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Dealing with piles can be painful and embarrassing. Most people hope they'll go away on their own. Sometimes they do. But other times, surgery becomes the only real solution.
How do you know when you've reached that point? Here are five clear signs that it's time to consider surgical treatment for your piles.
Piles, also called hemorrhoids, are swollen blood vessels in your rectum and anus. Think of them like varicose veins, but in a more sensitive area. They affect millions of people worldwide.
An estimated 1 in 20 Americans have hemorrhoids that are bothersome. The good news? Only about 5% of people develop symptoms with hemorrhoids. Of these, only 30% seek medical treatment. Of those who seek treatment, only 10% will need hemorrhoidectomy surgery.
Most piles can be treated with simple changes like eating more fiber or using over-the-counter creams. But some cases are different. They need surgical intervention.
Doctors classify piles into grades based on how severe they are:
Surgery is the most effective and strongly recommended treatment for patients with high-grade internal hemorrhoids (grades III and IV), external and mixed hemorrhoids, and recurrent hemorrhoids.
This is the biggest red flag. If your piles stick out of your anus and won't go back in, surgery is likely your best option.
Grade 3 prolapse means your piles come out during bowel movements or physical activity. The hemorrhoid can however be pushed back inside manually. You have to use your finger to push them back in.
Grade 4 prolapse is worse. Hemorrhoid protrudes past the anus but is too painful to be pushed back in. They stay outside all the time.
Grade 3 internal hemorrhoids have a high risk of complications, such as infection, swelling, and even anal infections or significant blood loss.
What to expect: If you have Grade 3 or 4 piles, your doctor will likely recommend surgical removal. The exact procedure depends on your specific case and overall health.
Some bleeding with piles is normal. But heavy or constant bleeding is a warning sign.
You should worry if you notice:
At this stage, the hemorrhoidal lumps are excessively large, prolapsing outside the anus even without bowel movements and cannot be pushed back inside. Patients experience constant pain and may bleed at any time.
Heavy bleeding can lead to anemia, making you feel weak and tired. More importantly, it could signal complications like infected or dying tissue.
Any rectal bleeding needs medical evaluation. While piles are a common cause, other serious conditions like colon cancer can also cause bleeding. Patients at high risk of colon cancer should undergo rigid proctoscopy, flexible sigmoidoscopy or colonoscopy.
When to seek immediate help: If you're losing significant amounts of blood or feeling dizzy and weak, don't wait. Get medical attention right away.
Not all piles hurt. Internal piles usually don't cause pain because there aren't many nerve endings inside your rectum. But when piles become severely swollen or develop blood clots, the pain can be intense.
Thrombosed piles are especially painful. This happens when blood clots form inside the swollen tissue. Thrombosed hemorrhoids have a purple-blue hue. They can be extremely painful. Sometimes they can rupture, causing severe bleeding.
Signs your pain level needs surgery:
Due to the development of hemorrhoidal lumps, patients frequently feel pain and have difficulty sitting, even when not having a bowel movement.
Treatment approach: For thrombosed piles, in the painful first 72 hours, you might prefer surgery. Acting quickly can prevent complications and provide faster relief.
Have your piles come back multiple times after treatment? This pattern suggests they won't improve with conservative measures alone.
Recurring piles often indicate:
Surgery is applied in cases unresponsive to medical treatment or when hemorrhoids show life-threatening complications.
The surgical advantage: While procedures like rubber band ligation may need to be repeated, patients were better off after surgery according to long-term studies. Surgery provides a more permanent solution for recurrent cases.
Some complications make surgery urgent rather than optional. These include:
Strangulated piles: When prolapsed piles get trapped outside your anus, their blood supply can get cut off. This causes the tissue to die, leading to severe pain and potential infection.
Significant anemia: Chronic bleeding can cause your red blood cell count to drop dangerously low. This makes you weak, tired, and can affect your heart.
Infection: Prolapsed piles are more likely to get infected because they're exposed to bacteria. Signs include fever, increased pain, and discharge.
Anal fissures: Large piles can cause tears in your anal skin, leading to additional pain and bleeding.
In addition to hemorrhoids, patients face other risks such as hemorrhoid infection, necrosis of the hemorrhoids, anal fissures, anal abscesses, and even rectal cancer.
When complications occur: Don't delay treatment. Hemorrhoidectomy (surgical removal of hemorrhoids) is necessary if the patient experiences symptoms such as strangulated hemorrhoids, anal bleeding, or severe infection.
If you need surgery, you have several options. Your doctor will recommend the best approach based on your specific situation.
Surgery options include:
Patients should not worry excessively, as there are now many modern surgical methods that are less painful, cause less bleeding, and have faster recovery times.
Don't ignore these warning signs. Early treatment prevents complications and provides better outcomes.
Consider surgery if you have:
The bottom line: Modern pile surgery is safer and less painful than ever before. If conservative treatments aren't working, surgical options can provide permanent relief and prevent serious complications.
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