Hemorrhoids are one of the most common anorectal disorders; according to NCBI it affects around 25% to 30% of the population. People of all ages, genders, races, and ethnicities are affected. Piles become increasingly common as people become older, affecting more than half of those over the age of 50. Hemorrhoids are very common, so don’t be shy to get help! Hemorrhoids are bulging, inflated veins that occur in the anus and rectum (Back passage). They can be unpleasant, painful, and cause rectal bleeding. Hemorrhoids, are natural cushions we’re all are born with, although they don’t bother us at first. They only cause uncomfortable symptoms when they become swollen and enlarged, then known as swollen piles.

Hemorrhoids (Piles) are a topic that most people avoid discussing and prefer being silent about. But being silent may prevent you from receiving treatment for a common ailment and which can land you up in severity. Your doctor isn’t shy about bringing up the subject of haemorrhoids, so discuss freely. 

When to see the doctor? 

Most people think of hemorrhoids as a minor problem, it can be very painful. It is important to know when to treat hemorrhoids on your own and when to seek help, as it can avoid unnecessary complications. 

Make an appointment with your doctor if you’re having any of the following symptoms related to your hemorrhoids:

• You notice bright red blood on your toilet paper or have rectal bleeding.
• Your rectum or anus is causing you agony and discomfort.
• You’ve tried over-the-counter medications for more than a week and they haven’t helped you.
• You experience a maroon or dark tar-colored bowel movement, which could be an indication of bleeding.
• You feel mass outside your back passage

If your rectal bleeding won’t stop and you’re feeling dizzy or faint, it’s a medical emergency that necessitates a visit to the Emergency room (ER). 

 How do doctors treat Haemorrhoids? 

 Hemorrhoids are treated by doctors in the office, in an outpatient clinic, or a hospital. Treatment depends on severity. For an initial stage of piles lifestyle changes can help you if given at on right time. For mild piles office procedures can help you. But for severe piles surgery is the only option.

Office procedures for very mild piles:

• Rubber band ligation: Rubber band ligation is a treatment that surgeons employ to treat internal hemorrhoids that are bleeding or prolapsing. A doctor wraps a specific type of rubber band around haemorrhoid’s base. The band stops the blood supply. Within a week, the banded component of hemorrhoid shrivels and slumps.
• Sclerotherapy: In this therapy, a surgeon injects a special chemical into haemorrhoids, which causes the haemorrhoid to shrink, while also stopping it from bleeding.
• Photocoagulation with infrared light: A doctor employs an infrared light instrument to treat internal hemorrhoids. Scar tissue forms as a result of the infrared light’s heat, cutting off the blood supply and reducing hemorrhoids.
• Electrocoagulation: A doctor inserts an electric current into an internal hemorrhoid with an instrument. Scar tissue forms as a result of the electric current, cutting off the blood supply and reducing hemorrhoids.

Surgical procedures for moderate to severe piles:

• Haemorrhoidectomy: A haemorrhoidectomy is a procedure in which a surgeon removes the prolapse of hemorrhoids (which is coming out from the back opening) by cutting it directly with a scalpel, scissors, or electrical energy source.
• MIPH (Minimally invasive procedure for Hemorrhoid): Internal hemorrhoid tissue is removed and the prolapse of the internal hemorrhoid is pulled back into the anus by using a special stapling circular device.

Today, let us know more about MIPH 

MIPH (Minimally invasive procedure for Hemorrhoid) or Stapled haemorrhoidopexy is a surgical procedure for treating hemorrhoids. It is the preferred therapy for third and fourth-degree hemorrhoids (a severe form of piles that protrude with straining and are visible on physical examination outside the anal margin. The manual reduction must be done on a regular or irregular basis). Stapled haemorrhoidectomy is a misnomer because the procedure removes the unusually slack and enlarged tissue which supports hemorrhoids that have caused the hemorrhoids to prolapse downward, rather than the hemorrhoids themselves.

A circular, short hollow tube is introduced into the anal canal for stapled haemorrhoidopexy. A suture (a long thread) is woven circumferentially through the anal canal above the internal hemorrhoids through this tube. The stapler (a disposable instrument with a circular stapling device at the end) is inserted into the hollow tube, and the suture ends are brought together and pulled inside the stapler along with prolapsed hemorrhoids. Stapler when fired causes cutting of slack tissue and stapling of hemorrhoids back to their original position.

