When Does Piles Require Surgery? Insights By Dr. Suprashant Kulkarni

What Is Piles?

Piles, also known as hemorrhoids, occur when the blood vessels near the anus become swollen. This often results from repeated straining during bowel movements or due to passing hard stools. Dr. Suprashant Kulkarni explains that these swollen vessels are commonly referred to as piles. However, it's important to note that other conditions such as fissures (tears), abscesses, fistulas, or even cancer can also cause similar symptoms in that region.

How Is Piles Classified?

The treatment plan for piles depends heavily on its classification. Dr. Kulkarni outlines four grades:

• Grade I: The hemorrhoids are internal and only cause bleeding. They do not protrude outside the anus.
• Grade II: The hemorrhoids may protrude during defecation but go back inside on their own.
• Grade III: The hemorrhoids protrude and need to be manually pushed back inside.
• Grade IV: The hemorrhoids remain permanently outside and cannot be pushed back in.

This classification helps determine the severity of the condition and whether surgical intervention is needed.

Initial Approach To Treatment

According to Dr. Kulkarni, the first line of treatment for all patients is conservative. This includes dietary modifications and lifestyle changes. Patients are advised on a fiber-rich diet and proper bowel habits. Only if these measures fail does surgery become an option.

When Is Surgery Needed?

Surgery is rarely the first step. Only about 5–10% of cases require it. Dr. Kulkarni mentions that surgical treatment is typically recommended in the following scenarios:

• Patients with Grade IV piles
• Patients with severe Grade III piles
• When conservative methods and lifestyle changes do not provide relief

In such cases, surgery becomes essential for long-term relief and to prevent complications.

FAQs

1. What causes piles to develop?
Repeated straining during bowel movements and chronic constipation are the most common causes.
2. Are all piles cases treated with surgery?
No, only 5–10% of cases, usually Grade III or IV, need surgery.
3. What are the symptoms of Grade I piles?
They are internal and primarily cause bleeding without any visible protrusion.
4. Can lifestyle changes help manage piles?
Yes, dietary adjustments and improved bowel habits are the first steps in management.
5. How do I know what grade of piles I have?
A medical examination is necessary to classify the grade accurately.
6. Is Grade II piles serious?
Not necessarily. If the hemorrhoids retract on their own, they can often be managed without surgery.
7. What should I do if conservative treatment fails?
Consult a specialist to evaluate if surgical intervention is required.