Piles (Hemorrhoids)
Swollen veins in and around the anus that can cause bleeding, discomfort and pain — usually very treatable.
Piles, or hemorrhoids, are swollen blood vessels in and around the anus and lower rectum. They commonly cause painless bleeding, itching, a lump or a dragging discomfort. Most early piles settle with fibre, fluids and simple measures, while advanced piles are treated effectively with modern laser surgery.
Piles are one of the most common reasons people visit a proctologist, yet many patients delay treatment out of embarrassment. They are rarely dangerous, but ongoing bleeding and discomfort can affect daily life. The good news is that piles respond very well to treatment — from simple lifestyle changes for early disease to quick, low-pain laser surgery for advanced cases.
पाइल्स (अर्श) भनेको गुदाद्वार वरिपरि सुन्निएका रक्तनलीहरू हुन्, जसले रक्तस्राव, चिलाउने र दुखाइ गराउँछ; अहिले लेजर शल्यक्रियाबाट सुरक्षित उपचार सम्भव छ।
Understanding Piles (Hemorrhoids)
Everyone has small cushions of blood vessels in the anal canal that help control bowel movements. When these cushions become swollen and enlarged, they are called piles or hemorrhoids. Internal piles form inside the anal canal and often cause painless bleeding, while external piles develop under the skin around the anus and can become painful, especially if a clot forms (a thrombosed pile).
Doctors classify internal piles by grade: Grade 1 stay inside; Grade 2 come out during a motion but slip back on their own; Grade 3 need to be pushed back; and Grade 4 remain outside all the time. The grade helps decide the best treatment.
Symptoms
- Bright red bleeding during or after passing stool, often painless
- A soft lump or swelling around the anus
- Itching, irritation or a feeling of moisture around the anus
- A sense of fullness or that the bowel has not emptied fully
- Pain or a hard, tender lump if an external pile clots (thrombosis)
- Mucus discharge or soiling of underwear
Causes & risk factors
- Chronic constipation and straining to pass hard stools
- A low-fibre diet and inadequate fluid intake
- Prolonged sitting, especially on the toilet
- Pregnancy and childbirth
- Persistent heavy lifting or a chronic cough
- Ageing, obesity and a family tendency to piles
Possible complications
- Ongoing bleeding leading to anaemia (low blood count)
- A painful thrombosed (clotted) external pile
- Prolapse of the pile that will not go back inside
- Strangulation of a large pile with severe pain
- Chronic irritation, itching and skin damage around the anus
How it is diagnosed
Piles are usually diagnosed by a simple, gentle examination of the anus, often with a short internal look using a small instrument (proctoscope). Because rectal bleeding can occasionally come from more serious causes, Dr. Sujan Shrestha may advise a colonoscopy for older patients or when the bleeding pattern is unusual, to rule out other conditions before treatment.
Treatment options
Early piles often improve with a high-fibre diet, plenty of water, avoiding straining, and short-term medicines or ointments to ease symptoms. Office procedures such as rubber-band ligation can treat many Grade 1 to Grade 2 piles without surgery. When piles are larger, keep bleeding, or repeatedly prolapse, a definitive procedure is the most reliable way to end the problem.
Surgical treatment
For advanced piles, Dr. Sujan Shrestha performs laser hemorrhoid surgery — a minimally invasive technique that uses a fine laser fibre to shrink and seal the swollen pile tissue with precision. Because there are no large cuts or stitches in the sensitive anal skin, patients typically experience far less pain than with traditional open surgery, minimal bleeding and a much faster return to normal life. Conventional surgery (open or stapled hemorrhoidectomy) remains an option for selected cases.
Recovery & aftercare
After laser treatment, most patients go home the same day and return to routine activities within a few days. You will be advised to keep stools soft with fibre and fluids, take warm sitz baths, and use prescribed pain relief. Mild discomfort or spotting for a short while is normal, and full healing usually occurs within one to three weeks.
When to see a doctor
See a doctor if you notice bleeding from the back passage, a persistent lump, or ongoing itching and discomfort. Seek prompt care for heavy or repeated bleeding, severe pain, or a hard, swollen lump. Never assume rectal bleeding is simply piles — it should always be checked to exclude more serious causes.
Frequently asked questions
No. Most early piles improve with a high-fibre diet, more fluids and avoiding straining, sometimes with simple office procedures. Surgery is reserved for larger piles that keep bleeding or prolapse despite these measures.
Laser hemorrhoid surgery is designed to be low-pain because it avoids large cuts and stitches in the sensitive anal skin. Most patients have only mild discomfort that settles with simple painkillers within a few days.
Treatment removes the current piles very effectively, but new piles can form if constipation and straining continue. A high-fibre diet, good hydration and healthy toilet habits greatly reduce the chance of recurrence.
Occasional light bleeding from piles is common and usually not serious, but ongoing bleeding can lower your blood count. Any rectal bleeding should be examined by a doctor to be sure it is not from a more serious cause.
Many people with desk jobs return within a few days, as laser surgery causes little pain and no large wound. Those doing heavy physical work may need a little longer, guided by their surgeon.
Get a clear answer from a specialist
Dr. Sujan Shrestha (MBBS, MS, MCh) offers evidence-based, minimally invasive care for piles (hemorrhoids) and the full range of GI conditions.