 Patients who undergo a minimally invasive procedure for hemorrhoids (MIPH)/ Stapled Haemorrhoidopexy benefit from the following:

• Return to work as soon as possible
• There is very little discomfort
• There are no cuts, hence there are no dressings required
• There are no follow-ups
• Released from the hospital in a day

Comparison between MIPH and Conventional Haemorrhoidectomy

Haemorrhoidectomy is a procedure that removes hemorrhoids from the body. You will be given general or spinal anesthesia to prevent you from feeling discomfort. Around hemorrhoids, incisions are made in the tissue. To prevent bleeding, the enlarged vein inside the hemorrhoid is tied off, and the hemorrhoid is removed. It is possible to suture the surgical area to shut it or leave it exposed. The wound is covered with medicated gauze. A knife (scalpel), an electric tool (cautery pencil), or a laser can be used to do surgery. In most cases, the procedure is performed in a surgical center. You’ll probably return home the next day or more.

Stapler Haemorrhoidectomy / MIPH (Minimally Invasive Procedure for PILES) is a procedure where an expert surgeon employs stapling equipment to remove a portion of the pile mass with a staple gun, addressing two major concerns: bleeding and prolapsed hemorrhoids. The titanium staples not only cut but also seal at the same time, which lowers bleeding and post-operative pain. Because no extra incision on the lower region of the anal canal is necessary, the patient does not require any post-operative dressing. A patient can return home the same day and resume normal life in a day or two.

The most prevalent complaints of piles are painless rectum bleeding and haemorrhoidal prolapse, painful defecation. When compared to open haemorrhoidectomy, the average length of surgery for MIPH and post-operative bleeding is much shorter. The postoperative pain score and subsequent need for analgesics are significantly lower in the MIPH. MIPH patients have a faster average wound healing time and a quicker return to routine activities. Less recurrence or incontinence is observed. Similarly, there are no significant differences in long-term problems between MIPH and traditional open haemorrhoidectomy in patients with MIPH.

MIPH is a frequently used and safe procedure for grade III and IV hemorrhoids. It results in less pain, a shorter hospital stay, and fewer early postoperative problems. Wound healing and return to normal activities are faster, and long-term problems are not significantly different.

What are Piles/Hemorrhoids?

Piles, also known as Hemorrhoids, are a collection of swollen tissues and veins in your anus and lower rectum. They can be of two types – internal and external. Internal hemorrhoids develop inside the anal canal, while external hemorrhoids develop on the skin around the anus. These hemorrhoids may vary in size. Piles may occur due to constipation, chronic diarrhea, lifting heavy weights, pregnancy, and straining while passing stools.  

Usually, hemorrhoids don’t require any treatment and resolve on their own. But when the condition turns severe, treatment is needed. The symptoms of piles depend on the type and location. In the case of external hemorrhoids, the symptoms might include irritation/itching in the anal region, pain, discomfort, swelling, and bleeding. In the case of internal hemorrhoids, the hemorrhoids cannot be seen, but they can cause painless bleeding while passing stools. Protruding hemorrhoids have feeling of some mass in the anal region that causes pain and irritation.

What are the various treatment/cure methods for Piles?

There are different ways to cure piles, depending on the severity of it. Some of the most effective treatment methods are:

For early and mild pile piles:

Home Remedies: If the hemorrhoids are mild, then you can cure them through certain home remedies such as making dietary and lifestyle changes, using over-the-counter hemorrhoid cream containing hydrocortisone, and soaking your anal area in warm water for 10-15 minutes every day.

Rubber Band Ligation: In this procedure, your doctor will place one or two tiny rubber bands on the base of the internal hemorrhoids to stop the circulation. Within a week, the hemorrhoid withers and falls off.

Sclerotherapy: Your doctor will inject a chemical into hemorrhoid to shrink it. Though this procedure causes less pain, it is also less effective than the rubber band ligation.

Coagulation: This technique uses laser or infrared light to harden internal hemorrhoids that bleed, shriveling them.

