Piles (Hemorrhoids)

Our Approach In Managing Piles (Hemorrhoids)

Treat early. Treat painlessly. Treat completely.

Piles exist on a spectrum from mild, self-limiting discomfort to severe prolapse requiring surgical intervention - and the treatment approach changes dramatically depending on where on this spectrum a patient falls. The single biggest barrier to effective treatment is not medical complexity; it is the reluctance many patients feel discussing rectal symptoms, leading to delayed presentation and progression to more advanced grades that require more invasive intervention.

At Shree Hospitals, our approach to internal and external piles diagnosis and management is built around clinical privacy, clear communication, and matching treatment intensity precisely to disease severity. Our hemorrhoid specialists ensure that patients with early-grade piles avoid unnecessary surgery, while those with advanced disease receive timely, effective intervention - frequently using modern, minimally invasive techniques that significantly reduce the discomfort traditionally associated with piles treatment.

1. Confidential Clinical Assessment

• Detailed history - bleeding pattern, pain characteristics, prolapse, and impact on daily activities, taken with sensitivity and discretion
• Proctoscopy and anoscopy - direct visualisation confirming hemorrhoid grade, location, and excluding alternative diagnoses
• Digital rectal examination - assessing sphincter tone and screening for other anorectal pathology
• Colonoscopy or sigmoidoscopy when indicated - particularly in patients over 45 or with alarm symptoms, to exclude colorectal pathology as a cause of bleeding
• Grading according to the Goligher classification - Grade I to IV - directly guiding treatment selection

2. Conservative & Medical Management
    
   For Grade I and many Grade II piles, non-surgical treatment is highly effective:

• High-fibre diet and adequate hydration - reducing straining, the primary driver of hemorrhoid progression
• Topical preparations - corticosteroid and local anaesthetic creams for symptomatic relief during flares
• Oral flavonoid-based venotonic medication - improving venous tone and reducing bleeding episodes
• Sitz baths - warm water soaks providing symptomatic relief for discomfort and itching
• Bowel habit modification - addressing chronic constipation or excessive straining as the underlying contributing factor

3. Office-Based Procedures
    
   For Grade II and select Grade III piles not responding to conservative measures:

• Rubber band ligation - a quick, office-based procedure placing a small band around the hemorrhoid base to cut off blood supply, causing it to shrink and fall away within days
• Infrared coagulation - using focused infrared energy to coagulate small internal hemorrhoids with minimal discomfort
• Sclerotherapy - injection of a sclerosing agent to shrink hemorrhoidal tissue, particularly suitable for early-grade bleeding piles
• Minimal recovery time - most patients resume normal activity immediately following these procedures

4. Laser Hemorrhoidectomy
    
   Laser hemorrhoid surgery and painless treatment in Mumbai represents a major advance in surgical piles management:

• Precise laser energy used to shrink and seal hemorrhoidal tissue with minimal bleeding and tissue trauma
• Significantly reduced post-operative pain compared to traditional surgical hemorrhoidectomy
• Faster wound healing and earlier return to normal activity - typically within a week
• Suitable for Grade II, III, and selected Grade IV hemorrhoids
• Day-care procedure in most cases - patients discharged the same day with minimal downtime

5. Stapler Hemorrhoidopexy & Conventional Surgery
    
   For advanced Grade III and IV piles, more extensive intervention may be required:

• Stapler hemorrhoidectomy (procedure for prolapse and hemorrhoids - PPH) - repositions prolapsed hemorrhoidal tissue without excision in the highly sensitive anal margin, reducing post-operative pain
• Conventional excisional hemorrhoidectomy (Milligan-Morgan or Ferguson technique) - for the most severe, circumferential, or recurrent cases requiring complete surgical removal
• Doppler-guided hemorrhoidal artery ligation (THD) - a minimally invasive technique ligating the feeding arteries without excision
• Selection of technique individualised based on hemorrhoid grade, distribution, and patient factors by our hemorrhoid specialist team

6. Post-Treatment Care & Recurrence Prevention

• Structured pain management protocol - even with minimally invasive techniques, appropriate analgesia ensures comfortable recovery
• High-fibre diet and stool softener prescription post-procedure - preventing straining during the critical healing period
• Sitz bath guidance for wound care following surgical intervention
• Long-term lifestyle counselling - addressing constipation, prolonged toilet sitting, and heavy lifting as modifiable risk factors
• Follow-up review ensuring complete healing and addressing any recurrence promptly as part of Piles treatment in Mumbai, India