Piles Surgery in Chandigarh
Expert diagnosis and treatment of piles (hemorrhoids / bawaseer) in Chandigarh, Mohali & Punjab — from in-clinic banding to surgical options, explained simply.
Contact for Further Information& JCI
What Are Piles (Hemorrhoids / Bawaseer)?
Piles — called hemorrhoids in medical language, or bawaseer in Hindi and Punjabi — are swollen, inflamed veins in and around the lower rectum and anus. They are one of the most common conditions seen in a colorectal surgery clinic.
Piles can be internal (inside the anal canal, above the dentate line) or external (under the skin around the anal opening, below the dentate line). Both can coexist. Most patients in Chandigarh, Mohali and Punjab delay seeking help out of embarrassment — but piles are entirely treatable and most cases do not require major surgery.
Important: Fresh bleeding when passing stool is the most common symptom of piles, but it should never be assumed to be piles without an examination. Bleeding can also be a sign of colorectal cancer or inflammatory bowel disease and must always be assessed by a specialist.
Grades of Hemorrhoids
Piles are graded I to IV. The grade tells your doctor how advanced your condition is and which treatment is appropriate. Grades I and II are usually treated in the clinic without surgery.
| Grade | What It Means | Typical Symptoms | First-Line Treatment |
|---|---|---|---|
| I | Small swellings inside the anal canal. Do not protrude out. | Painless fresh bleeding, mild discomfort | Diet changes, medications, rubber band ligation |
| II | Larger swellings. Protrude on straining but return on their own. | Bleeding, mucus, itching, discomfort | Rubber band ligation, sclerotherapy |
| III | Protrude on straining and need to be pushed back manually. | Prolapse, bleeding, discomfort, difficulty sitting | Rubber band ligation attempted first; surgery if fails |
| IV | Permanently prolapsed — cannot be pushed back in. | Severe pain, bleeding, inability to sit comfortably | Surgical treatment — haemorrhoidectomy |
Symptoms — When to See a Doctor
Do not delay — piles caught early are treated simply and quickly. If you have any of the following, book an appointment:
Fresh Blood in Stools
Bright red blood on paper or in the pan. Always get this checked — it may not be piles.
Lump Near the Anus
A soft or firm lump at or around the anal opening, sometimes tender or painful.
Pain or Discomfort
Pain while sitting or during bowel movement — especially with thrombosed (clotted) piles.
Mucus or Soiling
Mucus discharge or staining of undergarments — common with internal prolapsed piles.
Prolapse
A mass that comes out during straining — may go back on its own (Grade II) or need pushing back (Grade III).
Itching (Pruritus Ani)
Persistent itching, often worse at night. See also: Pruritus Ani.
What Causes Piles?
Piles develop when pressure on the veins of the anal and rectal region increases over time. In North India, a low-fibre diet and chronic constipation are the most common contributing factors.
Prevention tip: A high-fibre diet (dal, leafy vegetables, lauki, isabgol, whole grains), 2–3 litres of water daily, and not delaying the urge to pass stool reduce your risk significantly.
How Are Piles Diagnosed?
Diagnosis is quick, clinical, and nothing to be embarrassed about. Your surgeon sees these conditions every day. The examination takes a few minutes.
Clinical History
Symptoms, duration, diet, bowel habits, bleeding pattern, family history of bowel cancer.
External Examination & Digital Rectal Examination (DRE)
A gloved finger gently examines the anal canal and lower rectum for swellings, tenderness, or growths. This takes under a minute.
Rigid Proctoscopy
A short, lighted tube is passed into the anal canal to visualise internal haemorrhoids directly. This is the standard in-clinic test and also the instrument through which rubber band ligation is performed.
Flexible Sigmoidoscopy or Colonoscopy
Done when you are over 40, have a family history of bowel cancer, or have atypical bleeding. A sigmoidoscopy examines the left colon; a full colonoscopy examines the entire large bowel. Important: Before performing rubber band ligation, a flexible sigmoidoscopy is often done to exclude a proximal source of bleeding (polyp or cancer).
Digital rectal examination — a routine part of every piles assessment. Quick and well tolerated.
Rubber Band Ligation — The OPD Procedure
Rubber band ligation (RBL) is the most commonly performed procedure for Grade I and II piles — and for selected Grade III cases. It is done in the clinic (OPD) without anaesthesia and without admission.
Rubber band ligation — a tiny elastic band cuts off blood supply to the haemorrhoid, which then shrinks and falls off within days.
How It Is Done
A proctoscope is passed into the anal canal, and a suction-type band ligator (the Cook ligator is the most widely used in India) is applied directly to the internal haemorrhoid. The suction draws the haemorrhoid into the drum of the device, and a tiny rubber band is released around its base.
The band cuts off the blood supply. The haemorrhoid shrivels and falls off painlessly within 5–7 days, passing out unnoticed during a bowel movement.
