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Hemorrhoids Tips

Piles, Fistula and Fissures - How Can Ayurveda Be Beneficial In Them?

Piles, Fistula and Fissures - How Can Ayurveda Be Beneficial In Them?

Piles, fistula and fissures are the most common problems affecting the rectum and the anus. Both the rectum as well as the anus has a very rich vascular supply. There could be swelling of these blood vessels or tearing which can lead to the above conditions. Read on to know additional details about each of these conditions. 

Piles: In simple words, swollen blood vessels of the anal region are called piles. It can be internal or external, depending on how far it is from the anal canal. If it is located farther inside the anal canal, it is called internal piles.

Causes:

  • Chronic constipation, where the person has to strain to pass stools
  • Smoking and genetics can also lead to piles.

Symptoms: Starts off as painless bleeding, which happens in drops after bowel movement; the swelling happens much later. They can continue to grow and develop blood clots.

Treatment:

  • In the early stages, once identified, simple topical medications for symptom relief are sufficient.
  • Diet should be rich in fiber, with fruits and vegetables
  • Increased water consumption
  • Surgery if the disease has reached the stage of blood clots
  • Prevention is advised if there is a family history by consuming a fiber-rich diet and maintaining hydration

Fistula: When an infected anal gland bursts into the anal canal, it constantly discharges pus into the anal canal and becomes a fistula. Hygienic toilet habits can help in preventing fistulas.

Symptoms:

  • A constant wet feeling in the anal area, due to pus discharge.
  • This would be intermittent, and there would be periods with no discharge.
  • There could be a foul smell due to pus discharge.

Diagnosis and Treatment:

  • Identifying the exact location is important as surgery may be required.
  • An ultrasound scan or an MRI is usually done.
  • Newer techniques like Video Assisted Anal Fistula Treatment (VAAFT) are used. This locates the piles accurately and uses electric current to seal it with staples and surgical glue.
  • Conventional surgery is also used for economic or accessibility reasons.
  • Fissures: These cracks anywhere in the length of the anal canal are extremely common.

Symptoms

  • Very painful and the person may not want to go to the toilet
  • Rarely bleeding is also seen, maybe in very small amounts

Treatment:

  • Over 90% of the fissures do not require surgery
  • Switching to a high-fiber diet and improving hydration will help in managing these symptoms.
  • Topical relief can be provided by medications.
  • When they are recurrent, a procedure known as lateral sphincterotomy is done. This is an outpatient procedure and provides immediate relief.

Though one condition can lead to another, in most people, there is a strong genetic component, and working towards prevention is highly recommended.

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Laser Surgery In Piles!

Laser Surgery In Piles!

Piles are swellings that occur inside or around the anus. The other name for Piles is Hemorrhoids. They are a group of inflamed tissues in the anal canal. They contain blood vessels, support tissue, muscle along with elastic fibres. Internal piles are usually located between 2 and 4 centimetres above the opening of the anus and they happen to be the more common type. External ones occur on the outer edge of the anus.

Before looking at the tips for laser surgery in Piles, let us briefly discuss the symptoms and causes of Piles.

Symptoms

In most of the cases, the symptoms of piles are not that serious. They tend to resolve normally on their own after a few days. An individual suffering from piles can experience the following symptoms:

  • Hard, painful lumps are felt around the anus. They may contain coagulated blood.
  • A person suffering from piles can have a feeling that the bowels are still full, even after passing a stool.
  • Bright red blood is noticed after a bowel movement.
  • The region around the anus tends to be itchy, red and sore.
  • People with the problem of Piles can experience pain while passing stool.

Causes

Piles are mainly caused by having an increased pressure in the lower rectum. The blood vessels around the anus and the rectum tend to stretch under pressure. They may swell up or bulge, leading to the formation of piles. This can happen due to:

The problem of developing Piles can well be inherited and increases with age. 

Tips on Laser Surgery in Piles and Help from Ayurveda

Usually, surgeries involve cuts in the affected areas and are known to be painful and have a prolonged recovery period, multiple dressings and visits to the clinic. Even after undergoing so much of discomfort, there is quite a significant risk of recurrence.

This is where Laser Surgery can turn out to be much more effective in treating the problem of Piles.

