An in-depth discourse on piles and fissures by Dr Ashima Acharya

Piles and fissures are ailments which are very common and a large number of people suffer from it. Despite this fact few are ready to talk or discuss it, such is the taboo regarding one of our most important bodily functions. In India, a huge number of women suffer due to the socio-economic dynamics that come into play. A lot of stereotypical notions/societal norms/taboos make these easily treatable ailments into an acute condition creating havoc in everyday life.

We bring to our readers an in-depth discourse on piles and fissures by Dr Ashima Acharya, Specialist in Breast and Anorectal (Piles, Fissure, and Fistula) Surgery.

1) Can you share with our readers what these two ailments are and the difference between the two?

Piles and fissures are two very common ailments that a large number of people suffer from in our country. They are prevalent among our women population too. But for ages women have been putting everything else as priority over their own health. In addition to this, piles and fissures give some symptoms which are embarrassing for them to discuss with anyone. Even if the problem is there the first course usually is to go for home remedies, which might ease the pain only for a time being. However, in the long run, this causes more problems and from a minor symptom, it turns into a chronic one in many cases.

Pile is a condition in which there is swelling of blood vessels; to be precise they get swollen up inside the rectum due to constant pressure applied during motions. On the other hand, a fissure is a tear at the opening of the anus due to the passing of hard stools or constant application of pressure during motions. Fissures are very painful and disturb the daily routine, though piles are less painful in comparison but if left untreated can turn complicated.

2) What are the causes and symptoms of each of these ailments?

To understand the cause you need to understand your digestive system. It is a 30 feet tube from the mouth to anus. The entire process right from intake to digestion and finally expelling what is waste happens in this tube. Therefore firstly your diet should include foods which contain fibres for your digestive system to work well, e.g. fruits, green leafy vegetables and seasonal produce. Secondly, your daily intake of water and fluids should be minimum three litres to keep the tube lubricated. Third is regular exercise and fourth is not applying any pressure while passing motions. If any of this is insufficient, your stools will get hard and you will knowingly or unknowingly apply pressure. This will lead to cracks in your anal opening, which will cause pain while passing motion, itching and burning while defecation and sometimes bleeding. In long-standing cases, you may develop a small anal skin tag which also gets swollen and painful.

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3) What would be the First Aid and the subsequent course of treatment?

In case you have any of these symptoms increase the intake of water, stop consuming any non-vegetarian and spicy food. Eat fruits and salads, in case of too much pain switch to a liquid diet for a day or two. (Milk is not a liquid diet and sometimes causes indigestion, so should be avoided). One can have buttermilk, coconut water, vegetable soups, dal ka pani or rice water. And meet a specialist to get yourself checked at the earliest.

4) What are the lifestyle changes that one can adapt to cure the problem? Are there any home remedies?

If you are experiencing pain during motions apart from bringing in the above-mentioned changes in your diet you can take a painkiller till you see the doctor. Two lifestyle alterations are very crucial. One is water consumption and second is daily exercises. This will keep your intestine active and will allow it to throw the waste easily. Drink a few glasses of water early morning and it will allow you to pass your motion with ease. Do not read in the toilet or use your mobile phones as it leads to applying pressure while passing motion unconsciously and that can lead to internal piles.

5) What is the role of nutrition in curing these ailments? Can certain foods help in the healing process?

Food plays a major role in all medical issues. You need to include fibres in your diet which is present in fruits and raw vegetables and can be consumed as salads. Fibre promotes movement through your digestive system and increases stool bulk. Sprouts are an excellent source of fibre and protein, include them in your daily diet. Avoid spicy and oily food. Replace your fruit juices with whole fruits as the fibre is strained out in juices.

6) Many people are scared of surgery, I know I am. When does surgery become inevitable?

Once you have made lifestyle changes you would be symptomatically better but if the technical defects have already taken place e.g. the anal opening is tight or bleeding during the passing of stools or a painful swelling at the anus, then chances are once you stop medication your symptoms might come back. If you fail to respond to medication or your problem is long-standing chances are you may require surgery. And if you do there is nothing to get scared of as you would be able to get back to your daily routine within a couple of days. In western countries, they do these surgeries as an OPD procedure and patients go to work the next day. We don’t do that in India, here patients are admitted and then the usual procedure of surgery takes place.

7) Is it a major surgery? What is done and how does it help the patient? Does the patient get lifelong relief with surgery or can the problem occur again?

In surgery, we release your tight opening known as a sphincter, and surgery is known as Sphincterotomy. We may remove the anal swelling if it’s big and swollen, remove the fissure if any. In case of internal piles, if they are too big, we may remove them too with surgery or staplers. Surgery is major and done under anaesthesia (General, spinal or local). The recovery and healing depend on the lifestyle thereafter. If you maintain a healthy diet with regular exercises you will be healed for the rest of your life but if you go back to your previous lifestyle you may face the problem again.

8) What is the connection of piles with pregnancy? Can any precautions be taken to avoid the same?

During pregnancy, a woman takes iron and calcium supplements and she is relatively less active. Due to this reason, the stools may be hard and she has to apply pressure while passing motions which leads to painful fissures. This can be avoided by increasing the consumption of fruits, salads and water in your diet.

9) Anything else in particular that you would like to share with our readers?

Fissure is a painful condition and Piles is painless for the longest time until complicated. As long as you maintain your lifestyle with healthy habits you will be fine but if it’s bothering please see your doctor. Especially ladies should remember that your health and comfort is most important to your family and you can look after them better if you are well.  Spend some quality time for your own wellbeing. Inculcate healthy habits in your children from a young age so they can lead a healthy life as well. Piles and Fissures are not inherited but lifestyle is!

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