Piles & Haemorrhoid Treatment
Haemorrhoids, commonly called piles, affect nearly one in three adults at some point in their lives. Most cases are treatable without surgery when caught early. Even advanced cases have modern minimally invasive options. Here is what we do, and how we decide what is right for you.
Piles (also called haemorrhoids, or Arsha in Ayurveda) are swollen blood vessels in and around the anus. They are graded I through IV based on how much they prolapse. At Shri Manmukund Hospital, treatment is chosen based on grade and symptoms: conservative management for early grades, non-surgical OPD procedures like rubber band ligation and sclerotherapy for moderate cases, Ksharkarma or laser haemorrhoidoplasty for advanced grades, and conventional surgery only when clinically warranted. Most patients do not need surgery.
What piles usually look and feel like.
Not everyone experiences the same symptoms. If any two or more of these are present for more than a week, an examination is advisable.
Bleeding during passing stool
Bright red blood on toilet paper, in the toilet bowl, or on the surface of the stool. Usually painless. Most common in Grade I.
Anal discomfort or pain
Ranging from mild aching to sharp pain during or after bowel movement. May indicate thrombosed or strangulated piles.
Prolapse or lump
A lump felt or seen protruding from the anus. May reduce on its own (Grade II), need manual reduction (Grade III), or stay prolapsed (Grade IV).
Itching around anus
Persistent itching in the perianal region, often worse at night. Related to mucus discharge from prolapsed piles.
Mucus discharge
Wet feeling around the anus, staining of underwear, especially after bowel movements. Sign of prolapsed internal piles.
Feeling of incomplete evacuation
Persistent sensation that the bowel is not fully emptied even after passing stool. Sign of larger internal haemorrhoids.
Bleeding is often assumed to be piles, but persistent or heavy bleeding, dark blood, weight loss, change in bowel habits, or bleeding without straining can indicate more serious conditions including colorectal cancer. Any rectal bleeding lasting more than a few days should be examined by a specialist. Do not self-diagnose.
Piles are staged I through IV.
Grading is based on prolapse behaviour, not on symptom severity. Correct grading is essential to choosing the right treatment.
Grade I
Internal haemorrhoids that bleed but do not prolapse. Visible only on internal examination. Bleeding is the main symptom.
Grade II
Prolapse during straining but return on their own. Bleeding and discomfort. Often noticed only during bowel movement.
Grade III
Prolapse during straining and require manual pushing back. Persistent bleeding, discomfort, and mucus discharge.
Grade IV
Permanently prolapsed, cannot be pushed back. Constant discomfort, bleeding, and risk of strangulation.
Why piles develops.
Increased pressure on rectal veins is the underlying mechanism.
Almost every risk factor for piles reduces down to one physiological problem: repeated or prolonged pressure on the veins in and around the anus. When this pressure exceeds what the veins can tolerate, they enlarge, weaken, and eventually prolapse.
Not all risk factors are avoidable. Pregnancy and genetic predisposition are not modifiable. But most other factors can be addressed through simple changes, and doing so often prevents progression from mild to severe grades.
- Chronic constipation. Straining during bowel movements is the single biggest contributor to piles.
- Low-fibre diet. Insufficient fibre leads to harder stools and greater straining, damaging rectal veins.
- Prolonged sitting. Especially on the toilet. Modern habits like scrolling on the phone during bowel movements are a major contributor.
- Pregnancy. Both hormonal changes and physical pressure of the growing uterus contribute.
- Heavy lifting. Occupational or gym-related straining that increases abdominal pressure.
- Obesity. Increases baseline pressure on rectal veins.
- Ageing. Weakening of connective tissue in the anal canal reduces natural support.
- Genetic predisposition. Family history of piles substantially increases risk.
- Chronic diarrhoea. Repeated bowel movements can also irritate and enlarge haemorrhoidal veins.
Four steps to confirm the grade and cause.
Every consultation follows this same structure. Nothing is prescribed or planned before we have completed all four.
History
Detailed discussion of symptoms, duration, family history, diet, and previous treatments.
Physical Exam
Perianal inspection and digital rectal examination in private. Completed with dignity and consent.
Proctoscopy
If needed, a short in-clinic procedure to visualise internal haemorrhoids and confirm the grade.
Investigation
Blood tests or colonoscopy if red flags are present. Ruled out before piles diagnosis is finalised.
Five paths, chosen by your specific case.
This is the full range we offer. The right choice for you will be decided together after your examination, not before it.
Conservative Management
Best suited for: Grade I piles, early symptoms, prevention of progression
Dietary correction (high fibre, adequate water intake), stool softeners, sitz baths, topical medications, and specific lifestyle adjustments. This is where every patient starts, regardless of grade, because it addresses the underlying cause. For Grade I patients, conservative management alone often resolves early symptoms effectively.
Rubber Band Ligation & Sclerotherapy
Best suited for: Grade II and select Grade III piles, patients wanting no-surgery option
Office-based procedures with no cuts, no stitches, no admission. Rubber band ligation places a small band at the base of the haemorrhoid to cut off its blood supply. Sclerotherapy uses an injection to achieve the same effect. Both procedures take 10 to 15 minutes. You walk in, get treated, and walk out.
