While everyone has heard of Piles (or Haemorrhoids), somehow very few people know what they are and what to do about them.
The haemorrhoidal veins run in three clusters around the circumference of the anus, starting at one end just underneath the skin outside the anus and ending at the other just beneath the mucous membranes in the anus and rectum.
Piles are dilatations or varicose veins that may develop in this awkwardly place, but normal system of veins and may result in anyone, but do tend to occur more frequently in people with spinal cord injury.
How do you know that you have piles?
While many able-bodied people may experience anal pain or itching and discomfort as a result of piles, these symptoms are, of course, frequently missing in people with spinal cord injury (SCI).
There may be some blood in your stools or on your toilet paper.
There may be areas of discreet swelling protruding through the anal canal.
Piles may be accompanied by obviously inflamed skin around the anus and even some shallow or even deeper splits in the skin.
There may be aggravated spasticity in some people - especially spasticity of the muscles that pull the legs together - adductor spasticity.
Piles may result in leakage of faecal matter and liquid through the anus.
In able-bodied people, piles are frequently associated with excessive straining with constipation and seem to result from weak connective tissue around the veins in this region.
In SCI, imbalances in the autonomic nervous system tend to produce a general passive state of vasodilatation in these and other veins. Infrequent changes of position, long times spent on a toilet or commode during your bowel regimen and even rough manual stimulation of the anus and rectum during the bowel regimen can cause local trauma and lead to piles.
Irregularity of your bowel programme can also aggravate the situation.
Firstly, piles can aggravate spasticity.
Secondly, moderate or even large piles that have pushed out through the anal canal can result in leakage of faecal matter and moisture that may irritate the anal skin and the skin of the buttocks and predispose to pressure sores. Similarly, this may also raise your risk of urinary tract infection.
Piles may become infected and result in perianal abscesses that may need incision and drainage or antibiotics and may result in new being confined to bed.
Irritations of the anal skin and splits in the anal skin may precipitate episodes of autonomic dysreflexia.
Piles may lead to excessive bleeding.
What should I do about piles if I think I have them?
Firstly, if you are in any doubt about any new developments or changes in or around the anus, visit your doctor and let him or her examine you properly. Your doctor will be able to provide you with appropriate treatment.
This treatment may be a simple anti-inflammatory ointment or suppository, may involve an injection into the piles to cause them to shrink or may even involve surgery to remove the piles.
As always, prevention is better than cure and you should always observe the following precautions to prevent piles if you do not have them, and to prevent them from causing problems and progressing, if you already do.
Promote good circulation to your rectal area by practising excellent pressure care when in your wheelchair.
Minimise times spent sitting on toilet or commode to less than one hour.
Ensure generous lubrication of any gloved finger that is used for manual stimulation or evacuation of the rectum. Make sure that this stimulation is gentle.
Keep an eye open for anal bleeding.
If any piles begin to protrude through the anal canal, gently push them back with a lubricated, gloved finger if possible.
Warm baths may promote anal circulation if this is possible.
Clean and dry the anal area thoroughly following each bowel movement, or even every eight hours when there is irritation in the area.
ïƒ©Reassess the effectiveness of your bowel programme, take measures to avoid constipation and have a good look at your diet. Speak to your doctor about this if it is not satisfactory.
Many of my patients seem to have regarded the presence of large, protruding, bleeding piles and the resulting skin irritation and spasticity as an inevitable part of their lives. This is not the case and with active management of your bowel programme, meticulous hygiene and attention to these points, the impact of piles on the life can be minimised.