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Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. Hernias have a high rate of recurrence, and surgeons often use surgical mesh to strengthen the hernia repair and reduce the rate of recurrence. The use of surgical mesh may also improve patient outcomes through decreased operative time and minimized recovery time. Now let’s understand more about Hernia mesh.

What is hernia mesh?

A hernia mesh is a surgical device used to provide added backing to damaged or impaired tissue due to hernia till it gets healed. It is placed through the area around the hernia, attaching it with stitches, staples or glue. Mesh’s pores let tissue to grow into the device.

How a hernia mesh works?

A hernia surgical mesh functions as an elastic scaffold for hernia repair. It reinforces walls of muscles and prevents organs from protruding through them.

Types of Hernia mesh

Most of contemporarily existing hernia mesh devices are composed of synthetic materials or tissues of animals. Surgical mesh manufactured from synthetic materials is available in knitted or non-knitted variants. The synthetic hernia meshes are made of absorbable, non-absorbable or a combination of these materials. Animal-derived meshes are made of processed and disinfected intestine or skin of pigs or cows, which are absorbable, suited for application as an implanted device.

Is Hernia mesh safe?

Hernia repair using mesh is currently one of the most regularly accomplished surgeries in general surgery. The use of mesh is recognized to reduce recurrence rates of hernia. As per evidence, non-mesh repair of hernias are associated with a higher recurrence rate at 1 year when compared to mesh repair.

Currently, chronic pain following hernia surgery is the most concerning post-operative complication with recurrence rates decreasing than ever before by using surgical hernia mesh.

Hence, the focus in hernia surgery is now shifted in defining, assessing and identifying risk factors relating to chronic pain. Chronic pain hernia surgery is a vital problem for a considerable number of patients. Some identified risk factors for post-operative pain include younger age, female gender, hernia recurrence, operative complications, and elevated pain levels in the immediate post-operative period. However, recent evidence confirms the safety and effectiveness of mesh utilization in hernia surgery. The recent evidence demonstrates that hernia repair with mesh is not linked to an intolerable level of severe chronic pain. Complication rates are low for hernia repair surgery and in majority of cases, not related to the mesh itself. It is shown that pain scores normally improve post 1 year of hernia repair.

How long does Hernia mesh last?

Non-absorbable mesh stay in the body forever and is termed as an everlasting implant. It is used to provide long-lasting support to the repaired hernia. On the contrary, absorbable mesh gets degraded eventually, losing its strength over time depending on its composition. It is not meant to provide lasting support to the repair site. As the absorbable mesh material degrades, new tissue growth is meant to give power to the repair.

If you are unsure about the specific which mesh to go with, mesh manufacturer and brand used in your surgery and have questions about your hernia repair, contact your surgeon or the facility where your surgery was performed to obtain the information from your medical record. 

The Knee and its Structure

The knee is human body’s largest joint and its healthy maintenance is required to perform most of everyday activities, easily. The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The menisci are C-shaped wedges located between the femur and tibia. These act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together and provide stability whereas, the long thigh muscles provide strength to the knee. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

What is Arthritis and different types of arthritis?

The most common disease responsible for disrupting the harmony and causing chronic knee pain and disability is arthritis. Swelling and tenderness in any of the joints of our body, including the knees is referred as arthritis.

Although there are many types of arthritis, mostly knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis is a type of arthritis that can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, leading to knee pain and limiting knee function.

Treatment of Arthritis

Treatment of arthritis concentrates on providing relief from symptoms and improving function of the joint/knee. You may need to try multiple treatments or combine several treatments from the following to help you in getting relief from your arthritis.

