A Centre of Excellence for Piles Treatment in India

Piles, also known as hemorrhoids, is a common anorectal condition affecting almost 10 million people worldwide every year, regardless of their age and gender. It can be painful and may interrupt your daily life, but it is not a life-threatening disease. From non-surgical to surgical, there are various treatment methods available to provide a safe and effective solution for piles.

About Piles

Piles, medically referred to as hemorrhoids, is a common anorectal condition many individuals face at some point in their lives. This condition arises when the blood vessels in the anus or rectum become enlarged and irritated. It can develop either internal or external of the anus. Common signs and symptoms of piles include pain, discomfort, itching, irritation, bleeding and a burning sensation around the anus.

Several factors can lead to the onset of hemorrhoids, such as pregnancy, persistent constipation, and extended periods of sitting or standing. There are various treatment strategies for hemorrhoids, from lifestyle modifications and over-the-counter remedies to more advanced interventions like rubber band ligation or surgical procedures. For an accurate diagnosis and appropriate treatment approach, it’s essential to see an experienced proctologist or anorectal specialist.

Types of Piles

Piles are classified into two types: internal and external.

Internal Piles: Internal piles are inflamed blood vessels located within the rectum. While they are not visible from the outside, they can lead to significant discomfort and pain, and interrupt daily activities.

They are categorized into different grades based on their severity.

Grade 1: Grade 1 piles is the initial stage of the condition. They’re small, stay inside the rectum, and don’t protrude out of the anus. Most people don’t notice symptoms. To manage the symptoms of grade 1 piles and prevent their growth, simple treatments like diet adjustments, sitz baths, and creams are usually recommended.

Grade 2: Grade 2 hemorrhoids are larger than Grade 1. They can protrude from the anus during a bowel movement but generally return inside afterward on its own. For Grade 2 treatment, procedures like rubber band ligation, infrared coagulation, and sclerotherapy are commonly recommended.

Grade 3: Grade 3 hemorrhoids protrude from the anus during bowel movements and don’t go back on its own. It needs to be manually pushed back into the anus after each bowel movement. It can cause discomfort, itching, pain, and bleeding, making hygiene difficult. Common treatments for Grade 3 hemorrhoids include rubber band ligation, infrared coagulation, and sclerotherapy.

Grade 4: Grade 4 is the most advanced stage of the condition. They remain protruded and cannot be pushed back in. At this stage, the lumps are large, highly inflamed, and very sensitive. Common issues with Grade 4 piles include intense pain, bleeding, and hygiene concerns. Additionally, complications like blood clot formation (thrombosis) or restricted blood supply can arise.

External Piles: External piles develop around the anus. It can cause severe pain and discomfort and often always requires surgery.

Diagnosis of Piles

Before undergoing any procedure, your proctologist may recommend some diagnostic tests to determine the severity of the condition. Here’s how the evaluation and diagnosis process typically goes:

• Medical History: During the consultation, the doctor may ask about the symptoms you are facing, your medical history, your family history of piles, your dietary habits etc.
• Digital Rectal Exam (DRE): In this procedure, the doctor inserts a lubricated gloved finger into the anus to check for any abnormal growth in the anus.
• Anoscopy or Proctoscopy: In this procedure, the doctor uses an anoscope (a small tool with a light and a camera attached) to examine the anal canal and rectum.
• Sigmoidoscopy: In this procedure, the doctor uses a sigmoidoscope, a tool with a light and camera, to look at the end part of the large intestine.
• Colonoscopy: This test helps the doctor see why there’s bleeding, whether it’s from piles or some other problem.

Treatment Options for Piles

Piles can be treated with both surgical and non-surgical approaches. The type of procedure depends on the severity of the condition and the underlying health condition of the patient.

Non Surgical:

Rubber Band Ligation: Rubber band ligation, also known as hemorrhoid binding, is a non-invasive procedure to treat piles. This procedure is usually recommended when conservative methods, lifestyle changes, dietary restrictions and home remedies stop working. This procedure is performed on an outpatient basis, meaning no hospitalization is required. You can return to your home on the same day of the surgery. You may take up to 2-3 weeks to recover completely after the procedure.

Here are the steps involved in the rubber band ligation procedure.

1. First of all, you will lie on your back and the doctor will give you topical anesthesia to make you unconscious and ensure you won’t feel pain during the procedure.
2. Next, the surgeon will use a small tool and tie the lumps to cut off the blood supply to the piles lumps.
3. Over a period of one or two weeks, the lumps will shrink and fall off naturally and you will start feeling better.

