Piles or haemorrhoids are swollen, enlarged veins in and around the anus and lower rectum. The majority of people experience symptoms at some point. When large, prolapsed, or persistently symptomatic, they require medical or surgical treatment.
Internal haemorrhoids develop above the dentate line (the anal canal boundary) and are usually painless. External haemorrhoids develop below it, where pain-sensitive nerves cause immediate discomfort. The Grade I to IV grading system guides treatment.
- Grade I: Bleed but do not prolapse.
- Grade II: Prolapse and reduce spontaneously.
- Grade III: Prolapse and requires manual replacement.
- Grade IV: Permanently prolapsed.
At Ramkrishna CARE Hospitals piles are managed with a comprehensive approach and advanced surgical treatments tailored to the condition's severity.
Signs and Symptoms of Piles
Piles show recognisable symptoms whose severity reflects the grade:
- Bleeding during defecation: Bright red blood (not dark red) on toilet paper, stool surface or dripping into the bowl
- Prolapse: A soft lump protruding from the anus; reduces spontaneously (Grade II), requires manual replacement (Grade III), or is permanent (Grade IV)
- Pain: Internal haemorrhoids are usually painless whereas external haemorrhoids cause perianal pain, especially when thrombosed
- Itching and irritation (pruritus ani): Mucus from prolapsed haemorrhoids irritates the perianal skin
- Mucus discharge: Soils undergarments and causes perianal irritation
- Incomplete evacuation: The feeling that defecation is not complete, from the prolapsed tissue bulk
- Anaemia: Chronic small-volume bleeding can cause iron deficiency anaemia over months.
Causes of Piles
Piles result from raised pressure in the anorectal veins. Key factors include:
- Chronic constipation and straining: The most important cause, straining raises rectal venous pressure and distends haemorrhoidal vessels
- Low-fibre diet: Produces hard, difficult-to-pass stools that drive straining
- Prolonged sitting on the toilet: Increases anal venous pressure
- Pregnancy: The uterus compresses the pelvic veins and straining during labour worsens the condition
- Obesity: Excess abdominal weight chronically raises intra-abdominal and pelvic venous pressure
- Chronic diarrhoea: Repeated loose stools irritate the anal canal
- Heavy lifting: The Valsalva manoeuvre raises rectal pressure acutely
- Ageing: Connective tissue supporting haemorrhoidal cushions weakens, allowing prolapse.
Piles Diagnosis
Diagnoses include:
- History: Doctor asks about bleeding pattern, bowel habit, duration, diet and warning symptoms (like weight loss, dark blood, and change in bowel habit)
- Perianal inspection: Doctors examine external haemorrhoids, skin tags, fissures, and fistulae. During inspection the doctor will ask you to strain as straining reveals prolapsed internal haemorrhoids
- Digital rectal examination: The doctor palpates the rectum for masses and assesses sphincter tone; internal haemorrhoids are not felt unless thrombosed
- Proctoscopy: A rigid lit tube is inserted to visualise internal haemorrhoids and confirm the grade directly
- Colonoscopy or sigmoidoscopy: Doctors suggest them for warning symptoms, age over 50, or bleeding that cannot be confidently attributed to haemorrhoids.
Risk of Piles
Several factors significantly raise the risk of symptomatic haemorrhoids. They are:
- Age above 45: Piles are most prevalent between 45 and 65 as connective tissue support weakens progressively
- Pregnancy: Many pregnant women develop haemorrhoids and the risk peaks in the third trimester & during labour
- Low dietary fibre: Below 20 to 25 g per day raises the risk of constipation and straining
- Sedentary lifestyle: People who sit for prolonged periods without regular movement are at a higher risk
- Family history: A genetic predisposition to connective tissue weakness affects haemorrhoidal cushion support
- Portal hypertension: Liver disease raises gut venous pressure and causes haemorrhoids that bleed more severely and are harder to treat.
Complications of Piles
Neglected hemorrhoids can cause several complications:
- Acute thrombosis causing sudden severe pain and a firm purple swelling
- A prolapsed haemorrhoid trapped outside the canal (strangulation) loses blood supply and becomes gangrenous if not reduced urgently
- Anaemia causing fatigue, pallor, and breathlessness
- Skin tags and perianal skin changes like skin thickening and persistent itch.