  • Lose some weight (in case of overweight or obese patients)
  • Exercise: Muscle strengthening around the knees through exercise restores stability of the knee joint and reduces pain. Stretching of muscles through exercise aids in maintaining the mobility and flexibility of the knee joint
  • Pain-killers: These include over-the-counter paracetamol, naproxen, diclofenac, etc. However, these should not be continued for more than 10 days without your doctor’s consultation.
  • Corticosteroid or hyaluronic acid injections directly in the knee: Corticosteroids act as powerful anti-inflammatory agents whereas hyaluronic acid is a kind of lubricant in the knee.
  • Alternative therapies such as topical counter-irritant creams containing capsaicin, acupuncture therapy or supplementation with glucosamine and others can sometimes help to improve arthritis symptoms.
  • Physical or Occupational Therapy can also aid in teaching you ways of performing routine activity through exercises or alternate ways of performing routine work.
  • Using braces: Devices such as braces can either transfer the weight from the sides of the knee affected by arthritis or even support the entire knee.
  • Surgery: When every treatment from the above options fail to provide relief from arthritis of the knee, your doctor can recommend surgical options such as arthroscopy (removing the debris in the joint through a tiny telescope and other small equipments), osteotomy (altering the alignment of the knee by changing the knee’s shape) or total knee replacement (where the natural worn out knee joint is replaced by an artificial knee joint made of metals or plastic).

Usually, the treatment of arthritis is dependent on the specific type of arthritis present. But, sometimes the patients may need to try several different treatments, or combination of treatments before they determine what works best for them. However, in most cases, an exact diagnosis increases the chances for successful treatment of arthritis. After undergoing treatment, the doctor may recommend some physical therapy to help the patient regain strength in the knee and to restore range of motion making it possible to perform daily activities more effortlessly.

Cardiovascular diseases (CVDs) also called Heart diseases are a group of disorders of the heart and blood vessels. The numerous problems causing most of the CVD is atherosclerosis (blockages in coronary arteries), a process mainly governed by lifestyle factors. As per World Health Organization, It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause.  Cardiovascular diseases are showing an increase among the Indian population. The country-wise statistics of the WHO on non-communicable diseases estimates that NCDs account for 53% of all deaths in India, out of which CVDs have a major share of 24%.

In older men, nearly all heart attacks are caused by atherosclerotic blockages in coronary arteries. Conventional coronary artery disease also predominates in young adults. About 60% of these young patients have disease of just one coronary artery, while older patients are more likely to have disease in two or three arteries. The rate of coronary heart disease in young Indian men is almost twice as high as that in their western counterparts and there is evidence that CVD begins to affect Indians at least a decade earlier than it affects Europeans. When it comes to women, Cardiovascular disease remains the number-one threat to women’s health. There is a pronounced gender difference in cardiovascular mortality, more women than men die each year. A woman’s lifetime risk of dying from heart disease is eight times greater than that of breast cancer! Also, People with diabetes, particularly type 2 diabetes, may have the following conditions like Hypertension, cholesterol, poor sugar levels etc. that contribute to their risk for developing cardiovascular disease.

Listen to Dr. Nimit Shah as he takes the time to explain the various causes of heart attacks in the country and the different treatments available for the same.

Listen to Dr. Nimit Shah, Interventional Cardiologist in the UK, Dr. Nimit Shah talks about the various risks and benefits of angioplasty, the different kinds of angioplasty procedures, and the different kinds of drug stents available in the country for the same.

Read more about Meril’s  state of the art Drug Eluting Stent Evermine50 herehttps://bit.ly/331QdkF

COVID-19 is a worldwide illness currently affecting millions of patients. Patients suffering from cardiovascular diseases (CVD) are especially vulnerable to respiratory tract infections, including COVID 19 and also these patients are at an elevated risk of ill health and even death from COVID 19.  However, the extent of damage in heart patients is currently uncertain.

As per evidence, patients with known CVD have a case fatality rate of 10.5% in case of a COVID 19 infection. Also, evidence suggests that 16.7% of COVID 19 patients, having CVD, develop abnormal heartbeat while 7.2% patients get acute cardiac damage. Cases of acute-onset heart failure, heart attack and other fatal cardiac symptoms have also been reported in COVID 19 patients with CVD. Heart complications in COVID 19 patients are comparable with SARS and MERS patients.

