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Piles is a disease in which there is vericosities in blood vessels of rectum. It is also known as Hemorrhoids. Anatomically there present three sets of blood vessels; these include 1. Left lateral hemorrhoidal vessels, 2. Right inferior hemorrhoidal vessels and 3. Right superior hemorrhoidal vessels. These are the classical 3, 7 and 11'oclock positions of Hemorrhoids and also known as Primary Piles. In piles there occur stasis of blood inside the hemorrhoidal blood vessels. This leads to vericosities in these vessels and the condition becomes disease Piles.


Symptoms of Piles/Hemorrhoids


The symptoms of Piles include;

  • Bleeding
  • Prolapse of some mass during defecation
  • Pain (when associated with thrombosis or in Gd 3/ Gd 4 haemorrhoids).
  • Mucous discharge- in prolapsed haemorrhoids



Causes of Piles/Hemorrhoids



There are the following causative factors responsible for the disease piles;

  • Irregular bowel habits
  • Prolonged standing and/or sitting
  • Constipation
  • Straining during defecation
  • Heredity factors
  • Due to other associated diseases like colitis, diarrhoea etc.


Types of Piles/Hemorrhoids


Based on their location inside the anal canal, Hemorrhoids have been classified into following types;

1-INTERNAL:- These are within the anal canal and internal to the anal orifice. these are bright red or purple in colour, these are usually painless as anal canal membrane from where they originate is not sensitive to pain.

2-EXTERNAL:-Situated outside the anal orifice and covered by skin, two varieties may coexist and the condition is called internoexternal haemorrhoids.
Thrombosed Hemorrhoids - Anal Hematoma/External piles: This is a painful condition. There occurs clotting (thrombosis) of blood within the external pile mass.

Grading or Degrees of internal Hemorrhoids

Internal Hemorrhoids have been classified into following degrees or grades depending upton the chronicity and symptoms;

  • Grade -1 when haemorrhoids do not come out from anal canal, bleeding is only symptom
  • Grade - 2 haemorrhoids come out only during defecation and is reduced spontaneously after defecation
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  • Grade - 3 haemorrhoids come out only during defecation and do not return by themselves, but need to be replaced manually and then they stay reduced.
  • Grade -4 The haemorrhoids that are permanently prolapsed. At this stage great discomfort is complained of with a feeling of heaviness in the rectum

Possible complications:

  • Bleeding
  • Thrombosis
  • Anaemia
  • Strangulation

Piles/Hemorrhoids: Diagnosis

The diagnosis of the disease Piles/Hemorrhoids can be made by a local examination by your physician. During the examination (check-up) you may need to lie in lithotomy or left lateral or Knee-Abdomen position. Your doctor may perform a Digital examination (Check-up by finger) and sometimes direct visualization by an instrument called 'Proctoscope' may be required.

Piles/Hemorrhoids; Treatments

INJECTION THERAPY or SCLEROTHERAPY: ONLY WORKS IN 1st DEGREE HAEMORRHOIDS. Some so called doctors advertise “BAWASEER EK TEEKE ME JAD SE KHATM” BEWARE OF SUCH ADVERTISEMENT as there is no role injection in any disease other than grade 1 haemorrhoids. Moreover it may be RISKY if it is not injected properly or given in other diseases like FISSURE or FISTULA.

RUBBER BAND LIGATION:Previously it was treatment of choice in small haemorrhoids of gd 1 or 2, but now outdated because of its HIGH FAILURE RATE.

Cryosurgery: It involves destruction of piles masses by liquid Nitrogen at very low temperatures.


Kshara sutra is treatment of choice in grade 2 to 4 haemorrhoids. When tied to the base of haemorrhoids, leads to strangulation of vessels and the corrosponding pile masses shed off in 5 to 10 days. This is the minimally invasive procedure for Hemorrhoids.

Kshara sutra procedure for Hemorrhoids: How it is performed actually?




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