Piles Surgery
BDS (Bachelor of Dental Surgery), 6 years of experience
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What is Piles Surgery?
Piles surgery, conventionally known as a Hemorrhoidectomy, is the surgery for removing hemorrhoids or piles. Pile surgery is usually done as an OPD procedure, but some patients may require prior admission to the hospital. It is an invasive procedure. Pile surgery takes only about 30 to 60 minutes.
Hemorrhoidectomy or pile surgery may not be the primary choice of treatment for piles but is still the gold standard. Newer treatments available are less invasive and have lesser complications. However, Pile surgery is the only treatment of choice in advanced cases.
Let us explain to you in detail about Piles surgery in today’s article.
- What is the meaning of Piles?
- What are the causes for Piles Surgery?
- Who should get Piles Surgery done?
- Who should not get Piles Surgery done?
- What are the complications that require Piles Surgery?
- What are the tests done before Piles Surgery?
- What is the procedure of Piles Surgery?
- How to take care after Piles Surgery?
- What are the risks of Piles Surgery?
- What is the cost of Piles Surgery in India?
What is the meaning of Piles?
Piles, also known as Haemorrhoids, are masses of inflamed or swollen anal tissue, which is either protruding out or found inside the anal canal. Piles mainly consist of veins, soft tissues, muscle, and elastic fibers. They may occur due to reasons like chronic diarrhea or constipation, pregnancy, etc. Piles are usually diagnosed by the doctor during a physical examination and may require Pile Surgery.
Patients with piles usually present with bleeding while passing stools. This occurs due to the rupture of the dilated veins as the stools pass through the anus. They are of two types-
- Internal Piles- They are located at 2-4 cm above the opening of the anus. It arises from the upper 2/3rds of the anal canal and is covered by the mucous membrane. These are more common and usually very painful. These types of piles require Pile Surgery.
- External Piles- It arises from the lower 1/3rd of the anal canal and is covered by skin.
What are the causes for Piles Surgery?
Piles surgery (hemorrhoidectomy) may be performed for the following reasons-
- To stop bleeding from the anus upon passing stools
- To relieve hemorrhoid or piles pain
- Relieve itching around the anus
- Redness and inflammation in the anal region
- Feeling of lump in the anus. It contains clotted blood.
- Having a painful bowel movement
- Feeling of fullness in the bowel even after passing stools
- Difficulty and pain while passing stools
- Swelling around the anus
- Pain on sitting
- To prevent the progression of hemorrhoids to gangrene
Who should get Piles Surgery done?
Doctors recommend piles surgery to people with the following conditions-
- Prolapsed internal hemorrhoids, where the hemorrhoids bulge out from the anus. This is a painful condition.
- Failure of treatment by other methods like medications, etc.
- Relapse of piles, which can happen due to lifting heavy weights or putting prolonged excessive pressure while trying to have a bowel movement.
- Piles causing severe discomfort upon sitting or usual daily activities.
- Thrombosed piles, where the blood gets clotted inside the veins of the piles. This causes painful swelling of the piles and the anal tissues.
- Fibrosed piles, where the pile’s tissue gets scarred or thickened. This causes difficulty in passing stools.
- Very large external piles
- Strangulated internal hemorrhoids- Here the blood supply to the hemorrhoid is cut off which leads to clotting or infections.
Who should not get Pile Surgery done?
Piles surgery is not recommended for the following patients
- Those who cannot tolerate general anesthesia (e.g. the elderly)
- Patients with inflammatory bowel diseases (e.g. Crohn’s disease, Ulcerative Colitis) ( Know more about- What is Ulcerative Colitis? )
- Rectocele- This is a condition in females where the tissue wall between the vagina and the rectum gets weakened.
- Fecal incontinence- Inability to control bowel movements or stools
- Chronic illness
- Bleeding disorders, may lead to excessive blood loss during the Piles surgery.
What are the complications that require Piles Surgery?
Piles surgery is advised by the doctor immediately if the following complications occur-
- Excessive anal bleeding that leads to anemia
- Anal infections in the piles
- Inability to control bowel movements or stools
- Anal Fistula- Here a new passage is created between the anal canal and the skin near the anus.( Know more about- What is Crohn’s Disease ?)
- Strangulated hemorrhoids – Here the blood supply to the hemorrhoid is cut off which leads to clotting or infections.
What are the tests done before Piles Surgery?
The doctor performs a complete physical examination and examines the anus of the person for the piles.
The doctor may ask the patient the following questions-
- Have you noticed any blood or mucus in your stools?
- Has there been any recent unexplained weight loss
- Have you experienced any changes in your bowel movements or stool passage frequency?
- Has the color of your stool changed recently
- Does anyone in your family or relatives have piles
Following the initial physical examination, the doctor may perform the following tests-
- Digital Rectal Examination (DRE)- In this test, a thin hollow tube with a light known as a proctoscope, is used to see the anal canal from inside for the piles present.
- Tissue biopsy- A small amount of pile tissue can be taken as a sample to be sent to the lab. This is done to analyze the pile’s tissue better
- Colonoscopy – If the piles are accompanied by any other digestive disease, then the doctor may ask for a colonoscopy. This is also done to rule out the possibility of Colon cancer. ( Know more about- What is Colonoscopy? )
What are the procedures of Piles Surgery?
