Piles (Haemorrhoids)

Swollen and inflamed veins in the lower rectum and anal canal. They develop when pressure increases in these veins, causing them to stretch and bulge. They can be internal (inside the rectum) or external (around the anal opening) and commonly cause discomfort, bleeding, pain during passing stools, or a visible lump.

Causes

• Straining during passing stools
• Chronic constipation or diarrhea
• Long hours of sitting
• Low-fiber diet
• Pregnancy pressure
• Obesity
• Heavy lifting
• Family tendency

Symptoms

• Bright red bleeding during or after passing stools
• Pain during passing stools
• Swelling or a lump near the anus
• Itching or irritation
• Mucus discharge
• Prolapse of internal piles while passing stools

Types of Piles

Internal piles

1. Located inside the rectum
2. May bleed or prolapse
3. Usually less painful

External piles

1. Located under the skin around the anus
2. Cause pain and swelling
3. Thrombosed piles
4. Clotted external pile
5. Sudden severe pain with a hard, tender lump

Grading of Internal Piles

Grade I

• Swelling inside the rectum
• No prolapse
• May cause bleeding

Grade II

• Prolapse while passing stools
• Goes back inside on its own
• Bleeding or discomfort possible

Grade III

• Prolapses and needs manual pushing inside
• More irritation and mucus discharge

Grade IV

• Always outside
• Cannot be pushed back
• Painful and swollen

Diagnosis

• Clinical examination
• Digital rectal examination
• Proctoscopy or anoscopy
• Colonoscopy if bleeding cause unclear

Treatment Options

Grade I – Mild Internal Piles

1. Diet and lifestyle change
2. Warm sitz baths
3. Stool softeners
4. Topical creams or suppositories
5. Lifestyle changes to avoid straining
6. Laser therapy optional for persistent bleeding or irritation

Grade II – Moderate Internal Piles

1. Laser hemorrhoidoplasty commonly used for faster relief and minimal pain
2. Rubber band ligation if symptoms persist
3. Sclerotherapy or infrared coagulation in selected cases

Grade III – Advanced Prolapsing Piles

1. Laser hemorrhoidoplasty widely preferred
2. Stapled hemorrhoidopexy if internal prolapse dominates
3. Rubber band ligation for smaller components
4. Lifestyle measures for long-term control

Grade IV – Severe Prolapsed Piles

1. Laser treatment helpful in selected cases to reduce symptoms
2. Surgical hemorrhoidectomy for large or fixed prolapse
3. Stapled hemorrhoidopexy in suitable internal Grade IV piles
4. Pain control and local care until procedure

Descriptions of Common Procedures

Laser Hemorrhoidoplasty (Laser Treatment)

1. Uses focused laser energy to shrink internal hemorrhoidal tissue
2. Minimal pain, very little bleeding, and faster recovery
3. No cuts or stitches
4. Preferred for Grades II–III and selected Grade IV cases

Rubber Band Ligation

1. A small band is placed at the base of the internal hemorrhoid
2. Cuts off blood supply so the pile shrinks and falls off
3. Used mainly for Grades I–II

Sclerotherapy

1. Injection of a solution to shrink internal piles
2. Useful for early stages or when other procedures are not suitable

Infrared Coagulation (IRC)

1. Infrared heat seals off blood supply to small internal piles
2. Effective for Grades I–II

Stapled Hemorrhoidopexy

1. Internal piles are lifted and stapled back into place
2. Less pain than conventional surgery
3. Useful for Grades III–IV with internal prolapse

Hemorrhoidectomy (Conventional Surgery)

1. Surgical removal of hemorrhoidal tissue
2. Most definitive treatment for large or permanent prolapse
3. More postoperative pain but excellent long-term results

Aftercare and Recovery for Piles

Pain Control 

Warm sitz baths 10–15 minutes daily help reduce pain and swelling. Use prescribed pain medications as needed and avoid prolonged sitting.

Bowel Care 

 Keep stools soft with a fibre-rich diet, good hydration, and stool softeners if advised. Avoid straining and do not sit on the toilet for long.

Diet 

 Eat more fruits, vegetables, and whole grains. Limit spicy, oily, and processed foods that worsen constipation.

Activity 

 Light walking is encouraged. Avoid heavy lifting or strenuous exercise for 1–2 weeks or until cleared.

Hygiene 

 Clean with lukewarm water and gently pat dry. Use prescribed ointments as directed.

Bleeding 

 Mild bleeding for a few days is common. Seek review for heavy bleeding, severe pain, fever, or foul-smelling discharge.

Follow-Up 

 Attend scheduled reviews to ensure proper healing and to prevent recurrence.