Piles or hemorrhoidal disease is the most common cause of painless rectal bleeding
HEMORRHOIDS
Hemorrhoids, commonly known as piles, are a frequent cause of painless rectal bleeding. Contrary to anal fissures, they are typically painless unless complications like inflammation, infection, or strangulation arise. It's crucial to understand that hemorrhoids are normal anatomical structures within and around the anal canal. Composed of sinusoids, smooth muscle fibers, and connective tissues, they form three columns at the 3, 7, and 11 o'clock positions. In a resting state, they bulge and prevent the passage of fluids or solids, thus playing a vital role in continence. Problems arise when these hemorrhoids become noticeable, typically by protruding from the anal orifice or bleeding.
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There are two main types: internal and external. Internal hemorrhoids, located inside the anal verge, often bleed freely. Piles are classified by degree:
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First-degree: Bleeding occurs, but no mass protrudes.
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Second-degree: A mass protrudes during bowel movements but retracts spontaneously.
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Third-degree: The protruding mass requires manual replacement.
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Fourth-degree: The mass remains permanently prolapsed outside the anus.
External hemorrhoids rarely bleed but can become inflamed, causing painful swelling around the anal orifice.
Piles are often linked to lifestyle factors, particularly chronic constipation or diarrhea. Age and pregnancy can also contribute. It's essential to differentiate piles from rectal cancer. Therefore, any rectal bleeding, even small amounts, warrants medical evaluation and diagnosis.
Diagnosis involves a physical examination, including a digital rectal exam and possibly a proctoscopy. A colonoscopy may be performed to rule out other conditions higher in the colon.
Treatment depends on the severity. First and second-degree piles are usually managed with medication. Third and fourth-degree often require surgery. Several minimally invasive procedures are available, including ksharasutra ligation, ksharakarma (sclerotherapy), rubber band ligation, infrared coagulation, and laser procedures.
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