Piles Treatment in Indore

Haemorrhoids are mucosal swellings containing blood vessels inside or around the anal canal.

• Ans:Piles (पाइल्स)
• Bavasir (बवासीर)
• Masse (मस्से)
• Arsh (अर्श / आयुर्वेद)

• Internal Haemorrhoids (Above dentate line)
• External Haemorrhoids (Below dentate line)
• Mixed (Interno-External) Haemorrhoids

Note: Mixed haemorrhoids may prolapse, thrombose, or ulcerate.

Goligher's Classification.

Goligher's Classification (Grades of Internal Haemorrhoids)

Grade I: Do not prolapse and remain inside.

Grade II: Come out during defecation (motion) and reduce on their own.

Grade III: Prolapse during defecation and need manual reduction.

Grade IV: Remain outside and are irreducible.

In simple words: Too much pressure on the blood vessels causes them to bulge and stretch, just like a balloon filled with air.

Causes:

1. Straining – Pushing too hard during defecation (motion).
2. Long sitting – Increases pressure in the rectal area.
3. Irregular bowel habits – Long-lasting constipation or diarrhea.
4. Pregnancy – Increased pressure on the pelvic floor due to the growing baby.

Etiology (Causes) of Haemorrhoids (Continued)

1. Heavy lifting – Increased body pressure.
2. Genetics – Family history.
3. Ageing – Loosening of blood vessels with increasing age.
4. Obesity – Increased pressure on the rectal area.
5. Low-fibre diet – Poor dietary habits.
6. Less intake of water – Diet low in water and fibre.
7. Spending a long time on the toilet – Often associated with irregular dietary habits.
8. Use of western toilet – Prolonged sitting on the toilet may increase pressure on hemorrhoidal veins.

Chronic Constipation & Diarrhea

Requires you to push hard (straining) and spend more time on the toilet.

High pressure blocks normal blood flow and causes swelling.

IBD (Inflammatory Bowel Disease)

A long-term condition that can cause frequent diarrhea and straining.

Liver Cirrhosis & Portal Hypertension

Portal hypertension increases pressure in the venous system, leading to swelling of hemorrhoidal cushions.

Bedridden Patients

Patients who remain in bed for prolonged periods (e.g., after CVA/stroke or other illnesses) may develop irregular bowel habits and constipation, increasing the risk of haemorrhoids.

Rectal Mass or Growth

A rectal mass narrows the anal canal, increasing pressure in the rectal cavity and can lead to haemorrhoids.

Chronic Diseases

Examples include:

• Diabetes Mellitus (DM)
• Hypertension (HTN)
• Cerebrovascular Accident (CVA)
• Cardiac diseases
• Chronic Asthma

Abdominal diseases

They are usually not life-threatening, but if left untreated for a long period, they can cause many complications, such as:

1. Increased Bleeding

Can lead to anemia.

2. Pain

Haemorrhoids are usually painless, but if they become more swollen, they can be painful.

3. Prolapse

Initially, the haemorrhoids go back inside on their own, but over time they may become irreducible (cannot be pushed back).

4. Thrombosis

Due to long-standing haemorrhoids, a blood clot (thrombus) can develop, causing a very painful condition.

5. Ulceration

Due to constant rubbing, ulcers can develop, leading to pain and bleeding.

History of Symptoms

1. Bleeding during or after passing motion.
2. Swelling from the anal canal during motion.
3. Pain (mainly in cases of thrombosed haemorrhoids).
4. Itching.
5. Feeling of incomplete evacuation (incomplete motion).
6. Constipation, prolonged straining, or chronic diarrhea.
7. Mucus discharge.

Clinical Examination

1. General Examination
2. Look for pallor to rule out anaemia.
3. Local Examination
4. External haemorrhoids
5. Prolapsed haemorrhoids
6. Skin tag
7. Thrombosed haemorrhoids
8. Ulcer
9. Edema (swelling)

Per Rectal Examination (Digital Rectal Examination)

A digital examination is done to assess:

1. Haemorrhoids
2. Tone of the anal sphincters
3. Presence of blood
4. Tenderness
5. Any other abnormalities

Anoscopy

A simple examination performed to look inside the anal canal.

It helps to confirm the presence of internal haemorrhoids.

Note: Anoscopy helps to identify:

• Grade of haemorrhoids
• Source of bleeding
• Any fissure, polyp, or other disease of the anal canal

Sigmoidoscopy / Colonoscopy

Sometimes, bleeding from the anal canal may not be due to haemorrhoids. Therefore, sigmoidoscopy or colonoscopy is done to confirm the cause.

It helps to detect:

1. Rectal bleeding
2. Polyps
3. Inflammatory Bowel Disease (IBD)
4. Cancer or growth
5. These tests are usually done if warning signs are present, such as:
6. Dark stool mixed with blood
7. Weight loss
8. Irregular bowel habits
9. Family history of cancer
10. Palpable mass
11. Bleeding despite treatment

Light Proctoscopy / Procto-Rectoscopy

Used to examine the anal canal and rectum in more detail.

Non-Surgical Management (Without Operation)

1. Dietary Management

Things to prefer in diet:

• High-fibre foods
• Fruits: Papaya, Apple, Pear, Orange
• Vegetables: Carrot, Beetroot, Cucumber, Pumpkin
• Whole grains: Whole wheat chapati, Oats, Brown rice, Millet (Jowar, Bajra, Ragi)

2. Drink Plenty of Fluids

• Water: 8–10 glasses/day
• Coconut water
• Buttermilk
• Lemon water
• Clean soups

3. Reduce Oil & Spices

• Less oil
• Less spicy food
• Avoid junk food

4. Drink Plenty of Fluids

• Water (8–10 glasses/day)
• Coconut Water
• Buttermilk
• Lemon Water
• Clean Soups

5. Probiotic Foods

• Curd
• Buttermilk
• Dahi
• Idli

6. Healthy Fats

Things to Avoid in Diet Management

• Very spicy food
• Very oily & fatty food
• Fast food
• Processed snacks
• Excess red meat
• Maida
• Excess alcohol

Lifestyle Modification & Healthy Lifestyle

1. Regular Exercise

Include pelvic floor exercises.