Rubber band ligation might cost you between INR 25,000 to INR 75,000 in India.

Sclerotherapy: This is also a non-surgical approach to treat piles. The procedure is done on an outpatient basis, and you might need just a few days to fully recover afterward.

Here are the steps of sclerotherapy to help you understand the procedure properly.

1. To start, you will lie on your back so that the doctor will access the piles properly.
2. Then the doctor will inject a special chemical into the lumps to make them shrink.
3. Within a week, the piles will get shrunk and fall off eventually.

Sclerotherapy might cost between INR 25,000 to INR 80,000 in India.

Infrared photocoagulation: Infrared photocoagulation is a non-invasive method to address small to medium-sized internal piles. This treatment is the go-to option when diet alterations, lifestyle changes, or over-the-counter remedies prove ineffective. The entire procedure can be done on an outpatient basis, which means you won’t need an overnight stay in the hospital. Typically, full recovery is fast, and you can return to regular activities by next day after the procedure.

Here’s a breakdown of the infrared photocoagulation process:

1. To begin, you’ll lie on your back.
2. The doctor will use a specialized device that radiates a focused beam of infrared light.
3. This light precisely targets the piles and develops scar tissue around the piles.
4. The scar tissue is essential as it cuts off the blood supply to the piles, making them shrink over time until they detach and fall away.
5. After some time, post-procedure, you’ll observe the piles decreasing in size and eventually disappearing.

The cost of the infrared photocoagulation procedure might cost you between INR 30,000 to INR 55,000 in India.

Electrocoagulation: Electrocoagulation is a non-invasive technique to treat piles by using electric currents. When other conventional methods don’t bring relief, this procedure becomes one of the best treatments for piles. The process is carried out on an outpatient basis, meaning patients don’t usually need a hospital stay.

Here’s a step-by-step description of the electrocoagulation process:

1. To begin the procedure, you will lie on your back to allow easy access to the rectal area.
2. Then the doctor will insert a proctoscope into the anus to identify and locate the piles.
3. Then, a specialized probe is positioned at the base of the piles.
4. Then the surgeon will emit the heat from the probe to thicken the blood and cauterize the wall.
5. As a result, the piles begin to shrink due to the cut-off blood supply.

The cost of the electrocoagulation procedure is INR____ to INR____ in India.

Surgical

Open hemorrhoidectomy: Open hemorrhoidectomy is a traditional method used to treat piles. This procedure is typically done under general anesthesia. During this treatment, the surgeon creates an incision and surgically removes the hemorrhoids. Recovery after open hemorrhoidectomy can be longer, and you may take around 4-5 weeks to recover completely. This technique is typically reserved for treating advanced-stage piles.

Here’s a simplified breakdown of the open hemorrhoidectomy procedure:

1. Initially, you’ll be administered anesthesia to ensure you will stay pain-free and comfortable throughout the surgery.
2. Next, the surgeon will create an incision in the anal region to excise the piles.
3. After removing the hemorrhoids, the surgeon will close the wound using stitches.
4. Over the time, the surgical site will gradually heal, leading to improved comfort and relief.

The cost of open hemorrhoidectomy lies in the range of INR 35,000 to INR 95,000 in India.

Laser hemorrhoidectomy: Laser hemorrhoidectomy is a minimally invasive technique performed using local anesthesia. It is an outpatient procedure, and you can expect to leave the hospital the same day the surgery is done. This method typically offers a quicker recovery time compared to more traditional approaches. Post-surgery, recovery generally spans between 2-3 weeks. Your doctor might suggest certain over-the-counter medications to help manage the slight pain or discomfort after the procedure.

Here are the steps of laser hemorrhoidectomy:

1. To begin, you’ll be administered local anesthesia, ensuring you remain comfortable and pain-free throughout the procedure.
2. Next, the surgeon uses laser light to remove or shrink the piles lumps by hitting them directly and leaving the healthy tissues untouched.
3. Following the operation, you’ll be shifted to a recovery room to monitor the post operative condition.
4. Once the anesthesia wears off, you will be discharged from the hospital.

Laser hemorrhoidectomy may cost you between INR 45,000 to INR 55,000 in India.

Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is a surgical technique used to address piles. It is usually recommended when nonsurgical measures don’t provide satisfactory results, or when hemorrhoids are notably large or prolapsed, this method employs a specialized stapling device. This procedure is typically performed on an outpatient basis, meaning there’s no need for an extended hospital stay. Most patients can return home the same day of the surgery and might need a week or slightly more for a complete recovery.