For moderate to severe piles:

External Hemorrhoid Thrombectomy: In case of thrombosis (a painful blood clot) in external hemorrhoid, your doctor will remove hemorrhoid, which will provide immediate relief. This procedure is done under local anesthesia and is extremely effective if performed within 72 hours of the blood clot.

Hemorrhoid Removal: Also known as Hemorrhoidectomy, this is a surgical procedure in which the surgeon removes the excess tissue which is protruding out of anal canal that causes bleeding. This method is used to treat severe piles.

Hemorrhoid Stapling: This procedure is also known as Stapled hemorrhoidopexy. It blocks the blood flow to the hemorrhoid tissue by taking cutting and pulling the piles up on its position. It is usually used to treat internal hemorrhoids.

What is Anal Fissure?

An anal fissure is a tear in the mucosa (a thin, moist tissue) lining of the anus. The tearing of the skin causes severe pain and bleeding during and even after bowel movements. Though it is most commonly seen in infants and children, an anal fissure can affect people of all age groups. Most times, the fissure heals on its own with a month to six weeks. But if it persists after that, it can be considered chronic. Sometimes, the fissure tends to be deep enough to expose the muscle tissue.

The most common causes of an anal fissure are constipation, straining during bowel movements, passing large/hard stools, diarrhea, childbirth, and anal intercourse. A person suffering from an anal fissure may experience one or more of the following symptoms, which include, mild/severe pain during bowel movements, visible tear/crack on the skin around the anus, a small lump near the tear, streaks of blood after passing stools on the toilet seat or the tissue paper, pain after bowel movements that lasts for a long time.

How can Anal Fissure be cured?

Usually, Anal Fissure doesn’t require extensive treatment. Certain home remedies can help cure anal fissure and relieve symptoms. Some treatment methods to cure anal fissure are:

Home remedies: You can take measures to keep your stools soft, such as increasing the intake of fibers and fluids, and taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow.

Applying Nitroglycerin: Applying a nitroglycerin cream or ointment will help increase blood flow to the anal area and reduce inflammation.

Botox Injection: The Botulinum toxin type A (botox) injection may help paralyze the anal sphincter muscle and relax the spasms.

Blood Pressure Medicines: These medicines can also help relax the anal muscle. This can be used when nitroglycerin is not effective or causes significant side effects.

Surgery: If the anal fissure is severe, your doctor might suggest surgery known as the Lateral Internal Sphincterotomy (LIS), in which a small portion of the anal sphincter muscle will be removed to reduce pain and promote healing.

What is the difference between Piles and Fissure?

While piles are a collection of swollen tissues in and around the anus region, fissure refers to a crack in the anal cavity.

What is Anal Fistula?

An anal fistula is a small tunnel that develops between the anal canal and the skin near the anus. They’re usually the result of an infection near the anus causing a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind. In the fistula, the center portion of the anus gets infected and forms an abscess, which starts oozing pus.

What is the difference between Piles and Fistula?

Piles are caused due to constipation, diarrhea, pregnancy, and weight lifting, while fistula is caused due to trauma, Crohn’s disease, warts or cancer. Piles can usually be diagnosed by self by observing the signs and symptoms while detecting fistula might be difficult and may require an MRI scan or a sonofistulagram.
Piles are less severe as they can be cured with home remedies and other less invasive techniques, while fistula can only be treated through surgeries such as fistulotomy, seton techniques, advancement flap procedure, and LIFT procedure. Video-Assisted Anal Fistula Treatment (VAAFT) is a non-surgical method commonly used to treat fistula.

Be it piles, anal fissures or fistula, the first step to prevent them is by practicing better hygiene, especially when it comes to defecation. All three conditions can also be prevented by indulging in a high-fiber diet and increasing the intake of fluids, everyday physical activities and avoiding strains. It is also important for one to be mindful of the symptoms and seek immediate medical help to prevent the conditions from becoming severe.

Disclaimer: This blog is only for awareness purpose. We do not intent to promote any medications given in the blog. Please consult your physician before taking any medication.

Piles are very common but not something you’ll want to talk to your friends or loved ones about. Many people are ashamed of having enlarged piles. They don’t like to discuss symptoms and might be reluctant to go to the doctor. Some might be afraid of having a physical examination or finding out that they have a serious illness. But seeing a doctor about your symptoms is important if you want to have the right treatment.