Suggested precautions for CVD patients to prevent COVID 19 infection

Following precautions are advised for CVD patients to prevent COVID 19:

  • Maintain your recommended blood sugar and blood pressure levels through regular intake of medicines. Currently, it is recommended to continue the prescribed ACE inhibitors or ARBs for hypertension, despite some reports of raised risk to COVID-19 susceptibility.
  • Frequently monitor your blood sugar and BP levels to rapidly identify any irregularities and get appropriate treatment adjustments
  • Get enough supplies related to your co-morbid testing and medications, in case of local worsening of outbreak, for at least 15 days.
  • Practice frequent handwashing with soap and water
  • Practice good respiratory hygiene by covering your mouth and nose with a tissue or bent elbow, in case of coughing or sneezing
  • Avoid touching your face, nose and eyes
  • Avoid unwanted travel and socializing
  • Stay vaccinated for each available infectious disease
  • Eat plenty of fruits and vegetables
  • Consume yogurt and probiotics for a healthy digestive system
  • Sleep for at least 8-9 hours to reduce stress and maintenance of immunity levels
  • Avoid crowd exposure
  • Avoid handshaking
  • Immediately contact your doctor if you develop any respiratory symptoms such as cold, cough, feeling difficulty in breathing or fever.
  • Last but not the least, stay hydrated.

And, of course, continue to stay active and follow an overall healthy regime. Stay connected with the people you love via phone calls, chats or emails because this kind of isolation can take a toll on your physical health and well-being. It’s important to understand that we all need to be extra vigilant in case we leave home especially people with underlying cardiovascular issues. Be mindful that every surface is a probable source of infection and everything that you bring inside your house could be affected by the virus. While this pandemic is a concern for the entire world, people with a known history of hypertension and cardiac disease have to be even more careful and nowhere is the saying “Prevention is better than Cure” more applicable than in such people.

Piles mostly occur due to certain factors such as chronic constipation, chronic diarrhoea, lifting heavy weights, pregnancy, and straining while passing a stool. However, your lifestyle plays a significant role too – what you consume in a day or how regular you are at exercising. Studies suggest that due to the desk-bound urban lifestyle, many people are at an increased risk of getting piles. Thus, making certain changes to your day to day life may help you avoid conditions such as piles. The habits include consuming a high fibre diet, avoiding smoking and drinking, practicing good bowel movements and so forth. 

Haemorrhoids may not be the best of the topics to discuss but one in every few individuals suffer from them. Persistent irritation, bleeding, and unavoidable pain are just a few symptoms which can become severe after a certain point of time. Fortunately, there are numerous precautions to prevent piles from interfering with your daily life.

  • Fibre Rich Diet: One of the easiest ways for a regular bowel movement is to increase fibre intake in your diet. Filling up on fibre and avoiding foods such as fast foods, meat, frozen foods etc. helps people with infrequent bowel movement and chronic constipation. Piles prevention food items such as whole grains, legumes, vegetables, and fruits are loaded with fibre, thus making stools softer and easier to pass and can help prevent hemorrhoids. Patients with a high risk of hemorrhoids should choose high fibre breakfast cereals. Additionally, high fibre supplements are also available for these at-risk people.
  • Drink plenty of water: The best way to prevent piles is to consume foods and liquids that make your stools soft so they can pass easily. Drinking eight to ten glasses of water and other liquids may help you with that. This is a non-invasive and simple strategy to prevent them as it is a condition that is mostly linked to dehydration.  Drinking sufficient water every day does not just help you with piles but benefits your body entirely.
  • Regular Exercises: Regular exercising helps in bowel movements, improving circulation, and strengthen muscles in the pelvic area and lower back, thus preventing piles. However, if you already have a history of piles, you may want to steer clear of heavy weight lifting and other strenuous exercises. You can opt for light exercises such as yoga or regular jogging/walking.
  • Don’t make laxatives your friend: Avoid frequent use of laxatives (stool softeners) as they can cause a rise in pressure during bowel movements, thus leading to piles. The overuse of laxatives can lead to dehydration and mineral deficiencies. They can also cause long-term damage to the digestive system.
  • Don’t hold back: No matter how busy you are or what situation you are in when you have to go, go. Don’t try to suppress your urge to empty your bowels as it is one of the simplest ways to prevent hemorrhoids. If you feel you have to pass your stools, immediately do so as holding your urge for a prolonged period may later cause straining during bowel movements.
  • Avoid straining: Straining isone of the most common causes of painful and bleeding piles. Don’t excessively strain and put extra pressure during bowel movements as it may be harmful for you. Other reasons for straining could be pregnancy, chronic cough, and lifting heavy objects.