Here are the steps involved in the stapled surgery procedure:

1. You will lie on your back, and the surgical site will be cleaned.
2. Then, you will be administered under anesthesia.
3. Then the surgeon use a specialized stapling tool and cut off the blood supply and make the piles shrink.
4. After the surgery, the area may be treated with medications to aid healing.
5. With the reduced blood flow, the hemorrhoids will diminish, leading to faster recovery and less discomfort than traditional methods.

Stapled hemorrhoidectomy may cost you between INR 60,000 to INR 1,15,000 in India.

What are the Benefits of Piles Laser Surgery?

Piles laser surgery has various advantages over traditional procedures including:

• Minimally Invasive: Less invasive than traditional piles treatment with smaller incisions.
• Less Pain: Minimal discomfort after the procedure ensures ease.
• Quick Recovery: Get back to your routine faster than you’d expect.
• Reduced Bleeding: The laser’s precision minimizes blood loss.
• Outpatient Procedure: No hospitalization is required. You can return your home on the same day of the procedure.
• Lower Complication Rate: It is proved that laser treatment for piles has high success with minimal or low complications.
• No Stitches: No sutures are required in laser hemorrhoidectomy procedure.
• Minimal Scarring: As it is a minimally invasive procedure, you will not get scar on your skin after the procedure.
• High Precision: Laser surgery offers precise treatment, meaning it hits the piles directly and leaves the healthy tissues untouched.
• Effective: It provides long-lasting relief and reduces the chances of piles to recur after the procedure.

While these are the compelling benefits of laser surgery.your doctor will suggest the best treatment option according to your health condition.

How to Prepare for Piles Laser Surgery?

Preparing for piles laser surgery is crucial to ensure a smooth procedure and optimal results.

• Discuss with your surgeon about the procedure, risks, benefits, and post-operative care. Make sure to address any questions or concerns you may have about the procedure.
• Inform your surgeon about any medications, supplements, or over-the-counter drugs you’re currently taking.
• You should stop taking certain medications, especially blood thinners or anti-inflammatory drugs.
• You may be asked to follow a specific diet before the surgery.
• Stay hydrated, but avoid alcoholic beverages for at least 24 hours prior to the surgery.
• You might be advised to take a laxative or undergo an enema to clear the rectum. (Note: undergoing an enema is not a choice for the patient; it is always recommended by the doctor).
• Take a shower or bath on the morning of the surgery and avoid applying any cream or ointment around the anal area.
• Ensure the anal region is clean to reduce the risk of infection after the procedure.
• Wear comfortable and loose clothing on the day of the surgery. This makes it easier to change and ensures comfort post-procedure.
• Since you might be under anesthesia or sedation, ensure you have someone to drive you home after the surgery.
• Arrange someone to be with you for at least one day after the procedure
• If you smoke, try to quit or at least reduce your smoking habit several weeks before the surgery. Smoking can delay healing after the surgery.
• Lastly, always follow the specific instructions provided by your healthcare provider or surgeon.
• If you have insurance, keep your documents along with you to get the maximum coverage of the treatment.

The above-mentioned preparation tips may help you prepare for the surgery beforehand and ensure a successful recovery.

What is the Recovery Period for Piles Laser Surgery?

If you’re recovering from piles laser surgery, it’s essential to understand each step of the recovery process. Here’s a detailed guide to help you navigate through:

• Laser treatment for piles often provides quick relief from symptoms, making the post-operative period less daunting.
• Unlike traditional surgical methods, laser surgery is less invasive, resulting in reduced pain and discomfort in the post-operative period.
• Laser treatment for piles is typically an outpatient procedure. This means you don’t have to stay overnight in the hospital and can return home the same day after a short observation period.
• Eat a soft, fiber-rich diet to avoid constipation.
• It’s advisable to avoid any strenuous activities for the first week or two. You can take short walks to improve blood circulation and enhance healing.
• Drinking ample water aids in softening stools, preventing constipation, and ensuring smooth bowel movements, which is essential for the healing process.
• Soaking the affected area in warm water for 10-15 minutes can alleviate discomfort, reduce swelling, and promote faster healing.
• Your surgeon might prescribe pain relievers or recommend over-the-counter medications to manage post-operative discomfort. Always take them as directed.
• Straining during bowel movements can disrupt the healing process. Use stool softeners if necessary.
• A slight swelling or discomfort around the operated area is normal in the initial days. If the symptoms persist, you should consult your doctor.
• Ensure you attend follow-up appointments with your surgeon. They will monitor your healing progress and address any concerns you might have.
• You might need a few days off work to take rest properly.
• While many of the post-operative symptoms might fade within the first week, complete tissue healing might take a week or two.