The tips include:

  • Laser Surgery is less invasive in nature, which makes it quite a convenient treatment option for people suffering from Piles.
  • Patients can prevent themselves from having their tissues cut
  • The affected region gets treated with laser energy in a precise and focused manner.
  • The problem of Piles gets cured within a few minutes.
  • Laser Surgery ensures lesser pain and faster recovery time.
  • Most importantly, people can resume their normal activities immediately after surgery.
  • Ayurveda suggests people keep their anal region clean by cleansing the skin around the anus gently with warm water.
  • It also suggests applications of ice packs or cold compresses to provide relief from swelling.

Know How Ayurveda Can Help In Treating Piles!

Know How Ayurveda Can Help In Treating Piles!

Haemorrhoids or piles is a condition where the blood vessels in the rectum or the anus, become swollen. Research has indicated that almost 50 percent of people will experience such haemorrhoids prior to the age of 50. Haemorrhoids are of two kinds, namely, exterior and interior.

The disease can be difficult and painful to live with, which is why rapid diagnosis and treatment are required to cure the condition.

Symptoms-
Common symptoms of haemorrhoids include -

  1. Rectal bleeding
  2. Pain/discomfort
  3. Itching/irritation in the anal region
  4. Swelling/lump around the anus

Causes of Piles
The scientific community has yet to reach a consensus as to the exact cause of the condition. However, there are some factors that may increase the risk of the disorder. These include -

  1. Excessive strain at the time of bowel movement
  2. Chronic constipation, which results in excessive strain during excretion
  3. Sitting on the toilet seat for a prolonged period of time
  4. Prior family history of the condition

As someone suffering from piles, you should also engage in light exercises, so that you can keep yourself in shape. Obesity can increase the complication from piles, which is why maintaining an ideal body weight is essential. However, make sure that you do not lift weights, as it might aggravate the disorder.

Ayurvedic Treatment for Piles - 

Role and Benefits of Kshar sutra Treatment-
Kshar sutra ligation is an Ayurvedic therapy that uses a unique technique to treat anorectal diseases. Patients suffering from piles, anal fistula, and pilonidal sinus are commonly recommended this therapy. The treatment involves -

  1. A minor surgery is performed to ligate (tie up) the base of the pile mass with caustic threads (Kshara sutra).
  2. The kshara applied on the thread has antibacterial, anti-inflammatory properties that soothe or reduce irritation.
  3. The medicated caustic thread curettes out the anal passage and discards the epithelial lining, therefore allowing the tract to heal.

Unlike conventional treatment that requires one to undergo surgery, and is associated with many side effects, Kshar sutra permanently cures hemorrhoids. Moreover, this procedure has several benefits such as the following-

  • It is a minimally invasive procedure and has no serious complications
  • It is an out-patient treatment, meaning the patient can walk home immediately after the treatment is performed
  • It prevents the recurrence of the disease, which other conventional treatments cannot guarantee

Living with piles can be distressing and embarrassing. Hence, the best option to look for is a permanent cure using Ayurveda.

Other Ayurvedic Tips-

Several foods and Ayurvedic medications can provide relief for patients suffering from piles. A fiber-rich diet, for instance, will help prevent constipation. Here are some dietary changes that will help you deal with piles in an easier fashion.

  • Consumption of whole grains is recommended, in order to relieve constipation.
  • Green leafy vegetables, such as spinach and broccoli, will also help with the symptoms of piles.
  • Eat fruits such as bananas, apples, figs and papayas to ensure a strong and clear motion.
  • Drink lots of water and avoid alcohol as much as possible. Additionally, caffeinated drinks, such as coffee and sodas, should be avoided as well.
  • Mix Triphala powder with warm water and drink the decoction every night before going to bed. For better results, add a few drops of castor oil into the mixture.
  • Drink a glass of buttermilk every day.
  • A drink made out of haritaki and jaggery will also help to deal with the symptoms of piles.
  • Incorporate garlic, soaked chia seeds and flax seeds into your diet for better motion

Aside from the diet, there are some other ways of reducing the pain associated with the condition. A sitz bath is one such option. In order to take a sitz bath, fill up the bathtub with warm water. Ensure that the level of water is enough to keep your waist and hip submerged. Add an antiseptic such as turmeric or neem into the water to ensure that no infection results from the same. Now, sit in the water for a few minutes.

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Piles - How Can Homeopathy Treat It?

Piles - How Can Homeopathy Treat It?

