Piles Surgery
Piles Surgery
Introduction
Blood filled vessels are normally located in the rectum (last part of the colon) and the anus which play an important part in the process of defecation (act of passing stools per anus). These vessels can become big and tense leading to a condition called Hemorrhoids. As these are blood filled, the outer layer of these vessels can shed, causing bleeding. The normal discharge of the lining of the colon along with blood can also cause irritation and discomfort of sitting. Finally, these vessels can get swollen with blood causing immense pain.
Location
Blood vessels form an integral part of the wall of the rectum. These vessels lie in the second layer of the wall from inside out. Thus, loss of the innermost layer can lead to exposure and breakdown of vessel wall causing bleeding, especially in case of swollen vessels.
Problems
Hemorrhoids can cause painless bleeding, itching near anal opening, inability to sit, swelling near anus and pain
Symptoms
Hemorrhoids may or may not cause problems. The most common symptom of anorectal diseases is pain. It needs to be differentiated from a Fissure-in-ano. Otherwise, hemorrhoids can present with following symptoms –
1. Passing blood after stools – Usually bright red in color
2. Pain – Initially painless. Pain occurs either along with a fissure in ano or in the presence of large swollen hemorrhoids thrombosed hemorrhoids)
3. Passing white discharge – Causes itching
4. Need to scratch around the anal opening
5. Discomfort while sitting especially for prolonged hours like in a desk-job, driving a two wheeler, etc.
6. Prolonged time needed to pass stools – Some might read a book or newspaper
7. Excessive force needed to pass stools
8. Frequent normal stools in view of sense of incomplete bowel movements
9. Swelling near anus – Usually seen in later stages following falling of the internal hemorrhoids out of the anus or with external thrombosed hemorrhoids
Types
Understanding types of Hemorrhoids helps determine treatment options. Hemorrhoids can present as –
1. Internal Hemorrhoids
2. External Hemorrhoids
Internal Hemorrhoids
Hemorrhoids are usually present within the rectum and anal canal. As they become bigger, they grow to protrude out of the anal canal. The internal hemorrhoids are further sub-divided as
Grade
Grade I
Grade II
Grade III
Grade IV
Size
Small
Larger
Larger than II
Larger than III
Location
Lie within anal canal
Lie within anal canal
Outside anal canal
Outside anal canal
Prolapse
Never
Along with stools
Always
Always
Reducibility
NA
Immediately after stools
With a finger can be pushed back in
Never
External Hemorrhoids
External Hemorrhoids present as swelling at the edge of the anal opening following bleeding. The blood within the swelling usually clots. Hence, they are also called as perianal hematoma. These hemorrhoids can cause intense pain and require urgent medical treatment.
When to worry
Any bleeding after stools should prompt you to see a doctor. Painful swelling near the anus should prompt you to see a surgeon. Longer duration of bowel movement, discomfort in sitting, itchiness are some vague indicators to look out. Other alarming symptoms include loss of weight, sudden change in bowel habits like changing diarrhea and constipation, giddiness after bowel movement.
Tests to diagnose hemorrhoids
Hemorrhoids can be diagnosed and treated by your family physician. In case you don’t feel better or you need to be examined, you should consult a surgeon.
Digital rectal examination
Your family physician may advise you to get examined further. The first step is examination by inserting the index finger through the anus wearing gloves. Following lubrication with a jelly, the finger can feel and help detect abnormalities in the lower part of the rectum and anal canal. At times, it may not be possible to insert the finger like in an acute fissure, prolapsed and thrombosed hemorrhoids. A gentel examination is performed after explaining to the patient. In case of pain during digital examination, one must inform the examining doctor immediately.
Proctoscopy
The next step is to visualize the same two areas – lower rectum and canal using a proctoscope and light. A proctoscope is an instrument devised to visualize and diagnose hemorrhoids. This instrument can help treat hemorrhoids like putting a band and to take a biopsy from a swelling if needed.
Sigmoidoscopy / Colonoscopy
In case of elderly patients, bleeding per anus warrants further testing to look for any abnormality beyond the rectum and anal canal. It is prudent to evaluate even in the presence of hemorrhoids as they can co-exist with cancer of colon. A long slender tube is passed after putting the patient to sleep with mild sedative to see the proximal colon.
Treatment
Initial treatment consists of lifestyle changes
Lifestyle changes
1. Fiber rich diet increases the volume of the stools making evacuation easier. Foods rich in fiber include vegetables, fruits and salads.
2. Adequate water intake maintains water balance in the body. With inadequate water intake, the colon absorbs water from the lumen to maintain body water, thus making the stools hard. Generally, 2-3 liters of water intake would suffice an adult.
3. Walking as an exercise is supposed to improve bowel movement. A dedicated brisk walk for about 35 – 40 minutes daily is adequate.
4. Avoid prolonged hours of sitting in the toilet, excessive straining, straining to pass stools to finish off the process before leaving for work.