The above mentioned points may help prevent piles but they cannot cure them. If you think that you have the same symptoms as that of piles, then consulting your doctor must be your first step. Avoid exacerbating your signs with these steps. Consult your doctor if you’re experiencing severe pain, light or heavy bleeding after passing stools and if the patient is a child below 12 years of age.

Hemorrhoids are affecting more and more people in India because of stress, insomnia, constipation, and a growing inclination for fast food in the sedentary lifestyle of urbanites. Every year, almost 10 million people in India suffer from pain caused by piles. In the majority of the cases, hemorrhoids resolve on their own by simple lifestyle modifications. But the patients who are distressed due to large, swollen, and prolapsed pile may have to be treated with surgery. And, if you have recently undergone a haemorrhoid surgery then you must know the difficult part is over. Now, all you need to do is take care of little things to make the recovery faster and smoother.

Typically, the recovery from a piles treatment or surgery lasts one to six weeks, depending upon the severity of the hemorrhoids, the type of treatment, and the number of hemorrhoids removed. Most of the patients begin to feel better by the end of the first week, especially when the patient can keep their bowel movements smooth or a little loose. Mostly, the doctor may recommend a stool softener, a laxative, or both to prevent straining with bowel movements. During the recovery, pain can be critical if the stool becomes hard or if straining is needed to have a bowel movement. It is highly recommended to have a good routine to avoid constipation after piles operation. One should even remember that the medications that are prescribed to the patient for the recovery period can also cause constipation, so who usually takes constipation medication may need more than their typical regimen to prevent constipation. Let us now take a look at a few factors that one must consider and what is considered as a strict No-No post a piles surgery. 

Here are some effective steps, one should take to promote faster healing post a haemorrhoid surgery.

  • Only after a few days of surgery, the patient can return to regular foods and gradually increase the amount of fibre in their diet.
  • The patient should stay hydrated by drinking 8-10 glasses of water per day.
  • It is recommended to use stool softener so that the patient won’t have to strain during a bowel movement.
  • After the piles surgery, practising Kegel exercises (contraction and relaxation of anal opening) for 3-4 times a day can reduce the false sensation of defecation.
  • The patient should make some lifestyle changes like losing weight, maintaining balanced diet, etc.
  • Taking a small walk and drinking at least 2 glasses of water can help the patient feel the urge and pass soft stools in the morning.
  • The patient should take sitz baths at least 3-4 times a day to keep the anal area clean. 
  • Applying medicines to numb the area before and after bowel movements can help reduce pain or discomfort caused by the surgery.
  • Patient must exercise regularly or have basic to medium level of physical activities to avoid stiffness and other health issues.

Things to avoid after a piles surgery

Here are some points that should be avoided in order to minimize the pain and prevent the recurrence of the hemorrhoids after the surgery.

  • The patient should not consume anything for 4 hours after the piles operation. Later, start with liquids and eat a bland diet (plain rice, bananas, applesauce, etc.).
  • Avoid strenuous activities that include heavy lifting, running, jogging, football, and cycling, etc. for 1-2 weeks after the surgery.
  • The patient should avoid straining for a longer time during your bowel movements.
  • It is advisable to avoid the use of dry toilet tissue. Instead, the patient can use wet cotton to clean themself
  • Stop eating foods that cause constipation, such as cheese, white bread, dairy products, process food, etc.
  • The patient should avoid sitting for a long period. 