Ksharkarma (Ayurvedic Cauterisation)
Best suited for: Internal piles across grades, patients preferring classical approach
Ancient Ayurvedic para surgical technique using medicated caustic paste (Kshara) applied to the base of internal haemorrhoids. Causes them to shrink and detach. Dr. Vipin's PhD research was on the safety and efficacy of Apamarga Kshara ointment for this exact indication. Excellent results for Grade II and III with minimal complications.
Laser Haemorrhoidoplasty (LHP)
Best suited for: Grade III and IV piles, patients wanting faster recovery
Modern minimally invasive laser technique that shrinks haemorrhoids from within, without cutting or excision. Preserves the anal cushions (which serve an important physiological function). Performed under short anaesthesia. Most patients return to work within 3 to 5 days. Substantially less pain than conventional surgery.
Surgical Haemorrhoidectomy
Best suited for: Selected Grade IV cases, thrombosis, complications
Traditional surgical removal of haemorrhoidal tissue. Considered where less invasive options are not suitable, such as strangulated Grade IV piles, extensive thrombosis, or when previous treatments have failed. Requires 1 to 2 day hospital stay and 2 to 3 weeks of recovery. Used judiciously, not by default.
From first phone call to full recovery.
A typical journey through our care pathway. Your specific pathway may differ based on grade, treatment chosen, and recovery.
First visit and examination
30 to 45 minutes. History taken, examination completed, grade determined. All treatment options honestly explained. No pressure to decide the same day.
Planning your treatment
Time to consult family, seek a second opinion, or reflect. Once decided, pre-procedure blood tests and dietary preparation are guided.
Treatment day
Procedure performed as planned. Whether OPD, day-care, or admission is decided based on the technique chosen and your general health.
Structured follow-up visits
Scheduled reviews at day 3, 7, 14, and 28. Recovery monitored, wound care guided, dietary correction reinforced.
Full recovery review
Final review at 6 weeks. Complete healing confirmed. Preventive plan given to avoid recurrence.
Common questions, honestly answered.
Do I necessarily need surgery for piles?
No, most patients do not. Grade I piles usually resolve with conservative management alone. Grade II and III often respond well to non-surgical office procedures like rubber band ligation, sclerotherapy, or Ksharkarma. Surgical haemorrhoidectomy is reserved for advanced Grade IV cases or complications like strangulation or extensive thrombosis. In our practice, roughly 60 to 70 percent of piles patients avoid surgery entirely.
Is laser treatment for piles painful?
Laser Haemorrhoidoplasty is performed under short anaesthesia, so there is no pain during the procedure. Post-procedure discomfort is significantly less than conventional surgery. Most patients report mild to moderate discomfort for 2 to 4 days, well managed with oral analgesics. Compared to traditional haemorrhoidectomy, laser recovery is substantially easier.
What is Ksharkarma and how is it different from surgery?
Ksharkarma is a classical Ayurvedic para surgical technique that uses a medicated caustic paste (Kshara) to shrink and detach internal haemorrhoids without cutting. Unlike surgery, there is no excision, no stitches, and no wound. The tissue simply falls off in 7 to 14 days as it heals internally.
Dr. Vipin's PhD research was on the safety and efficacy of Apamarga Kshara ointment for this exact indication. It is particularly effective for Grade II and III internal piles, with success rates comparable to modern techniques and less risk of anal stricture or sphincter damage.
How long is the recovery from piles treatment?
Recovery depends entirely on the treatment chosen:
Rubber band ligation / sclerotherapy: Same day, back to normal activities in 24 hours.
Ksharkarma: 7 to 14 days for full healing, mostly outpatient.
Laser Haemorrhoidoplasty: 3 to 7 days back to work, 2 to 3 weeks full recovery.
Surgical haemorrhoidectomy: 2 to 3 weeks minimum, sometimes longer.
Can piles come back after treatment?
Yes, piles can recur, though good treatment paired with preventive care substantially reduces this risk. Recurrence is most common when underlying causes (chronic constipation, straining, low fibre diet, prolonged toilet time) are not addressed. This is why we do not stop at removing the current piles: every patient receives a preventive care plan targeting the underlying cause, and we follow up at 42 days specifically to reinforce that plan.
Are piles serious? Can they turn into cancer?
Piles themselves do not turn into cancer. However, rectal bleeding is a symptom shared with more serious conditions including colorectal cancer. This is why we insist on proper examination for every case of bleeding, especially in patients over 40, patients with family history of colon cancer, or when bleeding is accompanied by weight loss, change in bowel habits, or dark blood. Never self-diagnose rectal bleeding as piles without professional examination.
What is the cost of piles treatment?
Costs vary widely based on the treatment chosen and grade of piles. Conservative management is minimal. Non-surgical office procedures are moderately priced. Ksharkarma and laser are in a similar mid-range band. Surgical haemorrhoidectomy involves admission costs. We are ROHINI registered and offer cashless treatment through partner insurance providers. Detailed cost estimates are provided at the consultation, not before, because they depend on your specific case.
Ready for an honest opinion on your case?
Book a consultation. We will examine, grade, explain, and give you an honest recommendation. If we think you should be seen by a different type of specialist, we will say so.