Types of piles Part : 2

1. Internal pile

2. External pile

• Internal pile:

The internal pile means it is inside anal region and bleeding has started from inside because of pressure and this is not very painful and sometimes heals automatically.

• External pile:

In the external pile the nerves that are swollen comes outside from anal region through rectal and pain occurs it is very painful. It also has four stages

a) Grade one: During defecation or straining. No prolapse just prominent blood vessels, only bleeds

b) Grade two: a swollen region comes outside and goes inside itself automatically. Prolapse upon bearing down but spontaneously reduce.

c) Grade three: In grade three it will not go inside unless and until you push it with fingers prolapse upon bearing down and require manual reduction

d) Grade four: In grade four It is severe and chronic and it is unbearable and blood clot may form it is also called a thrombosed pile. permanent prolapse and cannot be manually reduced

The internal pile can be healed automatically but for grade fourth pile doctors advise compulsory surgery. Without surgery with wet cupping we can cure it completely.

Anal fissure:

 It is actually a tear in the mucosa moist region inside anal region it is caused because of hard stools and straining during defecation. When the mucosa is teared pain and burning occurs

3. Fistula

 The main reason for fistula is perianal abscess and improper drainage of ischiorectal abscess is the reason behind fistula. Actually meaning of fistula is pipe or tube whose one opening is outside and one is from inside. Outside area feels wet to fistula patients purulent discharge or sometimes blood discharge also occurs sometimes cirrus discharge sometimes toilet waste occurs and internal opening is in abscess

Anorectal regions which form a tunnel and fluids come out which causes discomfort to the patients it causes itching and painful. If chronic fissure is not treated it may cause fistula later on but main reason is abscess and many other causes like improper hygiene, disease which has caused low immunity such as tuberculosis, cancer, radiation, irritable bowel syndrome, assertive balanitis etc are the reasons for anal fistula main reasons are perianal abscess and improper drainage of ischiorectal abscess

Symptoms: piles patient will face bleeding problems during defecation because of thrombosed. Sometimes on the first stage there is no bleeding and fissure patients will complain about hard tools and burning sensation after defecation and bleeding occurs blood is not mixed with the faces it is seen on it. There is no need for proctoscopy to know anal fissure is in  6 o’ clock or 12 o’ clock position