There are two types of piles.

• External piles

External hemorrhoids cause irritation as they can clot under the skin, resulting in a hard painful lump. This is called a thrombosed or clotted hemorrhoid. There are cases when blood may pool under the skin and streaks of blood are noticed after straining to pass a stool. Typically rectal pain gets resolved within 2-3 days. However the swelling takes a while to disappear completely, leaving behind a skin tag. If the size of hemorrhoid is large, there will be hygienic concerns, irritation, inflammation and itchiness around the anus.

• Internal Piles

Painless, bright red, rectal bleeding during or following a bowel movement usually occurs for patients suffering from internal hemorrhoids. Typically, the blood covers the stool (hematochezia), or is smeared on the tissue paper, or drips in the toilet bowl. There is no change in the stool color. As stated above, internal hemorrhoids are swollen smaller veins that line the anal canal. But they sag and swell which makes them bulge out of the anus all the time. Bulged out hemorrhoids when squeezed by the anal muscles restrict blood flow, making the condition extremely painful. This results in mucous secretion.

Other symptoms include are

• Itching

This is a frequent complain as internal hemorrhoids often seep mucus which chafe anal skin. Skin irritation is bulging large hemorrhoids secrete mucous leading to mild irritation Discomfort is the patient often feels the urge to poop right after having a bowel movement. This uncomfortable feeling is caused due to the hanging swollen tissue mass. Larger the hemorrhoid, greater is the discomfort.

• Pain

Internal hemorrhoids generally are not painful. A strangulated, large hemorrhoids cause severe pain for which immediate treatment is required.

• Bleeding at stool is the first complaint.
• Protruding mass on straining or defecation.
• Pains can feel only in case of Ext. Thrombosed Piles.
• Itching at anal region.

Associated Symptoms

• Ultimate blood loss causing anaemia.
• weakness, lethargy, dizziness etc
• Poor health, low vitality, Poor performance at work etc.

• Herediatary
• Constipation / Straining
• Irregular bowel habits
• Chronic Dysentry or Diarrhoea
• Obesity
• Pregnancy increased pressure on superior haemorrhoidal vein

There are four stages.They are as follows

• In frist stage,No prolapse of piles mass , just prominent blood vessel.
• In second stage,Prolapse of piles mass on bearing down but spontaneously reduced.
• In thrid stage,Prolapse of piles mass on bearing down but require manual reduction.
• In fourth stage,Prolapse of piles mass on bearing down which won’t get manual reduced.

Treatment depends on stages of Piles. Usually 1st degree internal piles can be conserved with ayurvedic medicinaltreatment along with dietary restructions. However, second, thrid & fourth stage Internal Piles require Ayurvedic Kshar sutra treatment followed by dietary restrictions to avoid constipation.

Different treatments available for Excision of piles

• Injection Therapy
• Rubber band ligation
• Cryo surgery
• Modern surgery
• Stappler Therapy
• Doppler
• Infra red coagulation
• Ayurvedic Kshar sutra therapy