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PILES

What is Piles?

Piles or hemorrhoids, commonly known as Bawaseer (बवासीर) in Hindi is a very common anorectal condition. Piles are collections of veins and tissues located at the anal area that become swollen and inflamed. Piles may develop around the anal skin or inside the rectum.
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Types of Piles

External Piles

Causes

  • Constipation
  • Chronic diarrhea
  • Lifting heavyweights
  • Obesity
  • Pregnancy

Symptoms

  • Pain and discomfort in the anal area while sitting
  • Pain while passing a stool
  • Blood with stool
  • Itchiness, redness, and swelling near the anus
  • Painful lump around the anus
  • Feeling of unclear bowel even after passing stool
Internal Piles

Causes

  • Constipation
  • Chronic diarrhea
  • Lifting heavyweights
  • Obesity
  • Pregnancy

Symptoms

  • Pain and discomfort in the anal area while sitting
  • Pain while passing a stool
  • Blood with stool
  • Itchiness, redness, and swelling near the anus
  • Painful lump around the anus
  • Feeling of unclear bowel even after passing stool

Causes

No medical expert has been able to ascertain the exact cause of hemorrhoids. However, several risk factors which can significantly increase an individual’s chances of developing piles have been identified. Piles can be managed with home remedies to a certain extent in the initial stage, but when piles grow severe or become advanced, medical intervention is required.

Diagnosis

TEST

In case of external piles, the anorectal specialist will be able to diagnose it just through a physical examination. In case the hemorrhoids are internal, the doctor might do an examination of your rectum and anal canal. Two common tests which are done to diagnose piles are:
Digital examination – In this test, the piles specialist inserts a gloved, lubricated finger into the rectum to check if there are any kind of abnormal growths.
Visual inspection – Since internal hemorrhoids are too soft to be felt, the piles doctor might examine the lower rectum using a proctoscopy, an anoscope or a sigmoidoscopy. Using any of these devices, the doctor will carefully examine the lining of your anal tissues to check the severity and growth of your piles.

SELF DIAGNOSIS

Self-diagnosis of piles is not very difficult if you are well aware of the symptoms. If you think you have hemorrhoids, you can be pretty sure about it by checking your rectal motions. If you have piles, you will feel a hard and painful lump around your anus and that is the first sign of piles. When a person develops piles, he or she may experience the feeling of incomplete bowel even after passing a stool. The color of the stool may visibly change in case of piles, which is yet another way to self-diagnose piles. If you develop the problem, the stool may be bright red or visibly change into red. You may experience itchiness, soreness, and redness around the anal area. Additionally, you may also see blood in your stool or feel excruciating pain while passing a bowel movement.

Diagnosis by the Dr.

Most proctologists or anorectal surgeons diagnose piles through physical examination alone. Once you visit the doctor’s clinic, you are likely to be asked a few questions, like:
Does anyone in your family have piles?
When did you start noticing the symptoms?
Do you pass blood with your stool?
What are your dietary and lifestyle habits like?
What is your fitness regime like?
The doctor may also do a digital rectal examination to diagnose your piles. The piles specialist may also suggest tests like colonoscopy, sigmoidoscopy, and anoscopy to check for the presence of any gastrointestinal disease. In all these tests, the doctor inserts a small camera to check for any abnormalities in the anus, rectum, and colon. If the doctor sees that your piles are in an initial stage, the doctor might recommend lifestyle changes and some changes in your food habits. But if your diagnosis shows severity in your condition, you might be recommended to undergo surgery for piles.

SEVERITY

Grade I

The piles are generally in the form of minor inflammations and are found outside the anal lining. They are not visible to the naked eye

Grade II

They remain outside the anus. While passing stool, they may get pushed out of the anus and return without much ado.

Grade III

These haemorrhoids are prolapsed and appear outside the anus. They hang out of the rectum but can also be re-inserted easily

Grade IV

They remain outside the anus and cannot be pushed back easily. They are the most painful in nature.

Risks & Complications

During the surgery

The chances of any risk in surgery for piles are very low as it isn’t a complex one. But, like any other surgical treatment, the success or risks associated with piles treatment also depend upon the severity of the condition and the surgeon’s experience. In rare conditions, a patient may suffer any of the following conditions after a piles surgery:
Bleeding – The chances of bleeding during piles surgery is higher in the case of open surgery. In case the surgeon is not experienced enough to remove the inflamed tissues with precision, there are chances that the patient may suffer from bleeding.
Infection – Infections can develop at any point during piles surgery. The chances are higher in rubber band ligation treatment for piles.
Reaction to anesthesia – Many patients report experiencing side effects of anesthesia. Due to the reaction, the patient might feel drowsy and nauseated for a longer time than is anticipated.

If left untreated

The most common possible complication of piles is that they can get strangulated if left untreated for a long time. When piles become strangulated, the blood supply to those tissues is cut off, resulting in venous thrombosis within the piles. This may cause severe pain and even make the treatment complex. In case of piles geting strangulated, the person may experience excruciating pain within 48-72 hours which may gradually disappear after a week or so.
Another significant risk that a person may suffer if he or she leaves hemorrhoids untreated is anemia. Piles, when grown, may cause blood loss along with stool. If the problem is not treated in time, the constant blood loss might make the person anemic and that may give rise to several other health complications.

When to consult a doctor ?

