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When the blood vessels in the anus become swollen, a bulge is created which is known as piles or hemorrhoids. It can happen due to strenuous bowel movement. Piles can be internal or external. Anoscope/Colonoscopy are used for the diagnosis of piles.

Treatment options for piles are:

• Laser hemorrhoidectomy: It is used when the non-surgical means fail to treat the piles. It’s an outpatient procedure, where laser beams are directed on piles to make them shrink. This procedure has benefits such as lesser chances for recurrence, a high precision treatment, bladeless, relatively painless. It has highest success rate, creates less scars, allows faster recovery. Moreover, it requires lesser operation time and causes minimal blood loss.
• Stapler hemorrhoidectomy: It’s a suitable procedure for third-degree hemorrhoids, or for people with both internal and external hemorrhoids. In this advanced technique, a stapling device is used to remove the part of the pile mass with a stapler gun. This procedure offers benefits such as reduced postoperative pain, minimal bleeding, an earlier recovery time and a reduced hospital stay. It is faster than the traditional haemorrhoidectomy. Also, it requires no additional incision on the lower part of the anal canal, which is why the patient does not need to go for post-operative dressing.
• Open surgery (conventional): This procedure is opted for, when the location or amount of disease makes the wound closure difficult or when the chances of postoperative infection are high. An incision is made with a scalpel and a hemorrhoidal mass is clamped, tied, then excised (cut). Finally, the wound is left open in open surgery.

Based on the stage and the type of piles, the doctor may recommend either medical line of treatment or surgical line of treatment. Medical line of treatment include medication that can be consumed orally or ointments to be applied around the affected area. 

Non-surgical treatment for piles:

The doctors may recommend simple home remedies such as:

• Warm water bottle for external hemorrhoids to relieve pain.
• Ointments, creams (hydrocortisone or hemorrhoid cream) or rectal medicated suppositories. 
• Over-the-counter fiber supplements to soften the stools.
• Cold-compress on the anus to aid reduce swelling.
• Pain killers such as aspirin or acetaminophen.

Surgical treatment for piles:

Only when home remedies fail, the doctors may choose to perform surgical procedures:

Rubber band ligation: The doctor places a rubber band around the hemorrhoid to cut out blood circulation to it. As a result, it shrinks and can be removed. It is a procedure performed by doctors only, and should not be attempted at home.

Sclerotherapy: It is used as an alternative to rubber band ligation when the latter is not an option for the patient. The doctor injects a chemical into the blood vessel, resulting in the shrinking of hemorrhoids.

Hemorrhoidectomy: A minimally invasive surgery, Hemorrhoidectomy is further classified in three types:

Hemorrhoids are caused by increased pressure in the lower part of the rectum. Under pressure the veins around the anus bulge or swell leading to the formation of hemorrhoids. Factors contributing to increased pressure in the lower rectum are as listed below:

A phenomenon where the blood vessels in the anus become swollen and the bulge is known as piles. The swelling is created due to strenuous bowel movement which irritates the vein walls of the anus.

1. Overview: It’s an outpatient procedure, where laser beams are directed on piles to make them shrink. This procedure leaves lesser chances for recurrence of piles. 

2. Snapshots: 

• Procedure Type: LASER Surgery
• Anesthesia: Spinal Block/general anesthesia
• Hospitalization: 0-1 day
• Procedure time: 30 minutes
• Recovery Time: 3-4 days

3. Post-Surgical Care: 

• Take prescribed painkillers and take sitz bath
• Apply ice, eat high-fiber diet and have plenty of water/fluids 
• Refrain from strenuous activities and heavy weightlifting. 

4.Advantages of this Procedure: Lesser chance of recurrence, high precision treatment, relatively painless, highest success rate, less scars, faster recovery, lesser operation time, minimal blood loss and bladeless.

Piles or hemorrhoids can be classified into 3 main types - External piles (external hemorrhoids), Thrombosed piles (Thrombosed hemorrhoids) and Internal piles (Internal hemorrhoids).

External hemorrhoids: These are formed under the skin surrounding the anus and have the following symptoms-

• Soreness or itchiness around the anus.​
• Dull ache and uneasiness. 
• Swelling on the skin around the anus.
• Bleeding in severe cases.

Thrombosed hemorrhoids: A condition in which blood accumulates in external hemorrhoids and coagulates (thromboses); it can lead to:

• Inflammation​
• Swelling
• Hard lump near the anus.
• Severe pain

Internal hemorrhoids: These are formed inside the rectum. They can't be seen or felt and generally do not cause discomfort. However, passing stools can aggravate and cause:

• The affected area to bleed without causing any pain. Bloodstained stools or blood on the toilet paper while cleaning the area.​
• A prolapsed or protruding hemorrhoid forced through the anus, producing irritation and pain.

One should visit a doctor should any of the above symptoms show up. However, rectal bleeding is not exclusively because of hemorrhoids. Moreover, other causes such as other diseases, including anal cancer and colorectal cancer should be eliminated.

1.Overview: In this advanced technique, a stapling device is used to remove the part of the pile mass with a stapler gun. The titanium staples cut and seal at the same time. They thus minimize bleeding and reduce post-operative pain. 

2.Snapshots:

• Procedure Type: Minimally invasive procedure
• Anesthesia: General/spinal anesthesia
• Hospitalization: 0-1 day
• Procedure time: 30 minutes
• Recovery Time: 2 weeks (full recovery)

3.Post-Surgical Care: 

• Avoid heavy lifting and straining during bowel movements
• Follow all instructions given by your doctor
• Take prescribed painkillers
• Take sitz bath, apply ice, eat high-fiber diet have plenty of water/fluids
• Refrain from strenuous activities

4.Advantages of this Procedure: This procedure offers benefits such as reduced postoperative pain, minimal bleeding, an earlier recovery time and a reduced hospital stay. It is faster than the traditional haemorrhoidectomy. Also, it requires no additional incision on the lower part of the anal canal, which is why the patient does not need to go for post-operative dressing. This procedure has the highest success rate and is the most advanced procedure because of the precision and the outcome.

1.Overview: An incision is made with a scalpel and a hemorrhoidal mass is clamped, tied, then excised (cut). Finally, the wound is left open in open surgery.

2.Snapshots: 

• Procedure Type: OPEN Surgery
• Anesthesia: anesthesia
• Hospitalization: 7 days
• Procedure time: 30 minutes – 1 hour
• Recovery Time: 1-3 weeks

3.Post-Surgical Care: 

• Stay well-hydrated
• Take prescribed medication
• take a sitz bath, apply ice packs and take stool softeners to avoid straining and constipation
• Avoid heavy weightlifting and consume high-fiber diet with plenty of fluids.

4.Advantages of this Procedure: It is suitable for patients with bleeding and prolapsing third degree piles and when conservative methods failed to cure the piles. A doctor always prefers this procedure when the count of piles is very high and when the piles has recurred post operation.