examinations of the Anus and Rectum.

This is partly because the patient too is reluctant to have the examination made. It is only when, even after repeatedly taking medicines the symptoms keep recurring that the patient seeks the advice of a specialized doctor or a proctologist. Hence it is important to know as to when a person should consult a specialized doctor for his ano-rectal problems.

• Bleeding per rectum during defecation or after defecation.

• Pain during defecation, which may sometimes continue for a short while or a long period even after defecation.

• Burning sensation during or after defecation.

• Persistent constipation, mucous discharge. i.e. discharge of some sticky substance along with the feces. A feeling of dissatisfaction even after defecation, i.e. a person may feel that he still wants to defecate even after he has done so.

• A mass like protrusion coming out of the anus while defecating.

• Formation of an abscess in the pari anal area. This abscess may sometimes burst resulting in pus discharge. The abscess usually keeps recurring.

• Lack of appetite, or diminished appetite, indigestion, anemia, chronic backache or cramps in the calf muscles and body ache.

A patient having these symptoms should consult a specialized doctor and get a proper diagnosis so that proper treatment is possible.

In the examination of any disease of the anus-rectum the doctor usually uses a proctoscope or a sigmoidoscope. This scope is inserted inside the anal opening and proper diagnosis is made demanding upon the prevailing conditions and taking into considerations the internal structure and the deformities found in the anal canal which can be seen clearly with the help of an inbuilt light. No anesthesia or painkillers or any other drugs are required during proctoscopy.

This simple procedure can be completed within 2 to 5 minutes and can be easily performed on the OPD level, and the patient is not caused much inconvenience.

It is only after proctoscopy is done, that a perfect diagnosis can be made and proper course of treatment is decided. Hence, proctoscopy is of prime importance in the diagnosis of the ano-rectal diseases.

Types of Piles – Hemorrhoids.

As we have already discussed earlier, a patient usually refers to any ano-rectal problems as piles. But medical 
science describes different types of piles as follows.

Internal piles & External piles:  (Piles found inside the anal canal are named internal piles, and those 
outside are named external piles.)

• First Degree

• Second Degree

• Third Degree Piles

First Degree Piles:
               In this condition, the hemorrhoids are found inside the canal. However they may sometimes come out during defecation. The diagnosis of this type of hemorrhoids can be made only after proctoscopy since no signs are seen outside the anal canal or anus.

Second Degree Piles: 
             In this condition, the hemorrhoids come out of the anal canal during defecation. The patient feels that a part of the anal canal is coming out. These piles, i.e. the mass, which comes out, do now go inside by themselves after defecation but have to be gently pushed inside with the help of fingers.

Third Degree Piles:    
             In this condition, the hemorrhoids that have come out during defecation do not go inside neither can they be pushed inside the anal canal, they stay outside the canal. This is a dangerous condition because it leads to thrombosed piles (collection of blood in the pile mass) or strangulated piles. The collection of blood in the pile mass leads to infection- gangrene. This may further lead to portal pyemia or septicemia, which requires an emergency surgery. However, it is quiet rare for the disease to reach such an advance stage but the possibilities should not be overlooked.

          Besides this, in an advanced stage of fissure one or two pile masses may form at the anus. These are actually skin tags and are called sentinel piles. However, the diagnosis or differential diagnosis of the different types of piles, - hemorrhoids can be done only after proper examination or the peri- anal region and per rectum examination with a proctoscope by a Proctologist.

Pathya-Palan is very essential in preventing the disease.

Riding a cycle or a scooter for long distance is to be avoided. A habit of sleeping very late, anger, smoking, tobacco chewing, beetle nut chewing, alcohol consumption, meat, eggs, fish, bakery items (specially made up of refined flour), green & red chilies, pickles, millet, hot-pungent-spicy-sour food, sour curd, fried food, coffee, heavy or stale food are to be avoided.

Fresh buttermilk, cow’s ghee, Suran (Yam), butter and simple fresh light diet are beneficial. Exercise, specially walking, a habit of eating only when one feels hungry is also beneficial. One should also see that he/she is not suffering from constipation.

Some simple Ayurveda formulations like Abhayarishtham, Kankayan Gutika, Arshkuthar ras, Bhallatakavleh, Changeri Ghritam, Kutaja, Chitraka help to manage these conditions in its early stages.

However surgical procedures are necessary to cure the disease in the second and third stages. Procedures like Kshar- Sutra, Laser, Barron band ligation, Infrared coagulation, Cryosurgery, etc. are successfully carried out at our centre. We will be providing primary information of the different procedures in our forthcoming newsletters.

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