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Piles in India is generally used as a loose common term to include hemorrhoids, fistulas and fissures with skin tags.

True piles are those that present with PAINLESS BLEEDING due to swelling up of blood vessels in the anal canal.

Causes and Types -
Piles and their symptoms, which are one of the most common afflictions in the Western world, are also seen commonly in India. Not many people like to talk about it hence true statistics in India are not available. In India about 33% of the population over the age of 50 suffer from it. However they can occur at any age and can affect both women and men.

Because the presence of pile tissue is normal, it acts as a compressible lining which allows the anus to close completely. Disease should be thought of as pile tissue that causes significant symptoms. Unfortunately, piles tend to get worse over time, and disease should be treated as soon as it occurs.


An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include:

  • Aging
  • Chronic constipation or diarrhea
  • Pregnancy
  • Heredity
  • Faulty bowel function due to overuse of laxatives or enemas; straining during bowel movements
  • Spending long periods of time (e.g., reading) on the toilet

Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened veins protrude.

Piles can be classified into internal or external, and patients may have both types.

External piles occur below the dentate line and are generally painful. When inflamed they become red and painful, and if they become clotted, they can cause severe pain and be felt as a painful mass in the anal area.

Internal piles are located above the dentate line and are usually painless. Dentate line is a line seen in the anal canal that demarcates the area with pain sensation from that without it.

Grading of Piles

Grade I  Piles that protrude into but do not prolapse out of the anal canal
Grade II  Piles which prolapse on defecation but spontaneously reduce
Grade III  Piles that require manual reduction
Grade IV  Piles that remain prolapsed


Symptoms of piles/ hemorrhoids can include

  1. Bleeding,
  2. Faecal soiling,
  3. Itching, and
  4. Very occasionally pain.

Internal hemorrhoids cannot cause cutaneous pain, but they can bleed and prolapse. They can deposit mucus onto the perianal tissue with prolapse. This mucus with microscopic stool contents can cause a localized dermatitis, which is called pruritus ani.
Complicated hemorrhoids can cause perianal pain when incarcerated, strangulated and thrombosed.

Other Diseases

Fistulas are an abnormal small opening next to the anus from where discharge keeps occurring. This is due to a tunnel like tract between the anal canal and the skin. This condition always requires surgery for cure.

Fissure with skin tags lead to painful bleeding due to a small cut at the anal margin. It is usually associated with skin tags that are mistakenly called piles. This condition resolves in majority of the patients by use of creams and medicines to treat constipation. Skin tags can sometimes be a source of great irritation due to micro-incontinence. Rarely the patient needs surgery.

Polyps are usually found in small children and are associated with mucous discharge, bleeding and prolapse of mass from anal canal while passing stools.

Carcinoma or Malignancy is also seen frequently.

Rectal Prolapse : Part or full rectum comes out of anal canal during stools


Symptoms are due to bleeding ,itching, prolapse or thrombosis. Therefore, creams and tablets have a small role in treating piles. Suppositories, except for providing lubrication, have a small role.

Bathing in tubs with warm water universally eases painful perianal conditions. Relaxation of the sphincter mechanism and spasm is probably the etiology.

Many patients see improvement or complete resolution of their symptoms with the above conservative measures. Aggressive therapy is reserved for patients who have persistent symptoms after one month of conservative therapy. Treatment is directed solely at symptoms and not at the hemorrhoids’ appearance.

Old Conventional Treatment –

  • Surgery by ligating & cutting the piles mass under Anaesthesia
  • Injection of Phenol in Almond oil
  • Cryo or Bandligation

New Treatment (without surgery) –



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