Piles or Haemorrhoids is a disease of the anal canal. The veins in this region get affected. They swell as blood stagnates inside them. This causes discomfort while passing stool. The most obvious symptoms of piles are bleeding and pain at the time of excretion or passing of the stool. For most of the patients with piles, sitting or standing becomes a tedious task.

What causes piles?
The primary reason behind the occurrence of piles is a patient’s sedentary lifestyle. Most of it also depends on upon his or her diet intake. Many of us consume a lot of carbohydrates, fats and proteins in our regular meals. But, we forget or are simply reluctant to take up physical exercises. This, in turn, leads to increase in body weight and hampers the activity of our digestive system. As a result, patients develop diseases like piles.

Diet plays a vital role in preventing piles. If we don’t add an adequate amount of fibre or roughage to our diet, there is a potential threat of developing piles. Fibres help with the convenient evacuation of the stool. In fact, fibres form the bulk of the stool. Besides, insufficient intake of water may also cause this disease.

Natural ways to tackle Piles
Piles can be managed or tackled by bringing in some changes in our lifestyle. Some of the ways of managing piles have been listed below:

  1. Add more roughage and fruits to your diet
  2. Exercise regularly
  3. Avoid laxatives
  4. Sit in a tub of hot water to get relief from the pain
  5. Drink plenty of water

Homoeopathic treatment for Piles
When it comes to the treatment of piles, Homeopathy is quite safe and an effective method to get rid of the problem. It doesn’t have any side effect on the patient’s health. It doesn’t include any painful surgery for removal of piles. Moreover, homoeopathy is budget-friendly. Here are some effective homoeopathic medicines, useful in curing piles:

  1. Hamamelis: This medicine is useful in stopping the bleeding in piles. It can cure any venous congestion and bleeding. It can also be taken when the patient develops a feeling of soreness.
  2. Ratanhia: It gives relief from the pain due to piles. A patient suffering from piles feels immense pain and a burning sensation at the time of stool evacuation and even for hours after that.
  3. Graphites: It is prescribed to a patient suffering from both constipation and piles. It is given to them who are obese, have skin eruptions and constipation.
  4. Nux Vomica: It is given to patients who have a sedentary lifestyle, take spicy food and are active smokers and alcohol drinkers. Usually, patients who have been advised to take Nux Vomica are aggressive in nature. It cures piles as well as digestive disorders.

Things to remember: These medicines are only some of the homoeopathic remedies available in the market. It is best to consult a homoeopathic practitioner for the perfect treatment. 

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Know In Detail About Piles & Its Treatment!

Know In Detail About Piles & Its Treatment!

Are you feeling excruciating pain in the anal region? Is there a lump around the area that you can feel? Commonly called Piles, haemorrhoids, is a phenomenon where the blood vessels are inflamed or expanded in the anal canal. Veins in and around the anus and rectum are comparatively weak than the arteries which are quite intense. This is because the walls of the veins are pretty thin and pain or discomfort arises when there is too much pressure on the walls. There are two kinds of Piles the internal piles and the external piles; the discomfort and severity depend on the kind of piles you are suffering from.

Causes behind it - 
The causes of haemorrhoids are not certain and anyone can get affected by the condition. It is more prevalent in elderly people and pregnant women. Sometimes, the condition is also hereditary, so if your parents or grandparents suffered from piles, there is a possibility that you may develop it too. When the veins in the anal region are subjected to pressure, the veins swell causing painful haemorrhoids.

The common symptoms associated with the condition are:

  • Bleeding from the anus
  • Painful lump or swell near the anus
  • Anal itching
  • Tenderness or pain during bowel movements
  • Mucus Anal discharge

Treatment options for piles -
In a few cases, the Hemorrhoids can be treated with home remedies like a change in diet, warm sitz baths, and avoiding foods that may lead to constipation. For haemorrhoids of the first, second and third-degree, medications, home remedies and manual methods are preferred approaches. However, when the condition persists for an extended period with severe pain it is best to consider your physician.

The piles can be treated with:

  • Injection or sclerotherapy: Treats internal haemorrhoids
  • Banding: Treatment for prolapsed haemorrhoids
  • Coagulation: Treatment using laser
  • Surgery: Opted for in severe cases of haemorrhoids

Surgery is suggested when no other remedies for piles have responded. In the case of prolapsed haemorrhoids, or the fourth degree and higher degree, surgical methods need to be implemented. In common, surgery is deemed as the last option for piles treatment. Piles surgery is prescribed particularly by the surgeons in the situation where pain becomes unbearable.

