Piles surgery in Hyderabad: Haemorrhoids are blood vessels in the anal canal, they are present circumferentially in the anal canal but mainly located at the 3, 7, and 11 O clock positions of the anal canal. There are internal haemorrhoids inside the anal canal and external haemorrhoids covered by skin and are mainly located outside the anal canal.
Internal haemorrhoids: These are inside the anal canal and are covered by mucosa. They are small and are called haemorrhoidal cushions and are part of the normal anal continence mechanism. They are the ones that bleed when one passes stools. They can also enlarge and prolapse outside the anal canal and cause a lot of problems.
External haemorrhoids: These are situated outside the anal canal and are covered by skin. They generally don’t bleed but they are prone to clotting, a condition called thrombosed external haemorrhoids.
What causes haemorrhoids?
Haemorrhoids are blood vessels and have no valves. Raising intra-abdominal pressure, straining while passing stools, constipation, spending a lot of time in the toilet and lack of fiber in the diet, spending a long time in a toilet to pass stools, etc are some of the reasons for haemorrhoids.
What are the symptoms of haemorrhoids?
- Blood in stools– painless, bright red blood while passing stools is the most common symptom. The blood is bright red and not mixed with stool, it is separate from the stools and it splashes into the commode. The bleeding can be severe and continuous in some cases.
- Prolapse– the piles enlarge with time and come out of the anal canal; this is called prolapsing haemorrhoids. They either go back inside the anus after passing stools (Grade II Haemorrhoids) or need to be pushed inside (Grade III). Some large ones do not go back and stay outside the anal canal only (Grade IV).
- Itching– When haemorrhoids prolapse and do not go in, they cause itching around the anal canal.
- Pain– the external haemorrhoids when they suddenly form a clot, i.e., thrombosed external haemorrhoids, cause a lot of pain. There is a painful swelling at the anal opening.
What are the Grades of Haemorrhoids? Grafing of the Haemorrhoids helps assess the severity and also guides the treatment. The Haemorrhoids are graded as follows:
- Grade I– they are inside the anal canal and do not come out
- Grade II– they come outside the anal canal, but go inside completely by themselves after the stool is passed
- Grade III– They come outside the anal canal but do not go back, they have to be pushed inside the anal canal after passing stools.
- Grade IV: these are always outside the anal canal
What are the complications of Haemorrhoids?
- Anaemia – prolonged bleeding piles can cause anemia (low haemoglobin). Anaemia causes fatigue, tiredness, feeling low, and in extreme cases, heart failure.
- Strangulation: the haemorrhoids sometimes can come out of the anal canal and get stuck and do not go inside again. This happens when you strain. They become swollen, congested, and painful. This is an emergency condition and needs immediate hospitalization and treatment.
- Thrombosis of external haemorrhoids: the external haemorrhoids may clot and cause painful swelling at the anus.
What are the non-surgical measures to prevent bleeding from the haemorrhoids?
All those with haemorrhoids do not need surgery. Many of them can be managed with medications and some lifestyle modifications. The following measures should be taken:
- Do not strain while passing stools– straining puts pressure on the haemorrhoids and the haemorrhoids tend to get bigger with time when you strain and they start coming out of the anus. They also bleed more when you strain or put pressure to pass stools.
- Do not spend too much time on the toilet: spending lot of time in the toilet to pass stools, using your mobile or reading a newspaper in the toilet, waiting for the bowel movement to happen, not addressing constipation, straining to pass stools are very bad habits and they worsen your piles. The piles will enlarge and starting prolapsing.
- Diet rich in fibre– a high fibre diet rich in vegetables, green leafy vegetables taken regularly will prevent constipation. Passing soft stools daily without straining prevents bleeding from the haemorrhoids. Hard stools cause friction with the haemorrhoids
- Treat constipation- if you are constipated, discuss this with your doctor, and take high-fibre diet and other measures to resolve constipation. Addressing constipation is the single most important measure which reduces the bleeding from piles and prevents the worsening of piles.
- Drink plenty of water: drinking adequate water, at least 3 liters in a day, is known to prevent constipation and bleeding from hemorrhoids.
- Regular exercise: regular exercise is a natural laxative, improves your digestion keeps the bowel moving, and helps your constipation.
