Piles Treatment - Types, Diagnosis, Surgery & Recovery

What is Piles Surgery?

Piles surgery is the surgical removal or shrinking of piles. Hemorrhoids or piles are swollen tissues in the anus and rectum which cause difficulty in passing stool and significant discomfort.

Typically, piles surgery is not the first option for treatment. Lifestyle changes combined with medication are suggested, and surgery is considered a viable option if the condition becomes severe.

Types of Piles

Internal Piles

Internal piles are in the anal canal and the rectum and generally go away independently. You cannot see or feel them as they’re inside the anus. When internal hemorrhoids swell up and become long lumps, they’re called protruding hemorrhoids. Protruding hemorrhoids have 4 grades, which we will discuss later.

External Piles

External piles appear under the skin outside the anus and are visible. They may cause bleeding, itching, irritation, pain, and swelling around the anus.

Degree of Prolapse

• Grade 1: The swollen tissues are small, stay inside the anus, and do not protrude.
• Grade 2: The swollen tissues protrude from the anus during bowel movements but go back inside independently after the bowel movement.
• Grade 3: The swollen tissues protrude from the anus due to straining or bowel movement; however can be pushed back inside manually.
• Grade 4: These swollen tissues protrude outside the anus and do not go back inside, even with manual intervention.

Different surgical methods can be used to treat hemorrhoids depending on the intensity of symptoms, signs, and associated complications. Surgical intervention will act as a long-term treatment and provide prolonged comfort to the patient.

Why is Piles Surgery Required?

Piles surgery is necessary in cases where the tissues are severely protruded, thrombosed, or have stopped responding to other treatments. Hemorrhoids can make daily activities, such as biking, exercising, or even sitting for long periods of time, very uncomfortable and difficult. Moreover, chronic blood loss that occurs due to bleeding piles may also lead to anemia in a patient

However, it is important to note that different types and grades of piles require varying treatment.

Lifestyle changes, home remedies, and medications are required for hemorrhoids classified under Grade 1 and 2. However, surgical methods of removal are required for prolapsed and bleeding hemorrhoids. In general, surgery is considered the last option for the treatment of piles, especially in cases where severe pain is experienced.

To determine whether you need piles surgery, your healthcare provider will need to conduct some examinations. Your surgeon diagnoses external piles as they are visible. However, internal piles may need more investigation.

The doctor may conduct the following exams to diagnose piles:

1. Physical examination: Here, the doctor will check the area around the anus to determine the extent of the piles.
2. Digital examination: The doctor inserts a gloved, lubricated finger into your rectum where they feel for any abnormal growths.
3. Visual inspection: Sometimes, the internal piles are too soft to be felt, so the doctor takes the help of an anoscope, proctoscope, or sigmoidoscope better to examine the lower portion of the colon and rectum.

How to Prepare for Piles Surgery?

There are some things you may need to take care of before, during, and after the surgery. Thoroughly preparing for piles surgery ensures all aspects of surgery go smoothly, and no complications arise.

Pre-Surgery

Patients may feel anxious before surgery, however, this is natural since the surgical process is stressful. The surgeon takes the patient through the entire surgical process and helps answer any questions they may have. Furthermore, patients should avoid taking medications such as Aspirin and Ibuprofen as these may lead to bleeding complications and negatively impact the surgery outcome.

Day Before Surgery

A day before surgery, bowel preparation is required to be done by the patients under the guidance of surgeons. The bowel preparation process involves drinking a liquid called a colon lavage solution. Another way to ensure the removal of stools is by giving the patient an enema. Furthermore, the surgeon may suggest a list of medications required to be taken before the surgery to the patients.

Procedure Day

Piles surgery is a daycare procedure, which means the patient can go home within 24 hours. During this procedure, spinal or local anesthesia is administered to the patient. Piles surgery generally takes about 30 minutes to one hour. It is essential to follow the fasting instructions strictly as it may hamper the To maintain cleanliness, patients need to take a bath before the surgery. Patients must strictly avoid the application of lotions, deodorants, nail polish, and perfumes. Jewelry and contact lenses must also be removed before the surgery.

Rubber band ligation: The doctor places one or two tiny rubber bands around the base of the internal hemorrhoid to cut off circulation. The hemorrhoid withers and falls off within a week. Hemorrhoid banding may be uncomfortable and cause bleeding, beginning two to four days after the procedure but is rarely severe.

Injection (sclerotherapy): Your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it might be less effective than rubber band ligation.

Coagulation: Coagulation techniques use laser or infrared light or heat. They cause small, bleeding internal hemorrhoids to harden and shrivel.

Surgical Procedures

If other procedures haven't been successful or you have large hemorrhoids, your doctor might recommend one of the following piles surgery:

• Hemorrhoid removal (hemorrhoidectomy): Hemorrhoidectomy is an effective way to treat severe or recurring hemorrhoids. Complications may include temporary difficulty emptying your bladder, resulting in urinary tract infections. This complication occurs mainly after spinal anesthesia. Most people have some pain after the procedure, which medications can relieve. Taking a sitz bath may also help.
• Laser Piles Removal: The laser treatment for piles is a minimally invasive treatment and is best suited for people who may hesitate to undergo open surgery. The procedure involves using a diode laser to ablate and destroy the blood vessels that cause piles.
• Hemorrhoid stapling: This procedure, called stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used for internal hemorrhoids. Stapling generally involves less pain than hemorrhoidectomy and allows for a quicker return to regular activities. Stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Other complications may include bleeding, urinary retention, pain, and sepsis - a rare, life-threatening blood infection.

Note: Surgical methods are preferred for the treatment of piles surgery in patients who do not achieve effective results from non-surgical treatments.

Risks and Complications

Your surgeon will try to mitigate the risks involved with piles surgery to the best of their abilities, however, some complications like the following can be seen after surgery.

These are listed below.

• Urinary retention
• Fecal incontinence or involuntary stool passage
• Fecal impaction
• Bleeding
• Passing of blood clots
• Pus or infection
• Stenosis or anal canal narrowing
• Chronic pelvic pain
• Pelvic sepsis (rare)