Piles and Fistula

Piles or Hemorrhoids are swollen veins located around the anus and lower rectum. Almost 50% of adults above the age of 50 years have small haemorrhoids, although most of them do not have any symptoms. Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside the anus. External hemorrhoids are the most common and the most troublesome. Hemorrhoids cause pain, severe itching, and difficulty in sitting.

“The good news is that piles are treatable.”

Taking Piles treatment in India is common in people who have long standing constipation, and those who strain a lot during a bowel movement or those who have a family history of piles. Ladies during pregnancy also develop piles due to increased pressure of the enlarged uterus on the veins.


  • Extreme itching around the anus
  • Irritation and pain around the anus
  • An itchy or painful lump or swelling near your anus
  • Fecal leakage
  • Painful bowel movement
  • Blood on your tissue after having a bowel movement

Surgery for Haemorrhoids

Haemorrhoidectomy: Surgery to remove hemorrhoids is called haemorrhoidectomy. During haemorrhoidectomy, the doctor makes incisions around the anus to cut away the hemorrhoids. This is generally an outpatient procedure, and patients usually go home the same day. Surgery usually relieves the pain, swelling, bleeding, and itching caused by hemorrhoids. However one should expect pain after the surgery since the incisions are made in a highly sensitive area.

Stapled Haemorrhoidopexy: This is a minimally invasive procedure to treat hemorrhoids and/or prolapse, a condition in which the hemorrhoids or anal tissue slips down out of the anal canal. During this surgery, a stapler-like device is used to reposition the hemorrhoids and cut off their blood supply. Without blood, the hemorrhoids eventually shrivel and die. This procedure causes much less pain and faster recovery compared to traditional haemorrhoidectomy.

Laser Haemorrhoidectomy: A special, precise laser beam is used to burn away hemorrhoidal tissue. This is a simple procedure which causes less pain and faster recovery.


What are Piles (Hemorrhoids)?
Hemorrhoids are blood vessels surrounding the smooth muscles. Pathologically, “Hemorrhoids” are termed as coagulated blood lumps formed due to swelling and inflammation. This happens as a result of pressure being exerted on these blood vessels.
What causes Piles?
The exact reasons behind the occurrence of piles remain unknown. In case of piles, the blood vessels become thin and stretched, which leads to bleeding. This happens due to forceful activity of blood vessels against gravity for getting the blood back to the heart which is also known as venous return. Due to intra-abdominal pressure, blood vessels are displaced below and formation of hemorrhoids takes place.
What is the difference between internal and external Piles?
Piles get formed inside or outside the anus. Internal Piles or hemorrhoids are those which originate above the dentate line while external hemorrhoids are the ones which originate below the dentate line.
What risk factors are associated with Piles?

The risk factors associated with the occurrence of Piles are discussed below.


Piles consists of different parts, such as mucosa lining, vein and smooth muscle cluster and supporting connective tissue. With aging, deterioration of the supporting tissues takes place. This results in prolapse of piles. Mucosal lining becomes more sensitive with age, to the pressure from straining and may lead to complications.

Chronic constipation and diarrhea:

Constipation is a condition where straining is needed for bowel movements to pass hard stools. Inward pressure is generated on the hemorrhoids due to the hard stools and leads to troubles in the process of venous return. While outward pressure from abdomen and pelvic muscles causes formation of swollen hemorrhoids. Excessive use of laxative for constipation and Irritable Bowel Syndrome treatment may lead to hemorrhoid disease.


Obesity is another risk factor in the formation of piles. Sitting for longer period of time, lack of physical activities, can lead to obesity and further piles. The risk of piles is prevented with the physical activity, since it promotes strengthening of abdominal muscles as well as colon walls. Exercises such as aerobics help improving blood flow to the gastrointestinal tract which ultimately helps in venous return improvement.


Piles get formed during pregnancy as a result of hormonal changes making the veins relax. Piles can be itchy and painful. It has been reported that piles may disappear within few weeks after childbirth.

Diet and lifestyle:

Diet and lifestyle can also be reasons behind generation of piles. Low-fiber diet, alcohol consumption, excessive spicy food consumption, can contribute formation of piles. Low-fiber diet can lead to constipation while spicy food and alcohol may cause diarrhea. In both cases piles get formed.

What are different types of Piles?

Types of Piles or hemorrhoids are given below.

  • Grade I or First-degree hemorrhoids – these piles do not prolapse.
  • Grade I or First-degree hemorrhoids – these piles do not prolapse.
  • Grade II or Second-degree hemorrhoids – these piles prolapse on straining.
  • Grade III or Third-degree hemorrhoids – these piles prolapse on straining.
  • Grade IV or Fourth-degree hemorrhoids – these type of piles get permanently prolapsed.
Which are the symptoms of Piles?

Piles occur more commonly in young or middle-aged adults. Symptoms of Piles are listed below.

  • Itchiness around the anus
  • Blood in the stools
  • Presence of pain during defecation
  • Presence of hard lump around the anus
  • Discharge of mucus while emptying the bowels
  • Sore and red anus
  • Sense of fullness in the anus; even after going to the toilet
How to cope up with Piles during pregnancy?

Piles can be made less severe during pregnancy by making some dietary and lifestyle changes. These changes can help ease the piles pain and irritations. Given below are the changes to be made to ease piles.

  • Consuming high-fiber diet
  • Drinking plenty of water
  • Avoid long period in standing position
  • Improvement of circulation with regular exercise
  • Use of ice water dipped cloth to ease the piles pain
  • Application of lubricants for gentle pushing of piles inside the anus
  • Avoiding straining while defecating as much as possible
  • Making use of moist toilet paper for cleaning the anus, instead of dry one
What are the complications associated with Piles?
Most of the times, patients feel embarrassed to seek medical treatment for piles. It is recommended to consult doctors when symptoms of piles are noted.

Following complications may occur due to untreated piles:

  • Infection
  • Anal fistula
  • Gangrene
  • Incontinence in rare cases
  • Anemia due to excessive blood loss