Always prioritize your comfort and well-being during the recovery process. If you notice any unusual symptoms or feel concerned about any aspect of your recovery, consult your surgeon or healthcare provider promptly.

What are the Risks and Complications Associated with Piles Laser Surgery?

Like other surgeries, laser treatment for piles also comes with some risks and complications such as:

• Infection at the surgical site: Even with the utmost care, there’s a risk of bacterial infection in the operated area which requires close monitoring and treatment.
• Potential damage to surrounding tissue: Like all surgeries, there’s a minimal risk that nearby tissues could get unintentionally harmed during the operation.
• Allergic reactions to medications: Some individuals might have adverse reactions to the anesthesia or other medications used during the surgery, emphasizing the importance of a thorough medical history review.

What to Eat and Avoid After Piles Laser Surgery?

After undergoing piles laser surgery, your diet plays a pivotal role in ensuring a smooth recovery and preventing constipation, which can exacerbate the condition. Here’s a guide to help you navigate your post-operative diet:

What to Eat:

High-Fiber Foods:

Fruits: Apples (with skin), pears (with skin), bananas, berries, and prunes.

Vegetables: Leafy greens, broccoli, carrots, and Brussels sprouts.

Whole Grains: Oatmeal, whole wheat bread, brown rice, and quinoa.

Fluids:

Drink plenty of water to stay hydrated.

Herbal teas can be soothing and help with hydration.

• Legumes: Beans, lentils, and chickpeas are great sources of fiber.
• Lean Proteins: Fish, chicken, turkey, and tofu.
• Dairy or Alternatives: Opt for low-fat dairy products, or consider alternatives like almond, soy, or oat milk.
• Healthy Fats: Avocados, olive oil, and nuts can aid digestion.

What to Avoid:

• Spicy Foods: Can cause irritation to the digestive system and the healing surgical site.
• Caffeinated Beverages: Like coffee and certain sodas, which can dehydrate and cause constipation.
• Alcohol: It can dehydrate and may interfere with medications.
• Processed Foods: Foods high in salt and preservatives can lead to water retention and constipation.
• Refined Carbs: White bread, pastries, and other low-fiber foods can cause constipation.
• Dairy: For some, excessive dairy can lead to constipation. If you’re sensitive, limit your intake.
• Fried and Fatty Foods: They can be hard to digest and can slow down the digestive process.
• Red Meat: Takes longer to digest and might strain the healing area.

Remember to follow your surgeon’s specific dietary recommendations and pay attention to how your body reacts to different foods. Making smart dietary choices after your surgery can promote healing, reduce discomfort, and help prevent future issues with piles.

How to Treat Piles without Surgery?

Here are some home remedies you can try to manage the symptoms of piles.

• Apply aloe vera gel to the affected area for soothing relief.
• Use witch hazel on a cotton pad to reduce inflammation.
• Consume raw garlic or garlic capsules to aid internal healing.
• Soak in a warm bath with Epsom salts to relax the anal muscles.
• Dab apple cider vinegar on the piles for its astringent properties.
• Drink buttermilk mixed with rock salt and ginger to reduce inflammation from the inside.
• Apply coconut oil to the affected area for moisturizing and anti-inflammatory benefits.
• Consume figs soaked overnight to ease bowel movements.
• Use black tea bags as a compress; tannic acid helps reduce swelling.
• Drink pomegranate juice regularly for its antioxidant properties.
• Apply a paste of radish juice and honey for pain relief.
• Use cumin seeds paste on the affected area to soothe discomfort.

Exercises

Exercise can improve circulation, ease constipation, and bolster overall colon health, all of which can help prevent or relieve piles. Here are some exercises you can try at home:

Kegel Exercises (Pelvic Floor Exercises)

•    Tighten your pelvic muscles (like you’re trying to hold in urine).
•    Hold for a few seconds, then release.
•    Repeat several times.

Deep Breathing

• Sit or lie down comfortably.
• Breathe in deeply through the nose, expanding the diaphragm and filling the lungs.
• Exhale slowly through the mouth.
• This can help increase oxygen supply and improve circulation.

Yoga

• Child’s Pose: Helps relax the abdominal and rectal muscles.
• Legs-Up-The-Wall Pose: Improves circulation in the lower body.
• Forward Bends: Increases blood flow to the pelvic region.

Squats

• Stand with feet shoulder-width apart.
• Lower your body by bending your knees, as if you’re sitting in a chair.
• Make sure your knees don’t go beyond your toes. Return to starting position and repeat.

