Piles are small outpouchings of the mucosa of the anal canal with an inner buffer of blood vessels. They are seen in relation to the branches of the underlying arteries. When small, they do not cause any discomfort to the patient but as they increase in size, they may cause some problems. Depending on the site, they may be internal or external, to the anal orifice. Majority of piles are asymptomatic. Some may cause symptoms but are actually due to some other primary conditions.

These situations include:

• Cases of Cancer of the Rectum
• During pregnancy
• Due to straining at passing urine in cases of stricture urethrae
• Due to straining at stools due to chronic constipation.

During pregnancy, many patients experience an aggravation of piles in size and in the symptomatology. They may experience some constipation, increase in size of the piles, need to strain for adequate evacuation and sometimes bleeding. Pregnancy piles are due to the compression of the veins of the rectum by the pregnant uterus, relaxing effect of progesterone on the smooth muscles of the walls of the veins and an increase in the blood supply of the pelvis. The patient usually doesn’t require any specific treatment. General measures like improving hydration, having a high fiber diet, use of mild laxatives, application of local soothing creams and regular exercise should suffice in most cases. In case of requirement of surgery, as in any other pregnant patient, the second trimester is the safest time for surgical intervention. For severely symptomatic piles with pain or bleeding or deep fissures with acute pain during defecation with bleeding, the patient may require surgery which can be conducted with minimal risk to the growing foetus during the second trimester.

Symptoms  of piles:

• Asymptomatic
• Straining with feeling of obstruction at anal verge
• Something coming out per rectum
• Bright red bleeding per rectum
• Pain and swelling near the anus

Treatment:

Initially, conservative treatment with adequate hydration, high fibre diet, laxatives and local application of protective creams is tried. If this approach fails, then surgery has to be offered.