Today, open access to biomedical information on the internet or social media has created new opportunities for doctors and patients, but much of the information is subject to manipulation because the ordinary conventions of context and the reliability of provenance are constantly in question. Alike other medical information, Piles too have much content online. But the question is “Is it reliable?” To uncloud this confusion, on #WorldPilesDay we invited the renowned Proctologist and Lap. Colorectal Surgeon, Dr. Pravin Gore, with 21 years of experience to share his knowledge about piles and their treatment. Dr. Pravin Gore is currently practicing in Mumbai and is associated with eminent hospitals like Apollo spectra, Bhatia, Wockhardt etc. He has vast experience in laparoscopic surgeries related to problems in the colon, rectum, anus and other parts of the lower abdomen.

During his LIVE session with us on our Facebook page, Dr. Pravin Gore shared information on the following topics;

What is Piles?

Piles, also known as haemorrhoids are swollen and inflamed veins in the rectum and anus (canal through which we pass stools) that cause discomfort and bleeding. The size of piles can vary from person to person, and they are found inside (Internal Piles) or outside (External Piles) the anus. Usually, internal piles are 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.

 Symptoms and Causes of Piles

In most cases, the symptoms of piles are not serious. One of the most common symptoms of piles is bleeding post passing stools. Sometime you will notice no symptoms or signs at all. Nonetheless, a piles patient may experience:

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

Usually, piles are caused by increased pressure in the lower rectum. Also, sometimes piles tend to develop for no apparent cause but there are specific circumstances that may certainly increase the chances of one developing piles such as:

• Chronic constipation
• Chronic diarrhoea
• Lifting heavyweights
• Pregnancy
• Straining when passing a stool
• Cancer in the colon

How to prevent piles?

Fortunately, there are numerous precautions to prevent piles from interfering with your daily life.

• Fibre-rich diet
• Drink plenty of water
• Regular exercise
• Avoid frequent use of laxatives
• Don’t hold your bowel movements
• Avoid straining

How much time does it take to cure piles?

Usually, small piles may clear up without any treatment within a few days (7-10 days) and you will be able to resume most activities right away. However, large or external piles may take longer to heal depending upon the treatment.

What are the treatment options available for Piles?

If detected at an early stage, piles 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 swelling, redness and itching), painkillers, etc. 

If there’s no improvement to your piles after home treatments and medications, you may require other minimally invasive procedure such as:

• Coagulation (infrared or laser): This treatment is for internal piles. The technique uses infrared light or laser to harden and shrivel the internal piles.

Other surgical treatment options include:

• Haemorrhoidectomy: Haemorrhoidectomy refers to the surgical removal of internal or external piles. This procedure is considered to be the most effective way to treat severe or recurring piles.

In this method, piles are diagnosed and removed using a sharp instrument or laser and the wounds are then closed by stitching.

• Stapling: This method is an alternative to haemorrhoidectomy and is also used for prolapsed piles. The procedure includes stapling the last section, anal canal 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. According to Dr. Pravin Gore, Meril’s MIRUS Hemorrhoids Stapler offers better security and superior haemostasis which delivers optimum excision of prolapsed haemorrhoidal tissue. Stapling generally involves less pain than the other procedure and allows an earlier return to your regular activities.

• Other treatment options include band litigation, Haemorrhoid artery litigation & Sclerotherapy.

What are the chances of Piles relapsing after the surgery?

There are no chances of piles relapsing after the surgery if the piles are removed from the anal canal, but when the piles are just sealed with other treatment options, then there are 10% chances of relapsing. However, the reoccurrence of piles can also be well managed by avoiding constipation and straining while having bowel movements.

What is the difference between piles, fissures, and fistula?

Piles are mainly the swollen blood vessels in the anal canal, which occurs due to chronic constipation while fissures are kind of the cracks found in the skin of the anal canal and fistulas are the small opening in the anal canal, it is kind of cavity filled with pus.

Opting for the right treatment option completely depends on the severity of the condition and should be considered after consulting with your doctor. Summing up, if anyone is suffering from piles or has bleeding or pain from their anal canal should visit their doctor immediately. Because delay in the treatment can make the condition worse.

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.