As a surgeon, one of the commonest problems that I treat regularly is bleeding in stools. Largely, my patients are females who have been self-medicating themselves due to ignorance of their own health issues and awkwardness of being examined by a male doctor.
When questioned about their problems most of them would reply, “Doctor I have piles”
Bleeding in stools is commonly caused by a ‘fissure’ which is nothing but a cut in the soft mucosa of the anal region. It’s caused due to straining while passing hard stools.
People who deprive themselves of adequate intake of water and foods rich in fibre such as fruits and vegetables are common sufferers. Eating fibre rich food, drinking plenty of fluids and keeping bowel movements regular, thus avoiding constipation are the easiest remedies to cure a fissure.
Piles in layman terms or haemorrhoids in medical literature are basically enlarged veins that protrude out of the anal canal. These are often seen as a mass coming out of the anal region and can sometimes cause alarming bleeding in patients.
The bleeding is classically described as ‘painless, tap like bleeding in stools.’ Needless to say it is discomfiting to the patients. Very rarely are piles painful, when they are thrombosis or have a blood clot in them.
Hard stools can cause these enlarged veins to bleed, they are commonly seen in women during pregnancy, and rarely in patients who have an underlying malignancy.
In elderly patients one must be wary of bleeding from stools, as it may be an ominous sign of a growth or cancers of the rectum. If associated with constipation or diarrhoea, a reduced appetite combined with weight loss and feeling of fatigue it should be looked into by a clinician so as to rule out a malignancy.
The takeaway message should be that, at all costs bleeding from stools should not be casually dismissed as ‘piles’ a relatively easy to treat, common condition.
Patients have to be evaluated by a clinician, specifically a surgeon, who can ascertain the exact cause of bleeding, investigate and then treat it. One must also refrain from using alternate medicine remedies without consulting a clinician so as not to miss lurking malignancies, assuming “It’s only piles.”
The author is an associate professor of Surgery, K. J Somaiya Hospital,Consultant General and Laparoscopic Surgeon on piles