Difference Between Piles and Hemorrhoids

Piles vs Hemorrhoids

Hemorrhoids and piles are the same thing. There is no difference between piles and hemorrhoids. Sometimes people think that normal anal cushions are called hemorrhoids and swollen anal cushions are called piles. Some say that hemorrhoids are internal, and piles are external. This is not the case. Hemorrhoid is the medical term and pile is the general term. Nevertheless, this article will talk in detail about piles (or hemorrhoids), highlighting their clinical features, symptoms, causes, diagnosis, prognosis, and also the course of treatment/management they require.

What is Hemorrhoids (or Piles) and what are the causes?

There are three anal cushions in human anal canal located at 2, 7 and 11 O’clock positions (when the patient is supine). Hemorrhoids contain sinusoids,smooth muscles, andsoft connective tissue. These sinusoids are different fromveinsbecause they do not have smooth muscle in their walls. The sinusoid set is known ashemorrhoidal plexus. Anal cushions help maintain continence. They expand in size during straining to keep the anus closed. Hemorrhoids occur when the venous pressure is very high and when the sinusoidal complex comes down. Two types of hemorrhoids occur.Internal hemorrhoidsarise due to excessive expansion of superior hemorrhoidal plexus.External hemorrhoidsarise from the inferior hemorrhoidal plexus. Exactcause for hemorrhoidsis not known; constipation, diarrhea, low fiber diet, sedentary life style, straining, pregnancy, obesity, chronic cough, and pelvic floor abnormalities lead to hemorrhoids.

Clinical features, signs and symptoms, and diagnosis of Hemorrhoids (or Piles)

Diagnosis of hemorrhoids is clinical. Signs of external and internal piles present differently. Many individuals present with both.External pilesare very painful if thrombosed. This pain lasts a few days. If not infected they heal spontaneously leaving a skin tag.Internal pilesfeature painless, fresh bleeding after defecating. Blood covers the stools, drips down into the toilet bowl, or is seen on the toilet paper. Blood is not mixed with stools. Blood is not altered.

Observation of the anal region is adequate to diagnose external piles and grade III and IV internal piles.External pilesappear on the pectinate line. Skin covers the outer half, and the anoderm covers the inner half of it. These are very sensitive to pain.Grade III internal pilescome down while straining, but go back up with manual reduction.Grade IV pilesare already outside and irreducible.Grade II pilescome down while straining and spontaneously go back.Grade I pilesare just expanded blood vessels without prolapse. Other ano-rectal conditions like fistula, fissure, malignancy, and rectal varicies should be considered before making a definitive diagnosis.

Treatment/Management of Hemorrhoids (or Piles)

保守治疗是首先表示second degree hemorrhoids and in pregnancy. It involves high fiber diet, good fluid intake, NSAID, and rest. High fiber diet gives bulk to stools and holds water in the gut to help move bowel well. NSAID should not be used for more than 3 weeks because they cause skin thinning. Surgical procedures are indicated if no resolution seen with conservative methods. Rubber band ligation involves the application of a tight rubber band 1 cm above the dentate line to cut off the blood supply to hemorrhoids. In a few weeks, the hemorrhoid falls off.Sclerotherapyinvolves injection of a chemical agent to collapse the walls of sinusoids in hemorrhoids. Expanded hemorrhoids can be cauterized with laser, cryo, and electricity.Hemorrhoidectomyis good for severe cases. Trans-anal ultrasound guided hemorrhoidal dearterialization and stapled hemorrhoidectomy are two other common procedures.

Piles vs Hemorrhoids

Although many consider piles and hemorrhoids to be different, they are the same.