Usually, surgery cures piles. But the long-term success of a piles surgery depends a lot on your ability to make changes in your daily lifestyle and bowel habits to avoid constipation and straining. However, not all hemorrhoids can be prevented, but following these dietary and lifestyle recommendations can help you prevent the recurrence of hemorrhoids and avoid further treatment. 

Hemorrhoids, usually known as piles, are caused due to swollen veins around the anus or in the lower rectum. Every year, almost 10 million people in India suffer from this disease due to numerous factors such as stress, insomnia, constipation, and a growing inclination towards fast food. Studies suggest that every second individual in this world experience piles between the age of 45-60 and many women experiences it during their pregnancy. 

Some of the symptoms to diagnose piles include extreme itching, irritation, painful bowel movements, and blood in stools. Although the risk factors are still not determined, some of them may include straining during a bowel movement, complications from chronic constipation, and sitting for a longer period. Hemorrhoids can also be passed on genetically, so if you have a family history of piles, it’s most likely that you may develop them too.

Diet plays a vital role in treatment of piles; people who consistently consume a fibre rich diet are less likely to get the disease than the ones blindly following the junk food culture. The studies suggest that people these days need to inculcate good food habits to combat problems like hemorrhoids.

If you’re experiencing extreme pain or any of the symptoms mentioned above, then consulting your primary physician must be the first step. Your doctor generally can diagnose piles during routine physical examination. The doctor will check the area around your anus for

  • lumps or swelling,
  • internal hemorrhoids that have fallen through your anal opening, called prolapse
  • external hemorrhoids with a blood clot in a vein
  • anal fissures—a small tear in the anus that may cause itching, pain, or bleeding
  • Leakage of stool or mucus
  • Skin irritation etc.

The doctor will perform a digital rectal exam to examine external hemorrhoids, however, diagnosing internal piles may include an examination of your anal canal and rectum. Doctor examines your anus through a tube fitted with a light at its end, called a proctoscope. An endoscopy can also be recommended for a detailed evaluation and to rule out any other digestive tract disorders.

Piles may not show symptoms in many individuals at all times. You can often alleviate the mild pain and inflammation of hemorrhoids with home remedies. If detected at an early stage, it can be cured with just medication and simple lifestyle changes. However, if the symptoms are severe and pain is unbearable, the following medical treatment options for piles can assist you in curing them.

  • In majority of the cases, it resolve on their own. However, some anti-itching topical agents can significantly minimize the discomfort in patients.
  • Several OTC (Over-the-counter) products, such as painkillers and topical anti-inflammatory agents can help in minimizing redness and swelling surrounding the anus.
  • Taking laxatives (substances that loosen stools and increase bowel movements), upon doctor’s advice can help a patient with constipation for easy defecation.
  • In the later stages, surgery is a must and there are various surgical procedures available for the treatment of piles.

As mentioned above, some of the home remedies for the treatment of piles include eating high fibre foods such as fruits, vegetables, and whole grains, using topical treatments, and doing regular pelvic floor exercises. For continuous bleeding or painful hemorrhoids, your surgeon might advise other minimally invasive procedures available. Although only a small section of individuals suffering piles require surgery if any other procedure hasn’t been successful, your surgeon may recommend one of the following:

  • Haemorrhoid removal: In this procedure, you will be given general anaesthesia to combat pain. Incisions are made in the tissue surrounding the haemorrhoid. Then the swollen vein is tied off to prevent bleeding and the haemorrhoid is removed.
  • Haemorrhoid stapling: This procedure is used to treat prolapsed hemorrhoids. A surgical staple fixes the prolapsed haemorrhoid back inside your rectum while cutting off the blood supply so that the tissue will shrink and be reabsorbed. Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy.

Summing up, taking utmost care of yourself post-surgery should be your priority. Maintaining a healthy lifestyle including a balanced diet is paramount. Though you can expect some pain post a haemorrhoid surgery too but with proper treatment and following all the necessary doctor guidelines will gradually reduce the impact of the pain on your road to recovery. On the other hand, if you haven’t diagnosed piles yet then it is important to know that Hemorrhoids don’t always come with symptoms, so you may not realize you have them but in case you start experiencing any discomfort like itching or difficulty in passing stool and your personal attempts to treat them don’t show positive results then it’s better to let your doctor know. 

