Is Piles Surgery Painful?

In popular perception, the term piles brings to memory a painful disease and the remedy in the form of surgery is thought to be an even more painful disease. ‘ Thank God it’s not piles ‘ is a common expression of patients when they are diagnosed with any anal disease.

What are piles?

In medical terms, piles are called hemorrhoids where a bunch of normal blood vessels in the anal canal become engorged. With time, it starts descending down the anus and can protrude out typically at 3 locations in the anus.

Is it painful?

Generally, people refer to any anal condition as piles. Be it a fissure abscess or hemorrhoid or fistula, it is referred to as piles by people. Except for complicated piles, the rest of the stages of piles are mostly painless. The other conditions affecting the anus like fissures, abscesses, and fistula, etc are painful, to begin with.

What is rectal prolapse?

In this condition rectal tissue projects out of the anus all around and usually its neither painful nor causes bleeding. This condition is different from hemorrhoids.

Are piles the same as constipation?

Constipation is when

1) The frequency of stool is less (e.g.) passing stools once in 3 days. (or)

2) Passing hard stools (or)

3) Straining at stools

Constipation could lead to conditions such as fissures or hemorrhoids.

To More Know About Constipation

How do piles or hemorrhoids affect us?

Piles can lead to bleeding via the anus which is generally alarming to the patient. Sometimes patients may feel too shy to disclose it or may keep trying some home remedies etc and may come to the doctor with anemia ( extreme loss of blood). At this stage patients may actually come with symptoms of tiredness, weakness, breathing difficulty, leg swelling, etc due to severe anemia.

In later stages, hemorrhoid tissue ( which is a bunch of engorged blood vessels) might project out. This may cause pain when it doesn’t go back inside.

What are the stages of hemorrhoids?

Generally, 4 grades are recognized. In Grade I, the hemorrhoid tissue is enlarged but inside the anal canal. In Grade II, it starts descending the anus while passing motion but goes back inside on its own. In Grade III, it has to be pushed back inside. In Grade IV, it cannot be pushed inside and soon the blood vessels may get clotted (thrombosed hemorrhoid).

When should one visit the doctor?

Patients should visit at the first instance of bleeding. This is very important as the diagnosis needs confirmation and other causes need to be excluded. The latter assumes more importance in the elderly where an early cancer can be detected and potentially cured.

Is there any test for piles and their grading?

Luckily for piles, tests are generally not required as visualizing it is easy. Generally, the Surgeon or Surgical Gastroenterologist examines the area and inserts a small instrument called a proctoscope to look for piles and grades it at the same time.

When is a test necessary for piles?

To rule out other causes of bleeding, especially in someone above 50 years, a procedure called sigmoidoscopy is done even if the patient has piles. This is also very important before surgery for piles. In some patients who may appear to be anemic or when considering surgery, blood tests and other tests may be requested.

How are piles treated?

Purely based on the grade of hemorrhoid, early stages like grade I and grade II are generally treated with medicines, diet, and lifestyle changes. Grade III and grade IV are generally treated by certain procedures or surgery. Several factors may modify the treatment and these will be discussed by the Surgeon or Surgical Gastroenterologist.

What kind of procedures or surgery are available?

Stapler Hemorrhoidopexy

These range from injection of chemicals, band ligation, and coagulation with energy sources which are all outpatient procedures and are not very popular. Surgical procedures like stapler procedure, and laser procedure ( usually combined with hemorrhoidal artery ligation) are popular as they are less painful. Traditional surgical removal of hemorrhoids is reserved for Grade IV hemorrhoids and complicated hemorrhoids. The choice of procedure generally depends on several factors like number of hemorrhoids, secondary hemorrhoids, age, and comorbidity of the patient.

What are the Do's and Don'ts in Piles?

Do’s

Consult a surgeon or Surgical Gastroenterologist early. Delaying consultation or shying away from a medical examination may lead to delayed diagnosis or missing a serious cause for the bleeding.
Having adequate fiber in the diet. Learning about a diet rich in fiber like vegetables and fruits (not just juices) is important.
Having enough water. Even in winter or living in air-conditioned spaces throughout the day, drinking adequate water is a must.
Taking medicines properly. Taking partial treatment will result in partial recovery.

Don’ts

Having a stigma towards piles. Revealing symptoms to your family members or the doctor at the earliest is essential.
Self-diagnosis. It’s very common. Even if you make the right diagnosis, get it confirmed and know its severity.
Ignoring short-duration symptoms. Anyone with symptoms even once in a while should get checked.
Self-testing. It’s a common practice for patients with bleeding piles to keep checking hemoglobin to know if it’s improving with medicines despite the bleeding. Please Avoid it.

Myths and truths

Myth – Prolonged sitting causes piles.

Truth – Although piles are said to be an indirect effect of the bipedal gait of human beings, sitting for long is not a causative factor but in people with anal pain, it may worsen on sitting.

Myth – Piles means surgery

Truth – This is a common myth and prevents patients from seeking help from a surgeon. Lower grades of hemorrhoids are managed medically by surgeons.

Myth – Laser surgery is painless

Truth – Because of the minimally invasive nature ( no cutting of tissue), pain is minimal in laser surgery. When any excess skin has to be removed, it has the same pain as other methods.

Myth – Laser surgery is the best method to treat piles

Truth – Again this is a common myth. Early piles don’t require any procedure. Medical management is likely to suffice. If surgery is needed, depending on your condition, the doctor will discuss the pros and cons of less painful surgeries for piles like the stapler method apart from the laser.

Myth – Piles are cured with ointments and tablets.

Truth – In most low-grade hemorrhoids, bleeding is treated and prevented with medicines, and equally important are diet and lifestyle changes. In high-grade hemorrhoids, surgery is the best treatment.

Myth – Piles can be cured by diet changes

Truth – A fiber rich diet is an essential component of both treatment and prevention of future progression of piles. However it is not enough . Hydration, stool softeners ( even if stool consistency is normal) and medicines to control bleeding are essential in medical management. In advanced stages of piles, surgery is the best choice.

Myth – Surgery is complicated and will need repeat surgery

Truth – Surgery is generally straightforward in piles.Recurrences are rare. Such myths have perpetuated as people have confused piles with other anal conditions like abscess or fistula which can recur.