Piles (Hemorrhoids) | Dr. Chintamani Godbole | Colorectal Surgeon

Piles | Hemorrhoids
Dr. Chintamani Godbole
MS, DNB (Surgical Gastroenterology), FRCS (Edinburgh, UK)
Consultant – Colorectal Surgery & Peritoneal surface Oncology

What is a piles?
A pile, also known as hemorrhoid, is a
mass of tissue that contains dilated and
thin-walled veins, as well as extra growth
that develops in the inner and external
area of the anus. Internal piles occur when
there is excessive inflammation between 2
and 4 millimeters (cm) above the orifice of
the anus. Internal piles is the most
common form. External piles occur when
anus veins get dilated under the skin
around the anus.

What are the symptoms of piles?
Internal hemorrhoids
• Painless bleeding
• Perianal irritation and itching
• Perianal pain due to prolapse
• Acute pain
External hemorrhoids
• Acute thrombosis caused by
physical strain and exercise
• Swelling, pain, and redness in the
affected region
• Bright red bleeding after defecation
• Skin tags are excessively redundant,
hanging skin.
• Infection and abscess development
• A painful perianal mass is present.

What are the different grades of piles?
• Grade 1: These are small hemorrhoids inside the anus lining.
• Grade 2: hemorrhoids are slightly larger than grade 1 hemorrhoids and
also occur inside the anus. These hemorrhoids may be pushed out
when passing stool, but they will gradually return to their normal
position.
• Grade 3: These are also known as ‘prolapsed hemorrhoids’. They occur
on the exterior of the anus. The patient can push them back in by
pressing against them with fingers.
• Grade 4: These hemorrhoids cannot be moved back and must always
remain outside the anus. They must be treated by a doctor, who will
likely recommend surgery.

What are the complications of piles if left
untreated?
• Bleeding during bowel movements
• Anemia
• Poor cleanliness in the anal region may result in a wide range of
infections.
• Itching in the anal region
• Gangrene occurs when the blood supply to an internal hemorrhoid is
disrupted.

What is the diagnosis of piles?
• Digital rectal examination, proctosigmoidoscopy, and inspection of
the anoderm, including the distal anal canal.
• Hematological examinations: CBC, hematocrit tests, and coagulation
investigations
• Flexible sigmoidoscopy and anoscopy: Anoscopy is a required
examination for hemorrhoids, and flexible sigmoidoscopy is performed
to rule out the existence of any proximal condition.
• Proctography to indicate rectal prolapse
• Colonoscopy in some cases

What is the treatment of piles?
• If there is chronic bleeding, hemorrhoids may be treated in the hospital
using proctoscopy for 1st and 2nd-degree hemorrhoids.
• Outpatient techniques like banding or sclerotherapy may be used to
treat 2nd-degree hemorrhoids.
• Third and fourth-degree hemorrhoids need surgery. It is preferable to
get it done while it is in the third degree since LASER surgery is an
option that produces better outcomes.

Surgical Approach
• An open haemorrhoidectomy is a time-tested approach, however,
pain management after the treatment is a concern. One may not be
able to sit comfortably for almost a month. The pain threshold varies
from person to person.
• Stapled Haemorrhoidopexy: A method used to alleviate the discomfort
of an open procedure. Pain is significantly less compared to open
procedures.
• When you have prolapsing hemorrhoids, this procedure may be done
alone or in conjunction with mucopexy.
• LASER Procedure for Haemorrhoids: LASER has recently revolutionized
the treatment of hemorrhoids. The main benefit is that it combines
haemorrhoidal artery ligation with LASER, resulting in a better outcome
than other procedures. Pain associated is very minimal.

Get in Touch:
Address: Gadre Hospital, near Hindmata Cinema, Dadar East, Mumbai,
Maharashtra 400014
Phone: 84518 65944
Email: drchintamanigodbole@gmail.com
Website: drchintamanigodbole.com