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Piles are treated on the basis of severity and the type of symptoms, type of piles and health condition of the person. The treatment consists of:
• Home care treatment
• Minimally invasive procedure
All cases with symptoms, except for external piles with blood clots are typically advised to first opt for conservative treatment with home care treatment and medicines.
When the conservative treatment doesn’t work in a person suffering from grade I or II internal piles, he or she should go for minimally invasive procedure. Some cases of grade III piles may also be treated with the procedures.
A person suffering from external piles with blood clots or having grade III or IV internal piles should opt for surgical treatment.
Diet: eat food rich in fiber such as salad, fruits, whole grains and vegetables.
Fluids: drink good amount of water and other healthy drinks to avoid constipation.
Cold packs: you may use an ice pack wrapped in a towel to reduce pain and size of the hemorrhoids.
Toilet habits: avoid straining while passing stools and sitting for too long on the toilet.
If you are in a habit to wipe after passing stools, avoid wiping it too hard and instead use a damp paper.
Gentle push: a gentle pressure may be used to put a pile back inside the anal canal
Maintain anal hygiene: keep your anal area dry and clean.
Topical medicines: you can use an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or a numbing agent. Don’t use for too long especially steroids for more than a week, as they can cause thinning of the skin.
• Hydrocortisone rectal cream:adults can apply the cream to the external affected area as a thin film from 2 to 4 times in a day.
• Benzocaine Rectal ointment:adults and adolescents can apply to the area around the anus up to 6 times in a day.
Oral pain killers: You can take over the counter pain killers to relive pain such paracetamol or ibuprofen. Avoid ibuprofen if your pile are bleeding.
Stool softener: stool softener or a fiber supplement such as psyllium or methylcellulose.
Rubber band ligation:
This is the most commonly used minimally invasive procedure used to treat internal hemorrhoids. It is typically done to treat grade I and II hemorrhoids and some cases of grade III hemorrhoids. It is the most effective minimally invasive procedure with a success rate of 93%.
It is usually a well tolerated procedure which is done on OPD basis. Here, your doctor would put tiny rubber bands around the base of your internal hemorrhoids which would cut off the circulation. This would cause shrinkage and fall of the hemorrhoid within a weeks time.
Contraindication: anticoagulation therapy, perianal infection, advanced cirrhosis, active IBD.
A doctor injects a special solution (1% sodium tetradecyl sulfate or 5% phenol in almond or vegetable oil) into the base of an internal hemorrhoid, which causes loss of vascularity and formation of the scar tissue. This procedure can be opted in grade I, II and III internal hemorrhoids especially if a person is on anticoagulation therapy. It may cause less pain or discomfort, however it is found to be less effective than band ligation.
Complications: may lead to ulceration or rarely, a misplaced injection leading to infection, rectal perforation or fistula.
Contraindication: perianal infection and active IBD.
Infrared coagulation or electrocoagulation:
Your doctor would apply infrared radiation or electric current to the hemorrhoids which cuts off the blood supply, causing shrinkage of the hemorrhoid. This procedure can be used for grade I or II hemorrhoids.
Complications: are minor such as pain or bleeding.
Contraindication: perianal infection and active IBD
Here your doctor would surgically remove the hemorrhoid providing relief from the symptoms. He may use scalpel, scissors, diathermy or other devices to do it. The procedure is done under anesthesia.
Indication: This procedure is considered for people with clotted external piles, people with grade III or IV internal piles, or people with clotted external piles. It can also be used in cases where non surgical treatment has failed to provides relief.
Advantage: provides best long term results.
Urine retention (seen in upto 34% cases)
Anal canal narrowing
Loss of sensation
Here, your doctor would use a special stapling device to remove the internal pile tissue and put a prolapsing internal hemorrhoid back. This surgery is also done under anesthesia.
Indication: for internal circumferential prolapsing piles.
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