Often described as "varicose veins of the anus and rectum,” hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. The rectum is the bottom section of your colon (large intestine). The tissues supporting the vessels stretch. As a result, the vessels expand, the walls thin and bleeding occurs. When the stretching and pressure continue, the weakened vessels protrude. The two types of hemorrhoids, external and internal, refer to their location.

What are the different types of piles / hemorrhoids?

Internal Hemorrhoids
These form in the back passage about 2-4 cm above the rim (opening) of the anus. Their severity and size are classified into grades 1 to 4.
Grade 1 are small swellings on the inside lining of the back passage. They cannot be seen or felt from outside the anus. Grade 1 hemorrhoids are common. In some people they enlarge further to grade 2 or more.
Grade 2 are larger. They may be partly pushed out (prolapsed) from the anus when you go to the toilet, but quickly 'spring back' inside again.
Grade 3 hangs out (prolapsed) from the anus. You may feel one or more small soft small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
Grade 4 permanently hangs down from within the anus, and you cannot push them back inside. They sometimes become quite large.

Piles images

Symptoms can vary. Small haemorrhoids are usually painless. The most common symptom is bleeding after going to the toilet. Larger haemorrhoids may cause a mucus discharge, some pain, irritation, and itch. The discharge may irritate the skin around the anus. You may have a sense of fullness in the anus, or a feeling of not fully emptying your rectum when you go to the toilet. Symptoms from haemorrhoids may be very similar to a number of other anorectal conditions so it is important not to simply assume that haemorrhoids are causing the problem. A colorectal surgeon/specialist will be able to confirm the diagnosis and also exclude any other problems. A possible complication of haemorrhoids that hang down (grade 3-4) is a blood clot (thrombosis) which can form within the haemorrhoid. This is uncommon, but causes intense pain if it occurs.

External Haemorrhoid (Sometimes Called A Perianal Haematoma)
This is less common than internal haemorrhoids. An external haemorrhoid is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the haemorrhoid ('thrombosed external haemorrhoid') it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external haemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external haemorrhoid may bleed a little for a few days. It then gradually shrinks to become a small skin-tag. Some people develop internal and external haemorrhoids at the same time.


  • Hemorrhoids are one of the most common known ailments.
  • Millions of Americans currently suffer from hemorrhoids.
  • The average person suffers for a long time before seeking treatment for hemorrhoids.
  • Advances in treatment methods means some types of hemorrhoids can be treated with far less painful methods than before.


The exact cause of hemorrhoids is unknown. A lot of pressure is put on human rectal veins due to our upright posture, which can potentially cause bulging. Other contributing factors include:

  • Aging
  • Chronic constipation or diarrhea
  • Pregnancy
  • Heredity
  • Straining during bowel movements
  • Faulty bowel function due to overuse of laxatives or enemas
  • Spending long periods of time on the toilet (e.g. reading)


Any of the following may be a sign of hemorrhoids:

  • Bleeding during bowel movements
  • Protrusion of skin during bowel movements
  • Itching in the anal area
  • Pain in the anal area
  • Sensitive lump(s)


It is important that symptoms are checked by a colon and rectal surgeon first before you try self-treatments. They will perform a thorough examination and recommend treatment. Mild symptoms can be relieved frequently without surgery. With nonsurgical treatment, pain and swelling usually decrease in two to seven days. The firm lump should recede within four to six weeks.

Treatement includes:

  • Eating a high-fiber diet and taking over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed and bulky.
  • Avoiding excessive straining to reduce the pressure on hemorrhoids and help prevent protrusion.
  • Drinking more water to help prevent hard stools and aid in healing.
  • Taking warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day to help the healing process.


If pain from a thrombosed hemorrhoid is severe, your physician may decide to remove the hemorrhoid and/or clot with a small incision. These procedures can be done at your physician’s office or at the hospital under local anesthesia.