5. Pass stools following a stimulus. Postponing bowel movement in spite of a stimulus causes the stools to harden.
6. Cleaning after passing stools is preferably done with water or patting with wet wipes. Avoid dry tissues, rubbing and forceful jet of water.
Local Applications
Local applications of medicated creams help relieve the symptoms of hemorrhoids. There are many components each of which plays a different role in reducing discomfort.
1. Topical anesthetic – Lignocaine 2% preparation are used to relieve discomfort after passing stools
2. Steroids – Reduce swelling especially in thrombosed hemorrhoids
Oral medications
1. Pain relieving drugs – Especially when associated with moderate to severe pain
2. Hemorrological agents – These are drugs which are supposed to reduce the congestion of the blood vessels and help drain the blood and reduce symptoms
3. Laxatives – Osmotic laxatives like lactulose help retain water in the colon, thus softening stools to make passage easier and without much straining
4. Bulk laxatives – Increase the bulk of stools similar to high fiber diet. Available in powder form and consumed along with water
Interventions
1. Banding – A rubber band is applied usually to Grade II or III Hemorrhoids. This band snaps the blood supply to the hemorrhoid, thus shrinking it. In about 7-10 days, the hemorrhoid detaches and falls. This is an out-patient procedure. There can cause some discomfort following the procedure followed passage of blood, mucus after hemorrhoid falls.
2. Injection therapy or Sclerotherapy – This procedure involves injection of a chemical solution which causes the hemorrhoid to clot and eventually decrease in size. This is also an out-patient procedure. After this procedure, there can be some pain and bleeding which will eventually settle.
3. Infrared coagulation – Infrared light is used as a means to burn the tissue around the hemorrhoid to stop its blood supply.
Options in surgical treatment
Usually reserved for Grade III or IV. Options are
1. Open surgery
2. Stapler surgery
Open Surgery
Stapler Surgery
Anesthesia
General / Spinal
General / Spinal
Cut of Surgery
Yes
No
Site of cut
Skin and Anal canal
No cut
Pain after surgery
Yes
Less
Dressing after Surgery
Yes
No
Scar
Yes
No scar
Recovery time
2 – 3 weeks
3 – 7 days
Discharge
48 hrs
24 hrs
Testimonials
Real reviews from our patients on Google
Kranti Tandel
2 months ago
From the moment I walked into the hospital until the day I was discharged, I felt genuinely cared for.
A heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Read moreA heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Shilpa Nair
4 months ago
I had an excellent experience and am very grateful for the care and support I received. The entire staff was professional, friendly, and attentive, making me feel comfortable throughout the process.
A special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Read moreA special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Mahendra Patil
4 months ago
My 3 years 11 month year old daughter was diagnosed with 10 mm kidney stone Dr.A.k.Singhal,Dr.Manish Dubey,and Dr.Ashwita Shenoy performed the surgery to remove the stone on May 30th with immense success. I am deeply grateful for the exceptional care and professionalism demonstrated by this entire team.
From the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Read moreFrom the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Purva Shingare
4 months ago
Had kidney stone surgery done by Dr Manish Dubey. All staff was cooperative. Doctor Dubey made me so much relaxed that I was not at all worried about the procedure. Other doctors in the OT were also very sweet. The staff is very nice, hospital is clean ,no smell of medicines, housekeeping services are very good. Hospital food is also very nice,tasty and healthy. Insurance procedure is also very easy. The surgery procedure went so smoothly. I would surely recommend Mitr Hospital and special thanks to Dr Dubey.
Read more
Nikita Ghodke
6 months ago
I had an amazing experience at the hospital, which offers excellent facilities and truly stands out in terms of care and support. I was under the treatment of Dr. Vijaykumar Yadav, who is exceptional in his field. His kindness, compassion, and dedication to his work made a significant difference throughout my journey.
He is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Read moreHe is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Dimple Choudhary
1 year ago
Very polite staff N great service ☺️
Ketan Bhagat
1 year ago
Excellent,
We had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Read moreWe had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Pankaj Choudhary
1 year ago
Very experienced Doctor and cooperative staff. They give full time to patients for there Query and problems.
Blood test Camp organised for Woman's day was support and very helpful
Read moreBlood test Camp organised for Woman's day was support and very helpful
Sneha Omale
1 year ago
डॉ. अमित घरत इंडॉस्कॉपी खूप छान पध्दती ने केली . धन्यवाद डॉक्टर आणि त्यांची टीम . वेळोवेळी मदत केली बद्दल.
prathamesh palkar
1 year ago
“I am extremely grateful for the excellent service provided by Mr.Aditya Sir from the hospital TPA insurance team. He was incredibly professional, patient, and thorough in explaining my insurance coverage and guiding me through the entire process. His prompt assistance and dedication made everything smooth and hassle-free. I truly appreciate his kindness and efficiency in handling my queries. Thank you, Aditya Sir, for your outstanding support!”
Read more