2. Time for Eating is Fixed

• No prolonged sitting on the toilet.
• Avoid Long Sitting Work
• Avoid straining
• Avoid constipation
• Avoid eating junk food
• Avoid alcohol

Symptomatic Medicine

Allopathic

• Stool Softeners
• Lactulose syrup
• Polyethylene Glycol (PEG)
• To prevent constipation & reduce straining

Pain Relief

PCM (Paracetamol)

Local Creams & Ointments

(For relief from pain, itching & swelling)

• Lidocaine
• Combined cream containing local anaesthetic with steroid

Venotonic Drugs

• Micronized Purified Flavonoid Fraction (MPFF)
• Diosmin
• Hesperidin

Ayurvedic (Prescribed by Ayurvedic Physician)

• Arshoghni Vati – For piles (hemorrhoids)
• Triphala Churna – For relieving constipation
• Triphala Guggulu – For inflammation & wound healing
• Nagkesar Churna – For bleeding hemorrhoids

Homeopathic

• Aesculus Hippocastanum – For painful hemorrhoids, feeling of fullness
• Hamamelis Virginiana – For bleeding hemorrhoids
• Nux Vomica – For constipation
• Paeonia – For burning pain after passing stool

Office Based Procedure (Small Procedure without Major Surgery)

1. Rubber Band Ligation

Done: Without admission or with a short stay.

Benefits:

• No major stitches
• 5–10 min procedure
• Less expensive

Disadvantages:

• Pain & discomfort
• Bleeding
• Not suitable for large prolapse
• High chance of recurrence

2. Injection Sclerotherapy

Benefits:

• Simple & quick
• Slightly painful needle

Disadvantages:

• Pain & discomfort
• Ulcer
• Stricture formation

Recurrence (large haemorrhoids may require multiple sessions)

Not suitable for haemorrhoids [Note: likely refers to large/advanced stages]

⭐ Surgical Treatment (operative treatment)

Done for large hemorrhoids:

• Frequent bleeding
• Medicinal failure
• Thrombosed external haemorrhoids
• Recurrent haemorrhoids

Old Techniques –

• Open haemorrhoidectomy (Milligan-Morgan)

All haemorrhoids are completely cut.

Benefit

• Doesn't require modern equipment
• Less expensive
• Treat both internal & external haemorrhoids

Disadvantages –

• More pain after surgery than modern technique
• Requires regular dressing & good hygiene
• Recovery is longer
• Mild bleeding during healing period
• Anal stenosis (rare)
• Fecal incontinence (very rare)

Ferguson (Closed technique)

Benefit –

• Closed wound promote fast healing than open wound
• Good cosmetic outcome
• Less postoperative pain than the open (Milligan-Morgan) technique in many patients.

Disadvantages –

• Long operative time
• Stitch produce discomfort
• Risk of infection
• Wound breakdown if healing is poor
• Anal stenosis (rare)
• Fecal incontinence (very rare)

 New techniques

MIPH (Stapler) (minimal invasive procedure for hemorrhoids)

​Benefits –

• ​Less pain
• ​Short hospital stay
• ​Faster recovery
• ​No external wound
• ​Effective for all grade hemorrhoids with prolapse.

​Disadvantage –

• ​Expensive
• ​Infection (rare)

​Note – It require experienced surgeon & specialized equipment.

Laser hemorrhoidoplasty -

​Benefit –

• ​Very less pain
• ​No external wound
• ​Short hospital stay
• ​Faster recovery
• ​Low risk of infection
• ​Better cosmetic outcomes

​Disadvantage (Laser Technique) –

• ​Expensive than other technique.
• ​Requires specialized laser equipment & Experienced surgeon.
• ​Infection (very rare).

​

To prevent piles from developing, you need to make sure that you don’t get constipated as constipation is the primary cause of piles. Include high-fiber foods in your diet, such as beans, legumes, vegetables, fruits, whole grain cereals, bran, etc. in your diet. Exercise regularly and be physically active to improve the blood flow in the anal region. Remember to drink plenty of water too.

To prevent piles from developing and to reduce the symptoms, you can follow the tips below-

• Eat fiber-rich diet or fiber supplements to prevent constipation.
• Drink enough water or fluids to keep the body hydrated.
• Do not delay going to the bathroom when you feel the urge to pass stools.
• Avoid straining during bowel movements and sitting for long periods.
• Exercise daily to encourage bowel movements.

These habits will be helpful to prevent piles.

Laser piles surgery is a non-invasive method that doesn’t involve cuts, stitches, or scars. Hence, the recovery doesn’t take much long. You can recover completely within 2-7 days after undergoing laser piles surgery.

Laser surgery does not pose any major restrictions over the physical activities. You will be able to walk on the same day of surgery and resume the daily activities on the next day.

No. Laser piles surgery is minimal pain procedure as it is carried out under anesthesia (either general or local). The patient usually doesn’t feel pain in the anal region during the surgery. And the pain caused by piles also disappears shortly after surgery. 

1. Increased Bleeding.
2. Pain
3. Prolapse
4. Thrombosis
5. Ulceration
6. Constipation
7. Fissure
8. Fistula