Piles are an extremely common problem these days due to lifestyle changes. So if you have been experiencing extreme trouble due to this disease, then visiting your primary care physician should be your first step. Piles are usually self-diagnosable with some common symptoms such as itching, bleeding, and discomfort especially during bowel movements or when sitting. Your doctor might be able to observe external piles while diagnosing internal ones might require examination of your anal canal and rectum. It is of crucial importance to have a correct diagnosis before you decide to undergo any treatment for piles.

If detected at an early stage, haemorrhoid can be treated with just medication and lifestyle changes such as consumption of high-fibre diet to prevent constipation, taking OTC (Over-the-counter) medicines such as creams (Hydrocortisone – a medication used to treat redness, swelling, itching, and discomfort), painkillers, etc. Majority of the piles go away without any treatment, however, many patients require surgical treatment of piles due to extreme discomfort and severe condition. The nature of the treatment in piles depends upon the stage of the underlying condition. There are various surgical procedures available to treat this problem, however, as far as medical treatment is considered, the following options can help in treating piles:

  • Some anti-itching topical agents can significantly minimize the discomfort in patients.
  • Several OTC products, mainly painkillers and topical anti-inflammatory ointments can help in minimizing redness and swelling surrounding the anus.
  • Taking laxatives (stool softeners), upon your doctor’s advice can help a patient with constipation for easy defecation.

For constant bleeding or severe pain, your physician might suggest one of the other minimally invasive procedures available including:

  • Rubber Band Litigation:  A procedure in which the piles is tied off at its base with rubber bands, cutting off the blood flow to it. This treatment is only for internal piles.
  • Sclerotherapy (Injection): Your doctor injects a chemical solution into the haemorrhoid tissue to shrink it. While this procedure causes very little or no pain, it might be less effective than rubber band ligation.
  • Coagulation (infrared or laser): This treatment is for internal piles. The technique uses a laser or infrared light to harden and shrivel the internal piles.

The two most common surgical treatments for piles include Haemorrhoidectomy and Stapling. Amongst these two surgical interventions, removal of piles using haemorrhoid/piles stapler has been reported as the best outcome so far in terms of performance, safety, and ease of recovery. Only a small percentage of individuals with piles require surgery. However, if other methods have been ineffective or you have large piles, your doctor might recommend one of the following:

Haemorrhoidectomy: Haemorrhoidectomy refers to the surgical removal of internal or external haemorrhoid. The patient is usually kept under general anaesthesia. This method is considered to be the most effective way to treat severe or recurring haemorrhoid.

In this method, piles are diagnosed and removed using a sharp instrument or laser and the wounds are then closed by stitching. Post-surgery, the patients are advised to take sitz bath – a therapy done by sitting in warm water, avoid becoming constipated and use mild painkillers. As every procedure comes with minor complications, the potential complications in haemorrhoidectomy include:

  • Pain in the operated area
  • Urinary tract infection
  • Urinary retention (difficulty urinating)
  • Faecal incontinence (leakage from the bowel)
  • Faecal impaction (constipation for a long time)

Stapling: This method is an alternative to haemorrhoidectomy and is also used for prolapsed piles. The procedure includes stapling the last section of the large intestine, which reduces blood supply to the piles and causes them to slowly shrink. It also lowers the likelihood of haemorrhoids prolapsing. Stapling generally involves less pain than the other procedure and allows an earlier return to your regular activities.

Opting for a right treatment option completely depends on the severity of the condition and should be considered after consulting with your doctor. Post the surgery, it’s highly expected to have some light bleeding and yellow fluids from your anus. These signs may keep going from 1 to 2 months post the procedure. After 1 to 2 weeks of surgery, you should be able to return to your normal life. However, taking care of yourself post piles surgery should be of utmost importance. You can expect mild pain after the surgery. You can aid in your own recovery by consuming a high fibre diet, staying hydrated, and using a stool softener after consulting your doctor.

