Piles/Hemorrhoids, Fistula & Fissure
Piles (hemorrhoids) are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. Anal fistulas are abnormal connections between the anal canal and the skin around the anus, while anal fissures are small tears in the lining of the anus. These conditions can be painful and affect quality of life, but effective treatments are available at Blume Health.
Causes
- Straining during bowel movements
- Sitting for long periods on the toilet
- Chronic constipation or diarrhea
- Low-fiber diet
- Pregnancy and childbirth
- Obesity
- Heavy lifting
- Anal infections or abscesses (particularly for fistulas)
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
- Trauma to the anorectal area
- Aging (weakening of supporting tissues)
- Family history of hemorrhoids
Signs and Symptoms
- Bright red bleeding during bowel movements
- Itching or irritation in the anal region
- Pain or discomfort, especially during bowel movements
- Swelling around the anus
- A lump near the anus, which may be sensitive or painful
- Leakage of feces or difficulty cleaning after a bowel movement
- For fistulas: persistent drainage, pain, swelling, and sometimes fever
- For fissures: severe pain during and after bowel movements, bright red blood on toilet paper, visible tear in the skin around the anus
Diagnosis
Physical Examination
The doctor will examine the anus and rectum for swollen blood vessels and other abnormalities. This may include a digital rectal exam.
Anoscopy
A small instrument called an anoscope is inserted a few inches into the anus to examine the anal canal.
Sigmoidoscopy
A flexible tube with a light and camera is inserted into the rectum to examine the lower colon (sigmoid) and rectum.
Colonoscopy
A longer flexible tube examines the entire colon. This may be recommended if you have risk factors for colorectal cancer or to rule out other causes of bleeding.
MRI
Particularly useful for diagnosing and mapping fistulas, showing their relationship to surrounding structures.
Treatment Options
Lifestyle and Dietary Changes
Increasing fiber intake, drinking more water, regular exercise, and avoiding straining during bowel movements can help manage symptoms and prevent recurrence.
Medications
Over-the-counter creams, ointments, suppositories, and pads containing ingredients such as hydrocortisone, witch hazel, or lidocaine can temporarily relieve symptoms. Oral pain relievers may also help.
Minimally Invasive Procedures
For hemorrhoids: Rubber band ligation, sclerotherapy, infrared coagulation, or electrocoagulation can be performed in an outpatient setting. For fissures: Botox injections or topical nitroglycerin may help.
Surgical Procedures
For severe cases: hemorrhoidectomy (removal of hemorrhoids), fistulotomy (opening and draining of fistulas), or lateral internal sphincterotomy (for fissures) may be necessary.
Home Remedies
Sitz Baths
Sitting in warm water for 10-15 minutes several times a day, especially after bowel movements, can help reduce pain and irritation.
Cold Compresses
Applying cold packs to the affected area can help reduce swelling and numb discomfort.
Dietary Fiber
Increasing fiber intake through foods like fruits, vegetables, and whole grains can soften stools and reduce straining.
Hydration
Drinking plenty of water helps keep stools soft and prevents constipation.
Over-the-counter Products
Witch hazel wipes, over-the-counter creams, and suppositories can provide temporary relief from symptoms.
Preventive Care
- Eat a high-fiber diet (fruits, vegetables, whole grains)
- Stay well-hydrated by drinking plenty of fluids
- Exercise regularly to stimulate bowel function
- Avoid straining during bowel movements
- Don't sit on the toilet for long periods
- Go to the bathroom as soon as you feel the urge
- Maintain a healthy weight
- Avoid heavy lifting when possible
- Practice good anal hygiene
- Address constipation or diarrhea promptly
Surgical Options
Hemorrhoidectomy
Surgical removal of severe or large hemorrhoids. This can be performed using various techniques, including conventional excision, stapling, or laser surgery. Recovery may take 2-3 weeks, but results are usually permanent for treated hemorrhoids.
Learn More About This ProcedureFistulotomy
A procedure to open and drain an anal fistula. The surgeon cuts along the entire length of the fistula, from the internal opening to the external opening, allowing it to heal from the inside out.
Learn More About This ProcedureFistula Plug or Seton Placement
For complex fistulas, a plug made of biological material may be used to close the fistula, or a seton (a thread-like material) may be placed to allow gradual healing while maintaining drainage.
Learn More About This ProcedureLateral Internal Sphincterotomy
A procedure for anal fissures where a portion of the internal anal sphincter muscle is cut to reduce spasm and pain, allowing the fissure to heal.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of piles/hemorrhoids, fistula & fissure, our expert team is here to help you find the right treatment approach for your specific needs.