Dr.(Major) R.S RENGAN M.S., D.N.B., Dip Laproscopic Surgery (University of Strasbourg)Senior Consultant, General & Laparoscopic surgery                                                                         For Appointment: 94440 42294

Apollo First Med Hospital,Chennai.


Celebrate Life

Specialized centre for Gastrointestinal Surgery, Breast, Thyroid Endocrine, Vascular, Cancer & Cosmetic surgery


What are Piles/Hemorrhoids?

Piles are swollen blood vessels around the anus. When the pressure on these vessels increases,they swell up and form small lumps.These lumps vary in size and can occur inside or outside the anus.

What are the symptoms of piles?

In most cases piles are not serious and go away on their own after a few days. A person with piles may experience the following symptoms.


  • A hard lump may be felt around the anus. It consists of clotted blood. This can be painful.
  • After going to the toilet, a feeling that the bowels are still full.
  • Bright red blood after a bowel movement.
  • Itchiness around the anus
  • Mucus discharge when emptying the bowels
  • Pain while passing stools
  • The area around the anus may be red and sore.

Internal hemorrhoids are classified into four grades:

  • Grade 1 – there are small inflammations, usually inside the lining of the anus. They are not visible.
  • Grade 2 – larger than grade 1 hemorrhoids, but also inside the anus. When passing a stool, they may get pushed out, but return unaided
  • Grade 3 – often called ‘prolapsed hemorrhoids’; these appear outside the anus. The patient may feel them hanging out. They can be pushed back in if the patient presses with their finger.
  • Grade 4 – these cannot be pushed back in and need to be treated by a doctor. They are large and stay outside the anus all the time.

External hemorrhoids are small lumps that are located on the outside edge of the anus. They are very itchy and can be painful if a blood clot forms inside. This external hemorrhoid requires medical treatment straight away.

Why do piles occur?

The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge. Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to:

  • Chronic constipation
  • Chronic diarrhea
  • Lifting heavy weights
  • Pregnancy
  • Straining when passing a stool

The tendency to develop hemorrhoids may also be inherited. The risk of developing piles grows with age

Diagnosing piles

A doctor can usually diagnose piles after carrying out a physical examination, examining the patient’s anus.

The doctor may ask the following questions:
  • Has there been any blood on the stools? Any blood from hemorrhoids’ is always bright red because it comes from the rectum. Darker blood could signal a serious problem further up your bowels, and should be reported to a doctor as soon as possible.
  • Has there been any mucus on the stools?
  • Has there been any recent weight loss?
  • Have bowel movements changed recently?
  • What color are the stools?

For internal hemorrhoids, the doctor may perform a digital rectal examination (DRE) or use a proctoscope – a hollow tube fitted with a light. The proctoscope allows the doctor to see the anal canal and take a small tissue sample from inside the rectum, which can be sent to the lab for analysis.

If the physician is presented with signs and symptoms which may suggest another digestive system disease, risk factors for colorectal cancer, and some other factors, he/she may recommend ordering an examination of the colon using colonoscopy.

What are the treatment options for piles?

A good doctor will initially recommend some lifestyle changes.

  • Diet – piles can be caused by too much straining when doing bowel movements, which is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or switching your cereal breakfast to bran.
  • Body weight – if the patient is obese, losing weight may help reduce the incidence and severity of hemorrhoids.
Simple things you can do yourself to help prevent piles:
  • Try not to strain when you go to the toilet
  • Avoid laxatives
  • Exercise

Ointments & Creams– there are some over-the-counter (OTC) medications which help soothe the redness and swelling around the anus area..

It is important to remember that they do not cure piles, they only treat the symptoms.

Surgery is often needed in many cases of piles. The type and mode of surgery shall be decided by Dr Rengan after thorough examination. Surgery for piles is varied and the type of surgery depends on the type and grade of the piles.


A Fistula-in-ano is an abnormal connection between the lowermost ends of the digestive tract and the exterior. Technically a fistula can mean any unnatural connection between any 2 tracts or a tract and the exterior.

There are a number an anal glands lying between the anal sphincters. Blockage of these glands can lead to infection and abscess. This abscess can break out into the skin causing a fistula.

Fistula can be low-anal or high-anal. The High anal variants are much difficult to treat. A Good surgeon can however treat fistulas effectively.

Fistulas often present with
  • Discharge of Pus
  • Itching
  • Pain

It can prove to be the focus of infection which can cause sepsis throughout the body. It is therefore recommended that fistulas are treated immediately.

A number of techniques are in vogue to treat fistulas. A fistulectomy is a simple procedure used to treat fistulas. Newer methods such as fistula plugs and gels are also in use. They are quite effective but the cure rate is much lesser than the conventional techniques. However they are much less painful. In many cases, a technique called seton wiring is used to treat fistulas.

Dr Rengan has been treating fistulas for the past 20 years with great success. In case you feel you have a fistula, do not hesitate to come to HOME OF HEALING SURGICAL CENTRE.