Now and then, you may have come across the term ‘piles’ but it’s a topic that you usually don’t want to discuss with your loved ones. It often doesn’t cause any major obstacles, however, if they do cause any bleeding or unpleasant pain, it’s time to seek proper medical care. Many people have piles but the symptoms are not always obvious. They are most common among adults aged 45 to 65 but this does not mean that young people and children cannot get them. Women are more likely to get them during pregnancy. Let us now dig deeper into getting a better understanding of piles, its symptoms and treatment options available.

What is Piles?

Piles are inflammation of tissues in the anal pathway (canal through which we pass stools). They are a collection of blood vessels, tissues, muscles or fiber. In simple words, they are lumps inside and around your bottom (anus). The size of piles can differ from person to person, and they may be internal or external. Internal piles are usually in the range of 2 cm – 4 cm above the opening of the anus, whereas external piles appear on the outside boundaries of the anus. In some rare cases, people may develop external and internal piles at the same time. Piles are also categorized by their size and severity.

What are the signs and symptoms of Piles?

Small internal piles are normally innocuous. However, larger piles may cause mucous discharge, soreness, irritability, and itch. The most common sign of piles is bleeding post passing stools. Sometimes there are no symptoms at all and you may not even realize that you have one. Nonetheless, a piles patient may experience:

  1. A hard and painful mass which is present around the anus.
  2. Feeling of bowels being full, even after passing of stools.
  3. Noticing bright red blood after passing stools, on the toilet paper or toilet pan.
  4. Itching and inflammation of the anal area.
  5. Pain while passing stools.

More severe symptoms of piles include:

  1. Excessive bleeding from the anus.
  2. Possibilities of severe infection.
  3. Inability to control stool passage.
  4. Anal Fistula (a small tunnel that develops between the end of the bowel and the skin near the anus).
  5. Strangulation where the blood flow stops in the piles causing infection and even formation of a blood clot.

What are the causes of Piles?

Piles are caused due to the increase of pressure in the lower portion of the rectum. Due to increase in pressure, the blood vessels surrounding the back passage (anus and rectum) get stretched, get swollen or form a lump, which is referred to as piles. Also, some are tend to develop for no apparent cause but there are specific circumstances that may certainly increase the chances of one developing piles such as:

  • Long term constipation leading to straining during a bowel movement or prolonged sitting in the toilet. Passing large stools increase the tension in and around the veins.
  • Long term diarrhoea/Chronic diarrhoea; Sitting on the toilet pot for too long can weaken pelvic muscles and increase pressure on you rectum and anus.
  • Frequent lifting of heavy objects – Straining and holding your breath while lifting weights could cause the veins near your anus to become swollen and possibly push through your anus, resulting in the disease.
  • Pregnancy – Piles are common during pregnancy. This is apparently due to pressure impacts of the baby lying above the rectum and anus, and also the effect that the change in hormones during pregnancy can have on the veins. However, this occurrence during the pregnancy often go away after the birth of the child.
  • Being obese – Being overweight increases the risks of developing piles.
  • Unnatural sexual intercourse.
  • Regular consumption of diet poor in fibre content.
  • Cancer in the colon – Some symptoms may include bleeding from the bottom, itching, and pain around the anus.
  • Prior surgery in the rectum area.
  • Injury in the spinal cord.

Your physician can normally detect piles after carrying out a physical checkup. They will check the anus of the person with suspected piles. The session will then be followed up with questions related to your medical history. In the case of internal piles, a digital rectal examination (DRE) or the use of a proctoscope (an instrument used to examine the anal cavity, rectum, or sigmoid colon) is required. A colonoscopy (an exam used to detect changes or abnormalities in the large intestine and rectum) may also be recommended if symptoms of the patient indicate some other digestive disease. 

While piles can be hurting and weakening, they do not pose any ongoing threat to health and can be self-managed up to an extent. However, if the complications are serious and causing unpleasant pain and hindrances in your day to day activities, then proper and immediate medical attention is suggested.

