While most patients come with self-diagnosis of suffering from piles/haemorrhoids, I reassure them that it's a normal part of every human being and we are all born with them. Another myth is pain from piles. Piles are painless and cause bleeding, itching and sometimes jelly-like secretions, but they very rarely cause pain.

Yes. Contrary to belief, haemorrhoids (piles) are necessary for everyone. They have a role in continence (once ability to control/postpone defecation).

They will never cause cancer or turn into one.

Most people are concerned about the huge amount of blood they have lost, but in most cases it's very little (mls). It looks more as it is mixed with water and the water has turned red. It is very rare for one to lose excess amount of blood because of bleeding from piles. Piles is very rare to cause anaemia (low blood count), and if found, one might need colonoscopy to rule out other causes of bleeding.

Bleeding from the piles is bright red in colour and is never mixed with stool. It is usually self-limiting, lasting few days.

Causes of enlarged piles/bleeding are associated with increased abdominal pressure. Some of the causes of pressure are:
1. Constipation, requiring people to put pressure to pass motion
2. Chronic Cough
3. Weight lifting
Other rare causes include soft tissue disorders

Depending on size, they are classified into four categories (see the picture):
1st degree: Mildly enlarged
2nd degree: Big enough to meet the opposite side inside the anal canal
3rd degree: Come out but go back in on their own/can be pushed back
4th degree: Always outside and stay outside

If piles are bleeding intermittently, then treating the aggravating factor, which is constipation, in most of the cases will solve the problem. If persistent bleeding is the problem, then haemorrhoids can be dealt with proctoscopy and rubber bands in the clinic for 1st and 2nd degree haemorrhoids. 2nd Degree haemorrhoids can be treated with out patient procedures like banding or sclerotherapy. 3rd and 4th degree haemorrhoids need surgery.

It's better if it's done when its 3rd degree as LASER surgery is an option and gives better results. Surgical options includes
1. Open Haemorrhoidectomy: traditional method and time tested but pain management post procedure is an issue. One might not be comfortable sitting for almost up to 1 month. Pain depends on the individual threshold.

2. Stappled Haemorrhoidopexy: Designed to reduce the pain from open procedure. Pain is significantly less compared to open procedure. Complications are rare but can be troublesome to deal with if it happens.

3. Haemorrhoidal Artery Ligation: This can be done alone or combined with mucopexy if one has prolapsing haemorrhoids. It has almost NO complications as only artery is ligated.

4. LASER Procedure for Haemorrhoids (LASER For Haemorrhoids): LASER has now revolutionised treatment haemorrhoids. Laser Piles Treatment/Laser Piles surgery newer way of dealing with haemorrhoids. The biggest advantage of Laser Piles Treatment/Laser Piles surgery is that it combines hemorrhoidal artery ligation and LASER so one gets better result compared to other procedures. Pain associated with Laser Piles Treatment/Laser Piles surgery is very minimal. Laser Piles Treatment/Laser Piles surgery can be done as day care procedure. Currently we are using 1470 LASER which has no lateral spread beyond the haemorrhoids hence complications from Laser Piles Treatment/Laser Piles surgery is minimal.