Piles Surgery Procedures can be broadly classified under 2 subtypes-
- Surgeries without giving anesthesia
- Surgeries with anesthesia
1. Surgeries without giving anesthesia-
These are done in the doctor’s OPD clinic and don’t require anesthesia (a numbing agent). These are as follows-
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- Banding– Also known as Rubber Band Ligation, this is done to treat internal piles where a tight band is used around the base of the hemorrhoid to cut the blood supply to it. It requires 2-3 sessions in a span of over 2-3 months. It is not painful. Patients might experience mild discomfort. It is not advised in patients taking blood thinner medicines.
- Sclerotherapy– This procedure has the best success and results and is the treatment of choice for patients on blood thinner medicines. In this procedure, a chemical is injected into a hemorrhoid. This leads to the shrinking of hemorrhoid and stops the bleeding from it.
- Coagulation therapy– Also known as Infrared Photocoagulation, is a procedure, where infrared light or heat or extreme cold, is used to retract or shrink hemorrhoids. This is performed using an anoscope, where a thin tube is inserted inside the rectum to visualize the piles better for the procedure.
- Hemorrhoidal artery ligation (HAL) – Also known as Transanal Hemorrhoidal Dearterialization, is a procedure where the blood vessels that cause the hemorrhoids are located using ultrasound and ligated (closed off). This is more effective than the banding technique.
2. Surgeries with anesthesia
These are the surgeries that require hospitalizations and are done under anesthesia.
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- Hemorrhoidectomy– This procedure is used for those large external and internal piles that are causing severe complications and the symptoms are not getting treated with nonsurgical methods or medications. Either of the 3 types of anesthesia is given to the patient- local ( at the site of anus and rectum ), or regional (that numbs the lower part of the body ), or general anesthesia ( which puts the patient in deep sleep during the surgery ).
The surgeon then removes or cuts away the large hemorrhoids. Bleeding is managed by the surgeons and post-surgery patients are kept under observation for a few hours. Post this, patients can return home the same day.
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- Hemorrhoidopexy– This is also known as Stapling and requires anesthesia. This is used to treat the prolapsed hemorrhoids. In this procedure, the prolapsed hemorrhoids are pushed and placed back into the rectum using a surgical staple. The blood supply to the tissue is cut off which leads to the shrinking of the pile’s tissues. The recovery time is lesser and faster than hemorrhoidectomy.
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- Laser Treatment for Piles- Laser Treatment or Cauterization is a technique in which the surgeon uses a laser to burn and shrink the swollen hemorrhoids. Surgeons use a narrow beam of laser that operates only on hemorrhoids and prevents damage to the surrounding healthy tissue. Laser treatment causes very little bleeding and helps in faster recovery. ( Know more about- What is Gastric Bypass Surgery )
The duration of this surgery depends on the location and size of the hemorrhoids. In general, surgery may take 30 to 60 minutes. The patient is shifted to a recovery room post-operatively for observation.
Apart from this, the patient should take proper rest to recover from the lethargy caused by anesthesia. A thin cloth is placed inside the patient’s anus, which should not be removed till the doctor instructs.
How to take care after Piles Surgery?
After the Piles surgery, one may experience anal pain and discomfort. To reduce this discomfort, the doctor will prescribe some pain killers. Complete recovery can take around 2 to 6 weeks depending on the procedure done.
After the surgery, the doctor may advise the patient to follow these steps-
- Sitz bath– The patient is asked to sit and soak the anal area in the warm water for 20 minutes. The soak of warm water is made up of water and baking soda (sodium bicarbonate). This must be done 2 to 3 times a day.
- The patient is given antibiotics and painkillers. Local applications of medicines like ointments, etc. may also be given.
- Anal dilatation with a few fingers to prevent stenosis (narrowing) of the blood vessels.
- A diet that is high in fiber must be taken.
- Drink 8 to 10 glasses of water per day and keep the body hydrated.
- Using laxatives makes the stool soft that helps prevent straining during bowel movements.
- The patient should not do any strenuous physical activity that involves lifting or pulling heavy objects.
- Contact the doctor if the patient has a fever after surgery, feels dizzy, or has trouble urinating.
- The doctor may advise some lifestyle changes such as eating fibrous foods, losing weight, exercising daily, and drinking more water.
What are the risks of Piles Surgery?
Piles surgery may involve the following risks-
- Weakness
- Constipation ( Know more about- Diet Plan for Piles patients )
- Irregular bowel movements
- Difficulty urinating
- Infection in the part of the anus
- Infection at the surgical site
- Anal fissure
- Fecal incontinence
- Bleeding
- High fever
- Redness and pain in the anal region
If you are suffering from excessive bloating, bleeding, and constipation, please consult a doctor immediately.
What is the cost of Piles Surgery in India?
The total cost of Piles surgery in India can be around INR 1,50,000 to INR 3,50,000. However, there are many large hospitals and specialist doctors in India for Piles surgery. The cost of Piles surgery may vary across different hospitals.
If you are coming from abroad, in addition to the expenses of the Piles Surgery, there will be an additional cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the surgery, the patient is kept in the hospital for a few days for recovery. So, the total cost of Piles Surgery comes around INR 1,80,000.
We hope we could answer your questions about Piles Surgery through this article.
If you want more information and treatment of Piles Surgery, you can contact a General Surgeon.
We only aim to give you information through the article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.