- Laxatives: Bulk laxatives like Isabgul and poly ethylene glycol along with some stimulant laxatives (like Sodium Pico sulfate) and liquid paraffin are used for a week or two to address the constipation and reduce bleeding. We do not recommend long-term usage of laxatives as they can cause dependence.
- Medications: Flavonoids (like Daflon), calcium dobesilate, etc., are a few medications that when taken are known to reduce the severity of piles and bleeding from piles.
When to go for piles surgery in Hyderabad?
Not all patients with haemorrhoids need surgery. Many will improve with medical measures and may not bleed again if these measures are followed strictly and consistently. However, many patients continue to bleed despite following all non-operative and medical measures. Then one must one must consider surgery. One should go for surgery if:
- Continuous bleeding not improving with medical and lifestyle measures
- Patients with anaemia
- Patients with prolapsing haemorrhoids, Grade II, II, and IV haemorrhoids where the haemorrhoids come out of the anal canal,
- Patients with strangulation- this can recur and the piles have to be addressed surgically. The irreducible and strangulated piles are initially treated with medical measures to reduce the prolapse and congestion and later taken up for surgery once the swelling and bleeding have subsided.
What is the best surgery for Haemorrhoids?
There are many surgeries and treatment methods for piles. The type of surgery depends on the grade of piles.
1) Sclerotherapy– for very early piles, Sclerotherapy helps, this is an outpatient procedure, and sclerosing agents like Polidocanol, STD, etc are injected into and around the piles. The scar forms around the piles and they stop bleeding. This is done for very small and early piles.
2) Banding of the piles: rubber bands are applied over the piles with a band applicator. The piles fall off in a few days and get scarred. This is an outpatient procedure. This is done for very early and small piles.
3) Open haemorrhoidectomy: this is one of the earliest surgical procedures for piles. This is called the Milligan Morgan haemorrhoidectomy. The piles are removed/ excised completely. This is painful procedure is not preferred nowadays as there are many other painless options.
4) Stapler haemorrhoidectomy: This is a very good procedure for prolapsing Haemorrhoids. This is called as PPH or MIPH, standing for Procedure for prolapsed haemorrhoids or minimally invasive procedure for Haemorrhoids. This is a relatively painless, short hospital stay procedure, ideal for patients with large and prolapsing high-grade hemorrhoids. A circular strip of rectal mucosa above the anal canal is excised circumferentially with the help of a circular stapler. The prolapsing piles get fixed up inside the anal canal and the blood supply to the piles is cut off. This is a very good procedure for piles of all grades but is very often done for Grade II, III, and IV piles. This is very helpful for patients who have large circumferential piles.
5) Laser surgery for piles: this is the latest of all and is a relatively painless procedure, with no wounds and fast recovery suitable for all grades of piles, but lower-grade piles respond better. Laser heat energy is used to coagulate the piles which later shrink due to fibrosis and scar formation. This has many advantages like – less pain after a procedure, outpatient procedure, and fast recovery after the surgery.
What is the duration of Hospital stay and time to recovery after a haemorrhoid operation?
Most of the surgical procedures for Haemorrhoids are either daycare procedures (same-day discharge) or overnight stays in the Hospital. The recovery is good and fast as most of the procedures performed now are relatively pain-free and one can resume work and office within 3-4 days.
What are the measures or precautions to be taken after surgery?
After surgery, the patient is advised to follow this advice:
- Diet rich in fiber – a high-fiber diet like green salads, green leafy vegetables, fruits, oats, etc is to be taken to ensure bulky and smooth stools, to reduce pain and discomfort after surgery.
- Laxatives– Laxatives like Isabel, PEG (polyethylene glycol), and Liquid paraffin are routinely prescribed to all patients for a few days after the surgery to prevent constipation and to ensure a smooth passage of stool without pain or discomfort.
- Sitz bath– sitz bath is sitting in a tub of warm water and wetting the anal region in warm water for 10-15 min each time and 3-4 times a day. This is soothing and relieves swelling and discomfort after surgery. This is continued for a week or two after surgery.
- Avoid straining while passing stools- do not strain while passing stools.
Analgesics- some patients may need mild analgesics like paracetamol to relieve discomfort and pain after surgery.