Why is it painless? The band is placed above the dentate line — the junction between the sensitive lower anal canal and the insensitive rectal mucosa. There are no pain nerve endings above this line.
Illustration — Cook Suction Band Ligator in Use
⭐ Key Facts About Rubber Band Ligation
- OPD procedure — no operation theatre, no general anaesthesia, no hospital admission required
- Virtually painless — the band is placed above the dentate line where there are no pain nerves. Patients may feel mild pressure or a dull ache for 24–48 hours, easily managed with paracetamol
- Associated with proctoscopy or sigmoidoscopy — a flexible sigmoidoscopy is done first (especially in patients over 40) to exclude a higher cause of bleeding such as a polyp or cancer before banding is performed
- 1–3 haemorrhoids per session — more than this at once increases discomfort. Sessions are spaced 4–6 weeks apart
- 2–3 sessions usually needed for complete treatment
- Return to work immediately — for office/desk work, patients can return the same afternoon or next day. No sick leave required
- Day care — takes under 10 minutes. You go home the same day. No overnight stay
- Success rate: ~75–80% per session for Grade I and II hemorrhoids; cumulative success approaches 90% after 2–3 sessions (published evidence)
📋 Day Care Surgery & Insurance
Rubber band ligation is an OPD procedure — it requires no hospital admission. Most haemorrhoid surgeries (haemorrhoidectomy, stapled) can also be performed as day care surgery (same-day discharge) at Fortis Hospital Mohali. However, some insurance providers require a formal admission (usually one night) for reimbursement purposes. Your surgical team will advise you based on your insurer's policy and your clinical needs.
When Is Surgery Needed for Piles?
Surgery is not the first step — but it becomes necessary in specific situations. Your surgeon will discuss the most suitable option with you after assessment.
⚠️ Indications for Open Haemorrhoidectomy
Open surgery becomes the recommended option when:
- Grade III piles that do not respond to 2–3 sessions of rubber band ligation
- Grade IV piles — permanently prolapsed tissue that cannot be pushed back
- Large mixed haemorrhoids — significant internal and external components together (external haemorrhoids cannot be banded)
- Acutely prolapsed or strangulated haemorrhoids — a surgical emergency requiring urgent intervention
- Uncontrolled haemorrhoidal bleeding not responding to conservative treatment
- Circumferential haemorrhoids — involving the full circumference of the anal canal
- Patient preference after failed in-clinic treatment
Types of Open Haemorrhoidectomy
Milligan-Morgan Haemorrhoidectomy
The most commonly performed technique in India and the UK. Three haemorrhoidal columns are excised separately, and the wounds are left open to heal naturally. Very effective and long-lasting. Requires one night in hospital under spinal or general anaesthesia. The post-operative period involves some discomfort as bowel movements continue daily — managed with warm sitz baths, stool softeners, and regular analgesics. Return to desk work in 5–7 days; full activity in 2–3 weeks.
Ferguson Haemorrhoidectomy (Closed)
Similar excision to Milligan-Morgan, but the wounds are sutured closed after removal. More commonly performed in North America. Wound healing may be faster; outcomes are similar. Both techniques are well-established with comparable long-term results.
Emergency Haemorrhoidectomy
Required when haemorrhoids bleed continuously and do not respond to any treatment, or when an acute strangulated prolapse occurs. This is performed urgently to relieve pain and stop bleeding. Recovery is similar to elective haemorrhoidectomy.
Thrombosed External Pile — Evacuation
A blood clot (thrombus) inside an external haemorrhoid causes sudden, severe pain and swelling. Evacuation of the clot under local anaesthesia provides rapid relief. Best done within 72 hours of onset for maximum benefit. This is a day-care or OPD procedure.
Stapled Haemorrhoidopexy — When Is It Used?
Stapled haemorrhoidopexy (also called PPH — Procedure for Prolapse and Haemorrhoids) uses a circular stapling device to reposition prolapsed haemorrhoidal tissue back into the anal canal and reduce its blood supply. It does not excise the haemorrhoid — it repositions and fixes it.
✅ When Stapled Haemorrhoidopexy IS Appropriate
- Grade III internal haemorrhoids — particularly circumferential prolapse
- Patients who need a faster return to work (return in 3–5 days vs 1–2 weeks with open surgery)
- Patients with low pain tolerance or specific comorbidities where a less painful procedure is preferred
❌ When It Is NOT Suitable
- External haemorrhoids — the stapler cannot address these; they require open excision
- Thrombosed haemorrhoids
- Large mixed (internal + external) haemorrhoids
- Patients with anal fissure or significant perianal disease
Note: Stapled haemorrhoidopexy is not performed routinely because long-term recurrence rates are higher than with conventional haemorrhoidectomy — approximately 15–25% vs 5–10% at 5 years (published evidence ). The decision requires careful patient selection and discussion of this higher recurrence risk.
Stapled haemorrhoidopexy — the circular stapler repositions prolapsed internal haemorrhoids above the dentate line and reduces their blood supply.