The surgical treatments

  • Hemorrhoidectomy: This is the surgery done to remove piles. The physician performs a few minute cuts around the anus to remove them away. The area which is under operation is put under local or general anaesthesia. Hemorrhoidectomy is often a procedure for the outpatient case, and you are typically discharged on the same day itself. The patient usually takes about two to three weeks, to recover fully but then it can even take as long as five to six weeks to get back to normal pain-free life again.
     
  • PPHAnother surgical method is PPH. It is also known as stapled hemorrhoidectomy. In this surgery, the physician uses a device which looks like a stapler to reposition the pile and struck off their supply of blood so that they eventually shrink and die out. This surgical procedure is less painful than traditional hemorrhoidectomy as it removes haemorrhoid to where there are fewer nerve endings, so it hurts less. There will be faster recovery, few or no complications, minor itching, and bleeding.
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Piles - How Can Homeopathy Manage It?

Piles - How Can Homeopathy Manage It?

When a condition is painful, it is common to hate it. And, when the condition is the piles, you will hate it more, because, along with the pain it might embarrass you as well. Characterized by the enlargement of blood vessels that surround the anus, when the veins tend to swell towards the lower end of the rectum and anus, it is called piles. Swelling of the veins that are located within the rectum is called internal haemorrhoids. External pile is a condition where the veins towards the external part of the anal verge become swollen.

Symptoms that you may not fail to notice

  • Red blood spots on toilet paper, stools, or toilet bowl are a few symptoms of piles. This occurs when the pressure within the veins increases and causes them to tear and cause bleeding.
  • The patient also experiences pain during and after passing stools. This is due to inflammation of the veins that causes their swelling. The swollen veins apply strain on the muscles, cause spasms and is the reason for the discomfort that patients experience.
  • Persons suffering from piles may also face itching around the anal portion. The inflamed veins ooze mucous that gives rise to inflammation around the anus and causes itching.

Know the causes and how you can prevent it:

  • The primary cause for the piles is attributed to one factor which is heightened abdominal pressure.
  • Consequently, there is a build-up of pressure in the veins around the anus that causes the piles disorder.
  • The various causes for an increase in abdominal pressure are flatulence, constipation, obesity, sedentary lifestyle, diarrhea, pregnancy and sitting for prolonged durations.

What is the approach? 
Homeopathy serves as an effective cure for piles because it adopts a holistic approach. The homeopathic medicines are prescribed after studying the medical history of the patient and present physical condition. The person’s predisposition to illnesses is also scrutinized by the homeopaths.
Unhealthy lifestyle habits are recognized to be the reason for the bloating of the anal veins and piles symptoms. Hence, homeopathy aims to correct the underlying conditions that are causing discomfort.

Why homeopathy?
Homeopathy medications are considered effectual for alleviating the discomfort of the hemorrhoids by controlling the bleeding. Additionally, the treatment methods provide a permanent cure for the disorder because they address the underlying cause. The treatment is also focused on treating conditions that give rise to piles. And, there are no worries of side effects.

So, if you have been suffering from piles for a while now and seeking a definitive cure without side effects, you can very well opt for homeopathy under the able guidance of a homeopath practician.
 

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In Depth About Piles, Its Types, Symptoms & Important Facts!

In Depth About Piles, Its Types, Symptoms & Important Facts!

Hemorrhoidal diseases (also known as hemorrhoids and piles) are swollen veins in the walls of the anus and sometimes around the lower rectum. They may be termed as internal or external depending upon the anatomical position of origin.

Fast facts on hemorrhoids

  • The most common cause of painless rectal bleeding.

  • Pregnant women are more likely to suffer.

  • The likelihood of developing hemorrhoids increases with the advancement of age.

  • Regular physical exercise and healthy food habits can prevent hemorrhoids.

  • Medicines and surgery are needed to treat hemorrhoids depending on their clinical condition.

What causes hemorrhoids?

  • Low fiber diet does not form the bulk of the stool. This causes a person to strain while passing stool. Long-standing straining increases the pressure within the local blood vessels.