Walking

• A simple yet effective way to boost circulation and reduce constipation.
• Aim for at least 30 minutes a day.

Leg Lifts

• Lie on your back and lift one leg at a time without bending the knee.
• Switch legs and repeat.

Bicycle Legs: Lie on your back and cycle your legs in the air, as if pedaling a bike.

Brisk Walking or Light Jogging: This can help stimulate bowel movements and improve overall circulation which ultimately alleviate the symptoms of piles and prevents them from occurring.

What Can Happen If Piles Left Untreated?

Here are some risks and complications associated with piles laser surgery:

• Infection at the Surgical Site: As with most surgeries, there’s a risk of infection. Indicators include increased pain, swelling, redness, and possibly a pus discharge.
• Reaction to Anesthesia: Although rare, complications can arise from anesthesia, such as allergic reactions or breathing difficulties.
• Recurrence of Hemorrhoids: Even post-surgery, without appropriate care or lifestyle changes, there’s a possibility that hemorrhoids can return.
• Damage to the Anal Sphincter: In rare cases, the surgery might inadvertently harm the muscles controlling bowel movements, leading to potential incontinence issues.

What is the Cost of Piles Surgery in India?

The piles treatment cost may lie between INR 25,000 to INR 85,000 in India. However, the final cost may vary for each individual depending on various factors such as the cost of diagnostic tests, consultation charges, surgeon’s fee, anesthesiologist fee, the hospital or clinic you’ve sought for the treatment, location of the hospital, insurance coverage etc.

Here’s a glimpse of the cost of each type of piles removal surgery in India:

• Rubber band ligation: INR 25,000 to INR 75,000
• Sclerotherapy: INR 25,000 to INR 80,000
• Open surgery: INR 60,000 to INR 85,000
• Laser surgery: INR 45,000 to INR 60,000

Insurance Coverage

Above mentioned is the cost range of different types of piles treatment. It may vary for each individual, so it is better to consult your doctor to get an estimate as per your health condition. However, the coverage may vary for each individual based on their policy. If you have insurance, it is better to consult your insurance provider to understand the coverage of your policy.

Here are some insurance companies who usually cover the piles treatment cost.

• Star Health Insurance Pvt. Ltd.
• Reliance Health Insurance Pvt. Ltd.
• HDFC Ergo Health Insurance
• Niva Bupa Health Insurance
• Care Health Insurance

Frequently Asked Questions About Piles (Hemorrhoids)

Is piles common in females?

Piles is a common anorectal condition and may affect anyone regardless of gender. Constipation and pressure exert during childbirth is one of the main cause of piles in females.

How piles can be cured permanently?

The results of laser surgery are long lasting. But there are always chances that piles might recur. Laser surgery is the best, safe and an effective treatment option to get rid of piles. The doctor will suggest the best surgical approach based on the severity of the condition.

Do piles recur again after surgery?

Yes. there are some chances of piles to be recur again even after the surgery. You have to follow precautions after the surgery to prevent development of piles.

Can piles be cured without surgery?

Home remedies can manage the symptoms of piles but do not guarantee permanent resolution; laser surgery is the best treatment for piles and offers long lasting cure.

What are the long term side effects of piles surgery?

Long-term side effects of piles surgery can include anal incontinence, recurrence of hemorrhoids, and scar tissue formation.

Is piles surgery painful?

No. Piles surgery is performed under the influence of anesthesia so that you won’t feel pain and discomfort during the procedure.

What are the do’s and don’ts after piles surgery?

Do’s

• Eat fiber rich foods
• Drink plenty of fluids
• Take sitz bath
• Keep your anal area clean and dry

Don’ts

• Don’t smoke
• Don’t use harsh soap while cleaning the anal area.
• Don’t sit for long while passing stools.

Which type of anesthesia is used during piles laser surgery?

There are different types of anesthesia used during different types of surgeries. Local anesthesia is used in laser hemorrhoidectomy and general anesthesia is used in open hemorrhoidectomy. In non-surgical procedures, topical anesthesia will be used.

For how long do I need to take follow-ups after piles surgery?

It is important to keep an eye on the recovery process and attend proper follow ups up to 2-3 weeks after the surgery.

When can I return to my work after piles surgery?

You can return to your work within 2-3 days after laser surgery and 2-3 weeks after open surgery but it may take around 1-2 weeks and 2-3 months to recover completely after the respective procedures.

Is piles a permanent disease?

No. Piles is a curable anorectal condition but it can recur even after the surgery. You have to maintain hygiene and take precautions to prevent them from recurring.