Types of  Piles

Types - Piles is classified in two ways.

Internal piles - lies inside the anus. Usually internal piles originates from superior haemorrhoidal plexus of the upper part of anal canal and lies above the Hilton’s line. This type usually will not be painful, since it lies in the upper part of anal canal, which lacks pain-sensitive nerve innervations.

External piles - lies outside the anus. External piles originates from inferior haemorrhoidal plexus of the lower part of the anal canal i.e. it lies lower to the Hilton’s line. This type of external piles is most painful, since the lower part of the anal canal has pain-sensitive nerve fibres. Some piles patients may have both types. Piles can also be classified as

Primary piles – occurs due to hereditary reason without any causative factor or obstruction

Secondary piles – occurs in continuation with other diseases or obstruction to portal circulation like liver disorders, portal hypertension due to obstruction, rectal or pelvic tumours, cancer, spleenomegally, etc.

Prolapsed piles –is the piles which gets descend from the place of origin, i.e. internal piles descends to get visualised as external piles. This prolapsed piles should be cared for in the initial period itself or otherwise it may get strangulated and develop into gangrene. In the initial period, the protrusion gets inside or recedes without any assistance after passing stool, but in due course, the protruded mass will not recede even with the assistance of fingers.

Commonly suspected causes for development of piles
Pressure in the blood vessels may be due to

Obstruction

Physiological – Pregnancy and delivery can cause temporary increase of venous pressure and thus piles can occur. Pathological - Liver and portal vein disorders, pelvic or rectal tumours, cancer, etc., can cause obstruction and lead to piles. Erect postures of man – Animals are flat, but humans had become erect by evolution. This has been considered a major factor for development of piles. Hereditary – piles is often found to run in families Physical strain – pressure exerted while passing stool, coughing continuously for a prolonged time, weight lifting, etc., can also cause piles & tendency to prolapse and relapse Foods – Low fibre diet, more Spices, alcohol, lesser intake of water can produce hard stool, which may need of more strain in defecation and thus lead to piles Defecation – Both constipation and diarrhoea can cause piles. The strain for passing the stool is the main reason for the development of piles in both cases. Habits of alcohol, sedentary life and drugs can also cause piles Worries and mental strain can also cause havoc to the intestines and anus