Studies show that heart disease is the leading cause of death worldwide. And, aortic stenosis is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. It is also often referred to as a disease of the elderly however a lot of young adults have also been diagnosed with aortic stenosis. The disease can occur in a single valve or in a combination of the four valves.  Usually, aortic stenosis is most common in heart’s aortic valve and mainly occurs due to the buildup of calcium deposits that narrows the valve.  When it comes to the treatment for aortic stenosis, it completely depends on the severity of the patient’s condition. Suggesting a valve replacement surgery or advising patients with medication and lifestyle changes completely depends on the doctor. But, it is important to understand that no pill can cure aortic stenosis completely but there are few medications that may help in lowering down the risk and complications involved. Let us now look at the treatment choices available for treating aortic stenosis along with its cost in India.

Treatment of Aortic Stenosis

Aortic stenosis is a progressive disease, which means it will get worse with time. Due to this, aortic stenosis is measured as mild, moderate, or severe stages depending on how damaged your aortic valve is. Treatment options for aortic stenosis generally range from simple medications such as statins or surgical repair or replacement of the diseased aortic valve. No pill can cure aortic stenosis, but medication like statins can help you lower your cholesterol which can control your symptoms and lower the risk of heart attack and stroke for some time. However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. Although, medication may be appropriate only for a person for whom surgery is not an option or for someone who’s aortic valve condition is in a very mild stage without any major visible symptoms.

In most of the cases, aortic stenosis treatment requires surgical treatment to protect the heart from further damage. Generally, surgery for aortic stenosis treatment depends on each patient’s unique requirements and factors responsible for their condition. Two of such major surgical treatment options for aortic stenosis include aortic valve replacement and Balloon/surgical Aortic Valvuloplasty (BAV).

  • Aortic valve replacement: In this procedure, your diseased aortic valve will be replaced with the mechanical valves made of metal or with valve tissue from pigs, cows or human donors using traditional open-heart surgery or Transcatheter Aortic Valve Replacement (TAVR).  Undergoing a TAVR surgery is a better treatment option as it is a minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.
  • Balloon/surgical valvuplasty (BAV): It is a less invasive procedure because it is done by inserting a long flexible tube with a deflated balloon on its tip into the blood vessel from the groin. When the tip reaches the valve, the balloon is inflated which helps to open up the stenotic or stiffed heart valves and increase the blood flow through the heart.

Why consider India for aortic stenosis treatment?

According to doctors, aortic stenosis treatment in India can be obtained at highly economical rates as compared to the Western world. Due to low treatment cost and a high level of expertise for cardiac diseases including aortic stenosis, India has become a leading destination for medical tourism in the world. Generally, the treatment cost for aortic stenosis in India depends upon multiple factors such as the selected treatment procedure, used technology, the severity of the disease, location, pre- and post-operative care demanded and other selected services. However, irrespective of any procedure selected for aortic stenosis treatment such as a SAVR, TAVR or balloon valvuplasty, the cost is less than the hospitals in western countries. People visiting India for treatment are not only from neighbouring countries like Bangladesh, Afghanistan and Nepal but also from far off countries like Kenya, Nigeria, Iraq, Yemen, Kazakhstan, Iran, Uganda and Oman. In India, aortic stenosis treatment is preferably carried out at a number of well-renowned multi-specialty and super-specialty hospitals located across a number of metropolitan cities of India such as Mumbai, Delhi, Chennai, Hyderabad, Pune, etc. These hospitals offer world-class facilities and doctors who are well-versed in performing these surgeries, even in the most challenging situations.

According to global standards, the cost of aortic stenosis treatment in India ranges from a few thousand rupees a month. As per an estimate of 2016, the mean cost for TAVR procedure in the US were 69,592$ vs 58,332$ for SAVR. As compared to these estimates, TAVR cost in India is roughly half (34,900$) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the western world.

These numbers along with the quality of treatment provided in India and effectiveness of TAVR are clearly responsible for a spike in the numbers of international patients. This means that the trend has clearly changed in the past decade in terms of treating a faulty valve and allowing individuals to live those additional years with greater quality of life or in an improved health state.