Piles Treatment Options
Treatment is graded according to severity like Grade I and II respond to conservative approaches whereas Grade III and IV require procedural or surgical intervention.
Treatment options are:
- Conservative Management: The foundation for mild haemorrhoids and prevention for all grades. A high-fibre diet (25 to 35 g daily), 2 litres of water per day, avoiding straining and reduced toilet-sitting allows most Grade I and early Grade II haemorrhoids to shrink. Psyllium husk, stool softeners, topical creams, and sitz baths (warm water for 10 to 15 minutes twice daily) provide relief.
- Non Surgical Procedures: For Grade I, II, and selected Grade III not responding to conservative management:
- Rubber band ligation: A band at the haemorrhoid base cuts off the blood supply and the haemorrhoid falls off in 5 to 7 days
- Sclerotherapy: Doctors inject a special chemical injection that causes scarring and shrinkage and is effective for Grade I and II with predominant bleeding
- Infrared coagulation: A doctor uses short pulses of infrared light that coagulate and fibrose the haemorrhoid base and is for Grade I and II
- Laser Treatment: Laser haemorrhoidoplasty (LHP) inserts a laser fibre into the haemorrhoidal tissue to cause shrinkage through coagulation. Effective for Grade II and III haemorrhoids and is available at Ramkrishna CARE Hospitals, Raipur.
- Surgical Treatment: Recommended for Grade III failing office procedures, Grade IV, acute thrombosis, strangulation, and large external haemorrhoids.
- Conventional haemorrhoidectomy: The most definitive treatment and has low recurrence with 1 to 2 days hospital stay
- Stapled haemorrhoidopexy (PPH): A circular stapler excises prolapsed mucosa and repositions haemorrhoids. It results in less pain and faster recovery than conventional surgery and is indicated for Grade III and IV
- Transanal Hemorrhoidal Dearterialisation (THD): Doppler-guided suture ligation of feeding arteries reduces blood flow and causes shrinkage.
What is the Procedure of Piles Treatment?
The procedure is tailored to the grade and type of haemorrhoid:
- Consultation and grading: History, digital rectal examination and proctoscopy establish the grade and treatment options.
- Conservative or office treatment: Grade I and II: Dietary modification and fibre supplementation are suggested first. However, if symptoms persist doctors perform rubber band ligation, sclerotherapy or infrared coagulation in the clinic without anaesthesia.
- Laser or surgical treatment: For Grade III unresponsive and Grade IV piles doctors suggest laser or haemorrhoidectomy under spinal anaesthesia.
- Post-procedure care: Doctors suggest a high-fibre diet and hydration from day one, sitz baths, stool softeners for 2 to 4 weeks and advise avoiding straining permanently.
Benefits of Piles Treatment
Effective treatment delivers lasting relief and improves quality of life:
- Permanent cessation of rectal bleeding.
- Relief from pain, itching and mucus discharge
- Reduction of prolapse.
- Prevention of acute thrombosis, strangulation and anaemia.
- Improved quality of life, sleep, physical activity, and social confidence were restored.
Why Choose Ramkrishna CARE Hospitals for Piles Treatment in Raipur?
Ramkrishna CARE Hospitals, Raipur offers the complete spectrum of piles treatment ranging from dietary counselling and rubber band ligation to laser haemorrhoidoplasty and haemorrhoidectomy. Our colorectal surgery team manages all haemorrhoidal grades, including complex Grade IV prolapse and strangulation.
Patients across Chhattisgarh choose us for our experienced surgeons, modern theatres equipped for laser and stapled procedures, a compassionate private consultation environment and a structured followup programme. An embarrassing problem deserves discreet, expert, evidence-based care.
Conclusion
Piles are among the most common conditions in India, yet patients often delay help due to embarrassment, fear or the misconception that symptoms will resolve on their own. Early diagnosis and appropriate treatment can provide significant relief and prevent complications. Treatment is available for every grade. At Ramkrishna CARE Hospitals, Raipur our experienced specialists offer minimally invasive procedures and advanced surgical care tailored to each patient's needs.