Illustration — Stapled Haemorrhoidopexy (PPH / Procedure for Prolapse & Haemorrhoids)
💉 Sclerotherapy (Injection Treatment)
A chemical solution is injected into the base of the internal haemorrhoid to shrink it. Suitable for Grade I and early Grade II haemorrhoids, especially in patients who cannot tolerate rubber band ligation. Done as an OPD procedure. Less effective than banding for larger haemorrhoids.
✂️ Excision of Anal Tags (Skin Tags)
Anal skin tags are small, harmless folds of excess perianal skin. They often develop as a result of long-standing haemorrhoids, previous anal surgery, or a healed fissure. While not dangerous, they can cause discomfort, difficulty with hygiene, persistent itch (pruritus ani), or a feeling of incomplete cleanliness.
When Are Anal Tags Removed?
- Persistent itch or soreness that does not respond to hygiene measures
- Difficulty cleaning after bowel movements
- Tags causing psychological distress or discomfort during daily activity
- Tags removed at the same sitting as haemorrhoidectomy if surgery is already planned
- Not routinely removed if asymptomatic — excision is only when genuinely symptomatic
The procedure is a day-care excision done under local or spinal anaesthesia. An elliptical incision is made around the base of the tag, it is excised, and the wound is either left open or sutured with absorbable sutures. Healing takes 2–3 weeks. Multiple tags can be excised in one sitting, with skin bridges preserved between excision sites to prevent narrowing.
Illustration — Excision of Anal Tags (Perineal View)
After Your Procedure — What to Expect
Recovery depends on which procedure you have had. Here is a clear guide for each.
After Rubber Band Ligation
- You go home the same day — no overnight stay
- Mild ache or pressure in the rectum for 24–48 hours — take paracetamol as advised
- The banded haemorrhoid sloughs off in 5–7 days — you may notice a small amount of blood at this point, which is normal
- Return to office work: same day or next day
- Continue a high-fibre diet and adequate fluids to keep stools soft
- Call your doctor if: heavy bleeding, high fever, or severe pain not controlled by paracetamol
After Open Haemorrhoidectomy (Milligan-Morgan / Ferguson)
- Hospital stay: typically one night (or day care if uncomplicated)
- Warm sitz baths (shallow warm water bath) 2–3 times daily, and after every bowel movement — this is the single most effective comfort measure
- Stool softeners (lactulose, ispaghula husk) from day 1 — essential to prevent straining
- Pain relief: regular paracetamol + ibuprofen for the first 5–7 days; topical lignocaine gel for the wound
- Expect some blood-stained discharge for the first 1–2 weeks — this is normal
- Light walking from day 1 — avoid heavy lifting or straining for 4 weeks
- Return to desk work: 5–7 days · Manual work: 2–3 weeks
- Driving: avoid for 24–48 hours after anaesthesia, and while taking strong pain medication
- Call your doctor if: heavy bleeding soaking through dressings, temperature above 38°C, or inability to pass urine (urinary retention)
After Stapled Haemorrhoidopexy
- Less painful than open haemorrhoidectomy — the staple line is above the dentate line (pain-free zone)
- Hospital stay: day care or one overnight
- Sitz baths, stool softeners, and regular pain relief as above
- Return to desk work: 3–5 days · Manual work: 1–2 weeks
- Some patients experience a feeling of urgency or incomplete evacuation for a few weeks after surgery — this usually settles
- Follow-up appointment at 2–4 weeks to check wound healing and the staple line
Long-Term Care After Any Procedure
The most important thing you can do after any piles treatment is to address the root cause:
- Maintain a high-fibre diet permanently — dal, leafy vegetables, whole grains, fruits, isabgol
- Drink 2–3 litres of water daily
- Do not delay the urge to pass stool
- Avoid prolonged sitting on the toilet
- Stay physically active — walking 30 minutes daily reduces constipation significantly
- Return for review if symptoms come back — early recurrence is easier to treat
Success Rates & Recurrence
Understanding the success and recurrence rates of different procedures helps you make an informed decision with your surgeon.
Why Do Piles Come Back?
Recurrence after treatment is usually due to one or more of the following reasons — most of which are preventable:
Note: After stapled haemorrhoidopexy, recurrence is more common than after conventional haemorrhoidectomy. Patients are counselled about this before choosing this option.
Frequently Asked Questions
Can piles be cured without surgery?
Is rubber band ligation painful?
Why is sigmoidoscopy done before banding?
What is the success rate of rubber band ligation?
Why is stapled haemorrhoidopexy not done routinely?
How long is recovery after haemorrhoidectomy?
Can piles turn into cancer?
Read More: When Do Hemorrhoids Need Surgery?
Dr. Kapoor's detailed article explaining exactly which symptoms and signs indicate that surgery is necessary — and which can be managed with simpler treatment.
Read the Article →For appointments or enquiries: Contact page | drrajeevkapoor.com
