What is

Piles?

Piles are swollen blood vessels inside and outside the anus. They are similar to varicose veins but occur around the anus.

Internal piles – inside the anus, are usually painless but may bleed.

External piles – occur under the skin around the anus and can be painful.

Hemorrhoid grading system

Symptoms

Grade 1

These are the mildest form, and they are located inside the anus rather than protruding outside. But some may lead to bleeding and itching.

Grade 2

These hemorrhoids prolapse during defecation, but they return back into the anus on their own.

Grade 3

These hemorrhoids protrude and do not retract on their own. But you can manually back them up.

Grade 4

These protrude permanently and cannot be pushed back.

Problems that may occur if the piles is left untreated

  • Bleeding can lead to anemia.
  • Pain & swelling (especially if external or thrombosed)
  • Prolapse (persistent protrusion, discomfort, contamination)
  • Thrombosis (clot inside a vein, very painful)
  • Gangrene (rarely, in grade 4).
  • Infection/pus formation (rare) Ulceration of hemorrhoids
  • Fistula-in-ano (rare but possible)

Treatment or surgical procedures recommended for different types of hemorrhoidal piles or anus

Grade 1:

  • Procedures if bleeding persists: Rubber band ligation (RBL) Serotherapy Infrared Coagulation (IRC), Laser Therapy

Grade 2:

  • Rubber band ligation (gold standard), serotherapy, irradiation coagulation, laser therapy. Surgery is rarely required.

Grade 3:

  • Rubber band ligation (for selected cases) Doppler-guided hemorrhoidal artery ligation (DG-HAL/HAL-RAR) ປີ ປ Stapled hemorrhoidectomy, open surgery

Grade 4:

  • (Irreducible prolapse / Thrombosed / Ulcerated) Stapled hemorrhoidectomy Open surgery