"Knowing when to seek professional help for any health condition is of great importance and hemorrhoids are no exception. Getting medical help at the right time can help you avoid unnecessary complications. If you experience any of the following complications or conditions, it is time you check with an anorectal surgeon.
You have excruciating pain and discomfort in your anal and rectum area.
The stool that you pass is dark red, maroon, or tar-like in color. This can be a sign of internal bleeding.
You experience blood in the toilet paper every time you pass bowel.
No amount of medications and home remedies have been able to provide you relief from your symptoms.
If you feel dizzy and weak as a result of continuous blood loss along with your stool."

Various Treatment and cost

Home remedies to manage piles

Take sitz baths – Soak your anal region in warm water for 15-20 minutes 2-3 times a day.
Eat a high-fibre diet –
Include fruits, grains, and vegetables in your daily diet.
Drink enough water –
Stay hydrated. Make sure you drink 8-10 glasses of water every day.
Use topical treatments –
Apply OTC cream for haemorrhoids or witch hazel on your anal region.

Medicines for piles treatment

There are several medications available that can be used to manage the symptoms of piles.Over-the-counter (OTC) medication – OTC medicines such as painkillers, ointments, and creams can provide relief to the swelling and redness around the anal region.
Corticosteroids – These medications help to reduce pain and swelling in the anal area.
Laxatives – If haemorrhoids are caused due to constipation, you can take laxatives to find relief. Laxatives can help a person in having an easier bowel movement and reduce pain in the anal area.

Surgical Treatment for Piles

Hemorrhoidectomy – Hemorrhoidectomy is done to remove the protruding anal tissues that cause bleeding. This procedure is mostly used to treat piles of severe grades. The surgery is performed under general or local anaesthesia. In this procedure, the surgeon makes a few incisions around the hemorrhoidal tissue. The swollen veins inside the haemorrhoids are tied off to prevent bleeding and then the haemorrhoid is removed.
Hemorrhoid stapling – Hemorrhoid stapling procedure blocks or stops the blood flow to the inflamed tissues. This procedure is mostly used for internal piles. During the procedure, the arterial blood vessels within the piles are cut off which does not allow any further blood flow to the piles vessels. Due to this, with time, the size of the piles reduces and finally shrinks off. The surgery does not inflict much pain and ensures quick recovery of the patient. Complications include chances of recurrence, rectal prolapse.
Laser surgery – Laser surgery is considered to be the most advanced and effective treatment for piles. During this procedure, a laser beam is used to burn and shrink the haemorrhoids. The surgeon focuses a narrow beam of light on the anal tissues. The procedure is less invasive, causes no bleeding, and very minimal pain.

How to prepare for piles surgery?

Piles surgery is not a very complex treatment and as such requires no thorough preparation. But like any other surgery, you need to follow the doctor’s instructions to ensure that your surgery goes smoothly and you recover without complications. Before your surgery for piles:
Refrain from eating or drinking anything heavy. Take a very light meal, preferably only breakfast.
Avoid drinking any form of carbonated or caffeinated drinks, just consume clear liquids at least for 5 hours before the surgery.
If you are on any anti-inflammatory, allergy medicines or any blood thinners, the doctor will recommend you to stop it as soon as possible before the treatment.
Stop smoking and drinking alcohol to help you heal faster after the surgery.

Cost of Piles Surgical Treatment in India

Cost of piles surgery in Delhi – Rs. 45,000 to Rs. 55,000
Cost of piles surgery in Gurgaon – Rs. 43,000 to Rs. 54,000
Cost of piles surgery in Pune – Rs. 41,500 to Rs. 50,000
Cost of piles surgery in Mumbai- Rs. 45,000 to Rs. 50,000

How to recover after piles surgery?

The recovery route after piles surgery is usually simple with no major complications. If you follow the doctor’s recommendations and tips diligently, you will not experience any complications.
Eat a diet rivh in fibre.
Avoid lifting heavyweights.
Use a stool softener to aid you in having smooth bowel movements.
Stay hydrated. Drink at least 8-10 glasses of water every day.
Do not strain while passing a stool.

Insurance coverage

Piles treatment is generally covered under health insurance. Most insurance companies offer a specific amount of coverage for piles and other anorectal diseases. The amount of coverage you have will depend on the policy you buy.

One thing you should know is that medical treatment for piles won’t be covered in the insurance policy. Only the expenses of surgical treatment are covered and you also need to be hospitalized for at least 24 hours to file for a claim. You can opt for cashless payment or get reimbursement claims from your insurance providers as well.

If your claim is approved, you will be able to cover the entire cost of treatment, including diagnostic tests, medications, hospital stay, bed charges, and other consumables.

Some of the best and most popular healthcare insurance providers are
Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICIA Lombard, Max Bupa Health Insurance.

Recovery Timeline

The recovery rate after any surgery depends from individual to individual. The healing capacity of every person is bound to be different and hence the timeline of recovery after piles surgery varies for all. In most cases, recovery after open surgery or any form of invasive surgery for piles takes around 2-3 months and complete recovery after laser surgery takes 1 month to 45 days.
Recovery after 1 month
After piles surgery, for at least 1 month, the patient needs to follow the recovery tips and recommendations of the doctor. It is advised that the patient refrains from doing anything that puts strain on the surgical site. The patient should not eat anything too oily and spicy and consume only food rich in fibre. The patient should keep the surgical area free of any infection and take regular sitz baths.
Recovery after 2 months
After 2 months, the patient would experience much relief from the pain at the surgery site. But there might be scarswhich would take a few more days to heal and disappear completely. The patient might get back to normal work life without any major complications and also resume normal dietary habits.
Recovery after 3 months
After 3 months, the patient would be free from all post-surgery discomfort. There would be no scars at the surgical site and the wound would be healed completely too.

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