Rubber Band Ligation: This treatment works well on internal hemorrhoids that protrude during bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days. The wound usually heals in one to two weeks. Mild discomfort and bleeding may occur. Sometimes this treatment needs to be repeated for complete treatment of the hemorrhoids.


  • Bulging, bleeding, internal hemorrhoid
  • Rubber band applied at the base of the hemorrhoid
  • About seven days later, the banded hemorrhoid has fallen off, leaving a small scar at its base

Injection and Coagulation: This method can be used on bleeding hemorrhoids that do not protrude. Both methods are fairly painless and cause the hemorrhoid to shrivel up.

Hemorrhoid stapling: A special device is used to apply staples and remove tissue from internal hemorrhoids. While the stapling method can shrink internal tissue, it cannot be used for external hemorrhoids. This procedure is generally more painful than rubber band ligation, but less painful than hemorroidectomy.

Hemorrhoidectomy: This is the most complete surgical method for removing extra tissue that causes bleeding and protrusion. It is done under anesthesia using either sutures or staples. Depending on the case, hospitalization and a period of rest may be required. Contrary to popular belief, laser methods do not offer any benefit compared to standard operative techniques. Laser surgery is expensive and no less painful.

Hemorrhoidectomy is considered when:

  • Clots repeatedly form in external hemorrhoids
  • Ligation is not effective in treating internal hemorrhoids
  • The protruding hemorrhoid cannot be reduced
  • There is chronic bleeding


Hemorrhoids do not increase the risk of colorectal cancer nor cause it. However, more serious conditions can cause similar symptoms. Even when a hemorrhoid has healed completely, your colon and rectal surgeon may request other tests. A colonoscopy may be done to rule out other causes of rectal bleeding. Every person age 50 and older should undergo a colonoscopy to screen for colorectal cancer.


Immediate intervention also not required in all the cases of the piles, if it is not bleeding. Sushruta, father of surgery wrote a book on surgical procedures in 500 B.C. in his treaties he mentioned about a disease and line of management. He broadly categorized to bheshaja (medicine), kshara (Alkali application), agni (cauterization), shastra (surgical excision).This is a contribution by him in the management of piles to the Indian system of medicine.One among these treatment modalities is kshara karma. Ayurveda surgeons practice this procedure in hospital set-up. An alkaline paste prepared out of plants with other ingredients is called kshara. In the operation theatre under local /general/spinal anesthesia kshara to be applied to the piles. After one minute it should be washed with sour liquids. Within a minute of time it turns in to black color. This pile mass gets thromboses and necroses over a period of 8 days. Patient may have little pain after the procedure. This can be managed by analgesics. Have to stay in the hospital for maximum one day. Same day one can take normal food after coming out of anesthesia.


Kshar sutra by its chemical cauterization a nd mechanical strangulation of blood vessels, causes local gangrene of the pile mass and pile sheds off within 5 to 7 days. No effort is made to pull out the Ksh ar sutra or pile masses as it may cause pain and bleeding which is not des irable. The healing of the resulting wound takes a week’s time.



From the very first day of Kshar sutra ligation light diet like Khichri(Rice preparation with pulses) is advised. Patient is also advised to take plenty of fluids, blend diet, green vegetables and seasonal fruits. Patient is further advised to avoid spicy and fried food and not to strain during defecation.


From 3rd week of Kshar sutra application or after the falling of pile mass, lubricated index finger with jatyadi oil is gently introduced inside the anal orifice and is gradually rotated clockwise and anti-clockwise for 2 to 3 minutes.Patient is advised to carry out this practice of this procedure by himself by using the finger stall on right index finger after defecatio n in the squatting position daily for a period of 1 to 3 months. Such a practice is advised just to avoid any chance of post ligation narrowing of anal opening.


This also good boon for piles patients because –no cutting of the tissues (for internal piles), less pain, minimal invasive technique, less cost, less recurrence, less hospitalization.