All you wanted to know about piles ! Dr Sanjay Dalmia* MS FRCS FRCS (Intercollegiate) PILES (HAEMORROIDS) What are haemorrhoids? Haemorrhoids (piles) are swollen blood vessels in the anal canal. They are very common. One in three people experience haemorrhoids at some time in their life. Constipation and straining to open the bowels can cause congestion and enlargement of the veins in the anal canal. Haemorrhoids also occur more frequently in some families, and are more common during or after pregnancy. They can cause bleeding and discomfort and many protrude outside the anal canal. . What is injection of piles? This involves injecting a small amount of a chemical called phenol (usually 5% phenol in arachis oil) near the haemorrhoid causing the haemorrhoid to shrink. This treatment will usually take 4-6 weeks to be effective, so you should not expect immediate relief. Most people require more than one injection What is “banding of piles” and how will it help me? In some patients banding of piles would be the best treatment option. This involves using a small instrument to put a very tight elastic band over the haemorrhoid. This band cuts off the blood supply so that the haemorrhoid drops off, usually within 3-7 days after the banding. What should I do after banding or injection ? • You may experience some pain or discomfort for a day or so after the banding. You should take some painkillers if you need to. • After treatment you may feel that you want to open your bowels. If you open your bowels try not to strain. • Avoid using any applicators or creams directly into the anus. • Avoid strenuous exercise for a couple of days. • You can bath or shower as you wish. What is Halo procedure? This is Haemorroidal artery ligation under Doppler guidance. It has been seen to be effective in bleeding piles. This is a quick and painless procedure with good results. When do they need surgery? When piles are long standing, bleeding repeatedly, coming out through anal canal, cause chronic itching and discomfort, painful, they need surgery. Unfortunately a large number of patients, particularly in our country, present with these problems and need surgery. Surgery has a high success rate with a small risk of complications. Healing takes in 10-14 days or may take longer in some cases. What surgical options are available for piles ? Piles has a number of different operations and they have mostly been successful. In broad category they include standard haemorroidectomy or stapled haemorroidectomy.You should consult your doctor for further details on these. Do you treat piles with laser? Piles are generally not treated with laser. Stapled haemorroidectomy is sometimes termed as laser by patients or some doctors. It is painless therefore also termed as microsurgery by some. These are simplified terms for a long name. Which one is better of the two? There is no better or worse between these two. They have their own roles in different situations. Stapled haemorroidectomy is relatively painless and return to work is early. It is suitable in some cases of 2nd, most 3rd and 4th degree piles. Is there any risk of surgery? Surgery can cause infection, bleeding and some minor control problems that get needs managing as necessary. What should I do if I bleed after I go home? •A small amount of bleeding on your stool is normal. You may notice bleeding when the haemorrhoids fall off, leaving a small raw area inside the anus, (usually about 1 week after banding). •Very rarely there can be more bleeding. If you see a lot of fresh bright red blood or pass clots, you should seek medical attention. •You will be seen again to check that the banding has been successful. Sometimes the banding needs to be repeated. What care shall I take after operation in the long term Avoid straining to open your bowels and to go when you feel the urge rather than putting it off because you are busy. Try to increase the amount of fibre and water in your diet. Fibre forms the structure of cereals, fruit and vegetables. Do piles comeback after surgery? Piles once operated should not comeback at the same place. However anal orifice is like a ring and mostly piles are present only at 3, 7 and 11 o’clock position. In some cases piles can occur again in other places in the ring. • Author is a Consultant Surgeon at Calcutta Medical Research Institute and Belle Vue Clinic, Kolkata and is in charge of One stop Rectal clinic at Belle Vue Clinic, Kolkata on every Tuesday and Friday, 4-6 pm.