  • Pregnancy-associated hemorrhoids are likely due to the increased pressure of the enlarged uterus on the rectum and anus.

  • Prolonged sitting on the western toilet.

  • Obesity.

  • Long-standing diarrhea.

  • Advancement of age.

  • Previous rectal surgery.

  • Spinal cord injury

  • Colon cancer

  • Overuse of stool softeners.

  • Straining during micturition.

What are Internal and External Piles?

Internal piles normally lie inside the rectum. You usually can't see or feel these piles. They rarely cause discomfort. But long-standing straining during passing stool causes it to bleed and can push them through the anal opening. Internal piles are having four grades like grade 1 to grade 4.

External hemorrhoids are present under the skin around your anus. When irritated, external piles can itch or bleed.

Thrombosed hemorrhoids: Sometimes blood may pool in an external pile and form a clot that can result in severe pain, swelling, inflammation and a hard lump near the anus. Prolapsed, strangulated and inflamed piles are surgical emergencies and need immediate treatment.

What are the symptoms of hemorrhoids?

  • Painless rectal bleeding.

  • Swelling in and around the anus.

  • Soft mass coming out of the anus during passing stool.

  • Anal itching

  • Mucus discharge.

  • Sometimes the swellings are inflamed causing severe pain.

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Precautions To Avoid Haemorrhoids!

Precautions To Avoid Haemorrhoids!

Haemorrhoids are enlarged and elongated rectal veins and during defecation causes bleeding. Some precautions can avoid haemorrhoids to bleed. The fissure is ulcer and fistula discharging tract in that area.

The Precautions are -

1. Avoid prolonged sitting and continues travelling.

2. Take care of constipation that will minimise pressure on haemorrhoids.

3. Avoid spicy, and non vegeterian diet.

4. Keep regular eating habits with vegetarian fibrous fresh diet.

5. Eat fruits, salads as much as possible.

6. Take plenty of oral fluids and water.

7. Keep milk and milk product like curd and buttermilk in the diet regularly.

8. If any symptoms like burning, pain, bleeding, discharge or itching is seen then take consultation because these symptoms when neglected may increase the disease.

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Piles - How To Tackle Them?

Piles - How To Tackle Them?

Piles or haemorrhoids are swollen veins in the rectum or anus. They can have a lot of possible causes, but the exact reason is still unknown. The one most common reason that researchers cite is the excessive straining during bowel movement and increased pressure on the veins during pregnancy. Some of the common signs of this condition include discomfort, bleeding, and itching. A clot can be witnessed occasionally. There could be swelling around the anus as well.

How is a pile diagnosed?
Doctors often recognize this condition just by doing a physical exam of the rectum. By lubricating the glove and inserting a finger into the rectum, a doctor can gauge any unusual growth around the rectum area. A doctor might also use a sigmoidoscopy or a proctoscopy to witness the lower portion of the colon. Apart from this, a doctor might prescribe a colonoscopy, if he fathoms that there is a possibility of colorectal cancer or a disease related to the digestive system.

Treatment of piles

  1. Medication: In case of mild discomfort, a doctor might prescribe over-the-counter pads, ointments, creams or suppositories. Products such as these contain lidocaine, witch hazel or hydrocortisone that can relieve a person from itching and pain. One should stop consuming over-the-counter medicine, if there is no change in the condition.
  2. Haemorrhoid thrombectomy: If a clot has appeared along with a pile in the rectum, a doctor can remove it by making an incision and draining the clot. This can fetch instant relief. The best time to do this is within 72 hours of clot formation.
  3. Minimally invasive procedures: 
    • Rubber band litigation: This form of surgery involves placing a couple of rubber band at the base of the piles to cut off blood circulation. In due course, the haemorrhoids fall off. Although this form of treatment works for many people, the patient has the risk of bleeding within a few days of placing the rubber band.
    • Sclerotherapy: This form of treatment involves injecting a chemical into the haemorrhoid. The chemical shrinks the piles within a few days. There is hardly any pain involved with sclerotherapy.
  4. Surgical procedure:
    • Haemorrhoidectomy: This is the process by which a surgeon eradicates the excess tissue that might be causing the piles. The patient is sedated before performing this procedure. Some amount of pain is experienced after the procedure is over. The temporary difficulty of urination can be faced by a patient after this procedure.
    • Stapled hemorrhoidopexy: This surgery is only performed for internal haemorrhoids. The process involves blocking the blood supply. The process of stapling has less pain compared to a Haemorrhoidectomy. On the flip side, studies have shown that this procedure has an increased chance of recurrence of haemorrhoids.
       
