Piles (Hemorrhoids) | Dr. Chintamani Godbole | Colorectal Surgeon
                     Piles | 
Hemorrhoids
Dr. Chintamani Godbole
MS, DNB (Surgical Gastroenterology), FRCS (Edinburgh, UK)
Consultant – Colorectal Surgery & Peritoneal surface Oncology
What is a piles?
A pile, also known as hemorrhoid, is a 
mass of tissue that contains dilated and 
thin-walled veins, as well as extra growth 
that develops in the inner and external 
area of the anus. Internal piles occur 
when there is excessive inflammation 
between 2 and 4 millimeters (cm) above 
the orifice of the anus. Internal piles is the 
most common form. External piles occur 
when anus veins get dilated under the 
skin around the anus.
What are the symptoms of 
piles?
Internal hemorrhoids External hemorrhoids
• Painless bleeding • Acute thrombosis caused by physical 
• Perianal irritation and itching strain and exercise
•
• Perianal pain due to prolapse Swelling, pain, and redness in the 
affected region
• Acute pain
• Bright red bleeding after defecation
• Skin tags are excessively redundant, 
hanging skin.
• Infection and abscess development
• A painful perianal mass is present.
What are the different grades of 
piles?
• Grade 1: These are small hemorrhoids inside the anus lining.
• Grade 2: hemorrhoids are slightly larger than grade 1 hemorrhoids 
and also occur inside the anus. These hemorrhoids may be pushed 
out when passing stool, but they will gradually return to their normal 
position.
• Grade 3: These are also known as ‘prolapsed hemorrhoids’. They 
occur on the exterior of the anus. The patient can push them back in 
by pressing against them with fingers.
• Grade 4: These hemorrhoids cannot be moved back and must always 
remain outside the anus. They must be treated by a doctor, who will 
likely recommend surgery.
What are the complications of piles if left 
untreated?
• Bleeding during bowel movements
• Anemia
• Poor cleanliness in the anal region may result in a wide range of 
infections.
• Itching in the anal region
• Gangrene occurs when the blood supply to an internal hemorrhoid is 
disrupted.
What is the diagnosis of piles?
• Digital rectal examination,  proctosigmoidoscopy, and inspection of 
the anoderm, including the distal anal canal.
• Hematological examinations: CBC, hematocrit tests, and coagulation 
investigations
• Flexible sigmoidoscopy and anoscopy: Anoscopy is a required 
examination for hemorrhoids, and flexible sigmoidoscopy is 
performed to rule out the existence of any proximal condition.
• Proctography to indicate rectal prolapse
• Colonoscopy in some cases
What is the treatment of piles?
• If there is chronic bleeding, hemorrhoids may be treated in the 
hospital using proctoscopy for 1st and 2nd-degree hemorrhoids.
• Outpatient techniques like banding or sclerotherapy may be used to 
treat 2nd-degree hemorrhoids.
• Third and fourth-degree hemorrhoids need surgery. It is preferable to 
get it done while it is in the third degree since LASER surgery is an 
option that produces better outcomes.
Surgical Approach
• An open haemorrhoidectomy is a time-tested approach, however, pain 
management after the treatment is a concern. One may not be able to 
sit comfortably for almost a month. The pain threshold varies from 
person to person.
• Stapled Haemorrhoidopexy: A method used to alleviate the discomfort of 
an open procedure. Pain is significantly less compared to open 
procedures.
• When you have prolapsing hemorrhoids, this procedure may be done 
alone or in conjunction with mucopexy.
• LASER Procedure for Haemorrhoids: LASER has recently revolutionized 
the treatment of hemorrhoids. The main benefit is that it combines 
haemorrhoidal artery ligation with LASER, resulting in a better outcome 
than other procedures. Pain associated is very minimal.
Get in Touch:
Address: Gadre Hospital, near Hindmata Cinema, Dadar East, Mumbai, 
Maharashtra 400014
Phone: 84518 65944
Email: [email protected]
Website: drchintamanigodbole.com