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. For more information, consult Dr. Chintamani Godbole one of the top Colorectal Surgeon in Mumbai.

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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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

7. 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.

8. 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.

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