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Internal Hemorrhoids - How To Get Rid Of Them?

Internal Hemorrhoids - How To Get Rid Of Them?

Hemorrhoids or piles are diagnosed by swelling of veins in the lower part of anus and rectum. Due to swelling, the walls of rectum and anus are stretched and thus become irritated. Hemorrhoids are of two types: Internal and External hemorrhoids.

Internal Haemorrhoids: As the name suggests, the piles are not visible from outside. These are present deep inside the rectum, located above the pectinate line and these are covered with the cells that are present through the rest of intestines. Internal hemorrhoids are normally painless. The first sign of internal hemorrhoids is rectal bleeding. However, straining can push internalhemorrhoid and it protrudes through the anus and this can be painful.

Causes of Haemorrhoids
The swelling of hemorrhoid occurs only when the pressure in the small vessels of rectum and anus is increased and is engorged with blood. The size of the hemorrhoids is also increased. The increased pressure may be due to various factors:

  • Consuming low fiber diet and pushing or straining while passing stools, thus blood vessel pressure is increased.
  • Pregnancy also is a cause of swelling as there is the increased pressure of the uterus on rectum and anus.
  • Sitting for long on toilet also increases pressure.
  • Obesity is also a cause of hemorrhoids.
  • People suffering from diarrhea, both acute and chronic.
  • A person having colon cancer might have hemorrhoids.

Signs and Symptoms of Haemorrhoids:

  • The most common symptoms of hemorrhoids are painless bleeding, itching in anal, swelling and feeling of the presence of lump at the anus.
  • All these symptoms are associated with inflamed hemorrhoid.
  • Inflamed internal hemorrhoid can cause swelling, but is painless as there are no fibers attached to veins above the pectinate line that cause pain. However, passing hard stools can scrape off the thin lining of hemorrhoid, which can cause the painless bleeding.
  • Spasms of the rectum and anal muscles caused by these swollen hemorrhoidscause pain, especially when they are protruded through the anus.
  • Internal hemorrhoids can form a clot or thrombose resulting in severe pain.
  • The presence of inflammation, stool, and constant moisture and these can lead to itching and burning sensation in the anus among patient of internal hemorrhoid.

Treatment of Haemorrhoids

  • Diet: Haemorrhoids can be treated when individuals consume a fiber-rich diet in order to soften the stools and ease their bowel movements. Fiber-rich foods include fresh fruits, dry fruits, grains, vegetables, and cereals. About 20 to 30 grams per day of fibrous foods is recommended. Dietary fiber will help create bulk in the intestines which will help in softening of stools and ease bowel movement. Supplemental fiber available in the marketincludes psyllium husk, methylcellulose, and calcium polycarbophil. Other recommendations include increased intake of liquids and having stool softeners. Drinking enough water and liquids will prevent stool from hardening.
  • Over-the-counter topical treatment: There are various products available to treat hemorrhoids, such as gels, hydrocortisone creams, ointments, foams, pads, and suppositories.
  • Home remedies: Soaking anus in a warm sitz bath might also help in hemorrhoids for about 10 to 15 minutes per day. One should practice good hygiene and clean anus with warm water while showering. Avoid using soap and dry toilet paper. One can also use a cold compress on the anus.

Minimally Invasive Procedure for Hemorrhoids (MIPH)

Out of the various types of medical and surgical interventions available to treat Piles, Minimally Invasive Procedure for Hemorrhoids (MIPH) 0r painless stapler surgery is known to be very popular since it acts an alternative approach to surgical interventions made for piles.

MIPH is defined as a minimally invasive surgical technique in which a band of loose or prolapsed mucosa and sub mucosa in the rectum is excised, proximal to the piles and disrupted mucosa is fixed by ‘stapled end to end mucosal anastomosis.

This will ultimately occlude the blood supply to the superior hemorrhoidal artery above the hemorrhoidal tissue, resulting in the retraction of prolapsed mucosa back to its original anatomical position. A special circular stapler known as PPHO3 is used in the anastomosis and the whole maneuver will take around 30–45 minutes.

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