Hemorriods or piles are swollen veins in the rectum and anus beneath rectal  mucosa or anal skin that cause painless bleeding while going for defecation. Often described as “varicose veins of the anus and rectum.The tissues supporting the vessels stretch. As a result, the vessels expand, the walls thin and bleeding occurs. When the stretching and pressure continue, the weakened vessels protrude.


  1. Internal
  2. EXternal

Internal  hemorrhoids are with in the anus, just below the dentate line, the anus beneath the mucosa. Painless bleeding and protrusion during bowel movements are the most common symptoms.  We cant normally see them or feel them until it slides down, to form prolapsed of piles

External hemorrhoids are venous cushions  near the anus and are covered by sensitive skin.we can see them and feel them. Symptoms include bleeding and severe pain if these got thrombosed called as thrombosed external piles.

Thrombosed external hemorrhoids are blood clots that form in an outer hemorrhoid in the anal skin. If the clots are large, they can cause significant pain. A painful anal mass may appear suddenly and get worse during the first 48 hours. The pain generally lessens over the next few days. You may notice bleeding if the skin on top opens. 


  1. Upright posture of human beings is one of the main causes of haemorroids.. Other contributing factors include:

    • Constipation for long duration 
    • Pregnancy
    • Heredity
    • diarrhoea
    • Straining during bowel movements
    • Faulty bowel function due to overuse of laxatives or enemas
    • Spending long periods of time on the toilet (e.g., reading)


Any of the following may be a sign of hemorrhoids:

  • Most of the times painlessbleeding during defecation
  • Protrusion of skin during bowel movements
  • Itching in the anal area

Medical management

 First of all colorectal surgeon will examine do vidioscopic rectal examination and diagnose, then treat accordingly. Usually 1st and 2nd grade piles can be treated by medical management without surgery.

Treatment includes:

  • Eating a high-fiber diet and taking over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed and bulky.
  • Avoiding excessive straining to reduce the pressure on hemorrhoids and help prevent protrusion.
  • Shortening time on the toilet to only 1 to 2 minutes to help prevent protrusion
  • Drinking more water to help prevent hard stools and aid in healing.
  • Taking warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day to help the healing process.


  1. Indications for sugical treatment includes 3rd and 4th degree hemorrhoids.

    Surgical options are

    1. Laser treatment for piles
    2. Stapler hemorroidectomy
    3. Open hemorroidectomy

Laser treatment for hemorroids

  1. :it is new modality of the treatment. It’s advantages are 
  2.  no bleeding ,
  3.  no pain,
  4. discharge on the same day.

Stapler hemorroidectomy :

this is very useful in treating prolapsed hemorroids.advantages are minimal bleeding, less pain .It is a day care procedure

If pain from a thrombosed hemorrhoid is severe, your physician may decide to remove the hemorrhoid and/or clot with a small incision. These procedures can be done at your