1. Piles ( or Haemorrhoids - pronounced "hem-or-oids")

2. Fissure

3. Abscess

4. Fistula

5. Other Problems

None of these conditions can be diagnosed without properly examining the bottom. Avoiding this sometimes leads to severe complications. It may also be necessary to look inside the anus with a small telescope. This procedure is called either a "Proctoscopy" or "Sigmoidoscopy" depending on the type of instrument used. If  you are keen on reading more details about exactly how these conditions arise click here.

1) PILES:

Piles are usually painless. They cause bleeding without pain during passage of stool , and may produce one or more lumps near the anus as shown on the photograph on the right.  These lumps contain swollen blood vessels and blood.

Piles are caused by excessive straining (holding one's breath and pushing) during the passage of stool or by constipation. They are not caused by "hot foods" or by hot weather or by sitting for a long time in a car, scooter or bus seat. Excessive loss of blood from piles may lead to anaemia, which is recognised by pale skin and eyes, tiredness, shortness of breath, palpitations and sometimes chest pain.

Apart from bleeding, piles can also become "thrombosed" - when the blood in the piles clots, leading to pain and infection. Some infections can be serious and life threatening. The photograph on the left shows a case of infective gangrene resulting from late, neglected thrombosed piles.

TREATMENT: Piles in the early stages can be controlled by avoiding constipation and "straining" (holding of breath and pushing down hard while passing stool). Unfortunately people who suffer from severe bronchitis, asthma or prostate trouble may not be able to avoid straining.

Bleeding piles may be treated by simple and painless treatments such as injection or "Banding". Large piles require removal by operation. Medicines or local ointments and suppositories are of no use for large piles.

Piles can now be treated surgically by several different  methods:
1) Standard surgery (Open Hemorrhoidectomy) - in which the piles are removed using a knife, or other means like heat (electrocautery) or freezing (cryosurgery)
2) Surgery using a Stapler (Stapled Hemorrhoidectomy) - in  which a special instrument cuts out the tissue responsible for the enlarged piles.

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2) FISSURE:

A fissure is a wound in the sensitive skin of the anus. Such a wound is usually caused by hard stool. It is a very painful condition and may cause bleeding or a painful lump. It is not caused by "excess heat". The hot spicy foods may aggravate the pain.

Hard stool that is forced out scrapes back a painful little tag of skin that then sticks out from the bottom and is visible as a "skin tag". In the picture on the right - skin tags from two very painful fissures (in the front and iatteh back) can be seen along with a pink colored wound which is the fissure itself.

TREATMENT: Fissures can often be cured by medication to soften stool and soothe the pain and inflammation. If that fails an operation is required to create the conditions to promote healing of the fissure.

Botox injections have been used to cure fissures by relxing anal ring muscle spasm.

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This is a collection of pus - it is essentially a boil next to the anus. It is very painful and may produce a lump. It is not caused by heat, hot foods or hard motions. Typically a person with an abscess finds it very painful to sit down and can be observed to sit leaning to one side - so that it is possible for an experienced doctor to make a diagnosis by just looikg at the way the person sits.

TREATMENT: Most often abcesses need to be lanced open in a minor surgical procedure. Abscesses that are ignored or wrongly treated with antibiotics alone can lead to serious complications and occasionally fistula formation.

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These conditions are often wrongly referred to as "piles" because they produce bleeding or pain but the actual cause may be some very serious diseases requiring urgent treatment. These include Ulcerative Colitis or cancer

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Avoidance of Constipation: Constipation may be avoided by eating plenty of fruits and vegetables every day or by taking extra fibre in the diet which helps to soften the motions. It is also important not to hold back motions and postpone going to the toilet. This can cause constipation. Constipation cannot be avoided merely by drinking a lot of water or fluids.

Operation For Piles And Other Conditions:

1. They usually require admission to hospital for one to three days depending on the condition.

2. A "spinal" anesthetic is often used, so there is no pain immediately after operation - though there may be some pain later, which can be relieved by appropriate medication.

3. Blood transfusion is not required.

4. The patient is allowed to eat within a few hours after the operation.

5. There is no need to avoid passing stool after operation. The stools are often easier after surgery.

6. A rest period of one week may be required after the operation.

7. Recurrence of piles: Piles can recur after many years if constipation and straining continue.In addition, a patient who has been treated for piles may get some other problem such as an abscess or a fissure which may be mistaken for piles.

Please email me if you have any doubts or questions.