Hemorrhoids (Piles) | Symptoms, Grades, Treatment

Piles are swollen blood-vessel cushions inside or around the anus. They are extremely common, usually harmless, and almost always treatable — but the right treatment depends on the grade. This page explains every grade, when to worry, and which options are available in Vadodara.

Introduction

Hemorrhoids known in everyday language as piles and in Gujarati as bavasir or mulvyadh are one of the most common conditions in the world. Roughly half of all adults experience symptoms from piles at some point, yet most delay seeking help because of embarrassment, fear of surgery, or the hope that home remedies will be enough.

This page gives you a complete picture: what piles actually are, how they are graded, what causes them, which symptoms need attention, and the full range of treatment from dietary changes to day-care laser surgery. If you arrived here from our rectal bleeding or blood in stool page, you are in the right place — piles are the single most common cause of both.

What Are Hemorrhoids?

The anal canal contains three natural vascular cushions — clusters of tiny blood vessels, smooth muscle, and connective tissue — that help with continence and fine control of stool passage. When these cushions become enlarged, engorged, or displaced downward, they are called hemorrhoids. The word "piles" is simply the lay English term; both mean the same thing.

Internal vs External Hemorrhoids

Internal hemorrhoids sit above the dentate line, inside the anal canal. They are covered by a mucous membrane that has very few pain fibres, which is why internal piles usually bleed without pain. They are the type that prolapse (come out during straining).

External hemorrhoids sit below the dentate line, around the anal opening. They are covered by skin rich in nerve endings, which is why external piles — and especially thrombosed external piles — can be intensely painful, even without bleeding.

Grading System

Internal hemorrhoids are classified into four grades based on how far they prolapse. The grade determines the treatment.

Causes and Risk Factors

Piles develop when pressure on the anal cushions increases chronically. The usual contributors include:

• Chronic constipation and straining. The single biggest risk factor. Hard stools require prolonged pushing, which engorges the cushions.
• Low-fibre diet. Refined flour (maida), white rice without dal, and minimal vegetables lead to hard, small-volume stools.
• Inadequate water intake. Especially common in Gujarat during summer.
• Prolonged toilet sitting. Reading, scrolling, or straining for more than 5 minutes disrupts venous return.
• Sedentary lifestyle. Long hours of desk work or driving increase pelvic congestion.
• Pregnancy. The growing uterus presses on pelvic veins, and hormonal changes soften connective tissue. Piles are very common in the third trimester.
• Obesity. Excess abdominal fat increases intra-abdominal pressure.
• Heavy lifting. Repeated straining (gym, manual labour) raises abdominal pressure.
• Ageing. Connective tissue weakens over time, allowing cushions to slip downward.
• Chronic diarrhoea. Frequent liquid stools irritate the anal canal and keep cushions swollen.

Symptoms

The symptoms you experience depend on whether the piles are internal or external and what grade they are.

Internal Piles

• Painless bright-red bleeding: blood drips into the toilet bowl or coats the stool. This is the hallmark symptom.
• Prolapse: a soft lump that comes out during straining and may or may not go back in.
• Mucous discharge: a clear, slimy fluid that stains undergarments.
• Itching (pruritus ani): caused by mucous discharge irritating perianal skin.
• Sense of incomplete evacuation: the prolapse can make you feel like stool is still present.

External Piles

• Painful swelling at the anal verge, especially if thrombosed.
• Skin tags: small flaps of skin that remain after a previous external pile resolves.
• Difficulty with hygiene: skin tags and swelling make cleaning difficult.

Diagnosis

A clinical examination is usually all that is needed. Dr Samir Contractor performs a digital rectal examination followed by a proctoscopy — a short scope that visualises the anal canal and lower rectum. This takes under 5 minutes, is done in the OPD, and tells you the exact grade of your piles.

If the bleeding pattern suggests a source higher up — dark blood, mixed blood, weight loss, change in bowel habit a colonoscopy is recommended to rule out polyps or other conditions.

Treatment Options

Conservative Treatment (Grade I, Early Grade II)

• Fibre: 25–30 g/day from whole-wheat roti, chhilka wali daal, fruits with skin, vegetables.
• Water: 2.5–3 L per day.
• Stool softeners for short courses (ispaghula husk, lactulose).
• Sitz baths: warm-water soaks for 10–15 minutes, 2–3 times/day.
• Topical ointments and suppositories containing local anaesthetic, steroids, or astringents. Use for 7–10 days only prolonged use can thin the skin.
• Avoiding straining: do not spend more than 5 minutes on the toilet. Do not scroll your phone.

Office Procedures (Grade I–II)

• Rubber-band ligation (RBL): A small rubber ring is placed around the base of the internal pile to cut off its blood supply. It shrivels and falls off in 5–7 days. No anaesthesia needed.
• Sclerotherapy: A chemical is injected into the pile to shrink it. Best for small Grade I piles with bleeding.
• Infrared coagulation (IRC): A beam of infrared light coagulates the tissue. Useful for small, bleeding internal piles.

Laser Hemorrhoidectomy (Grade II–III)

A diode laser fibre is used to shrink the hemorrhoidal tissue from within. Advantages include less post-operative pain, less blood loss, and faster return to work (typically 3–5 days). It is not suitable for very large Grade IV piles with significant external component.

Stapler Hemorrhoidopexy (Grade III–IV)

A circular stapling device lifts the prolapsed cushions back into position and cuts off their excess blood supply. The procedure takes about 30 minutes under spinal or general anaesthesia. It carries less pain than traditional excision but slightly higher long-term recurrence in some studies.

Conventional Excision Hemorrhoidectomy (Grade III–IV)

The gold standard for advanced piles. The enlarged cushion is excised under direct vision. Post-operative pain is higher, but long-term cure rate is the best of all techniques. Modern wound-care protocols and pain management have improved recovery significantly.

Thrombosed External Pile — Emergency

A thrombosed external pile that presents within 48–72 hours is best treated by incision and clot evacuation — a minor procedure done under local anaesthesia in the clinic. After 72 hours, the clot begins organising and conservative treatment (sitz baths + analgesia) is usually preferred.

What Happens If Piles Are Ignored?

• Grade progression. Grade I piles left untreated with continued constipation often progress to Grade II, then III. Early treatment is simpler, cheaper, and more comfortable.
• Chronic anaemia. Daily small bleeds can cause iron-deficiency anaemia — fatigue, pallor, and breathlessness on exertion.
• Thrombosis. A prolapsed internal pile can become trapped (strangulated), clot, and cause severe pain requiring emergency treatment.
• Skin problems. Chronic mucous discharge leads to perianal dermatitis, itching, and breakdown of the skin around the anus.
• Missed coexisting pathology. Self-treating "piles" for years without evaluation risks missing a fissure, fistula, or rarely a rectal tumour that was there all along.

Why This Matters in India

Frequently Asked Questions