Piles, also known as hemorrhoids, are a common but often misunderstood condition. While many cases can be treated with lifestyle changes and medications, more advanced stages may require surgical intervention. Understanding the stages of piles, or the grades of hemorrhoids, is essential to determine when surgery might be necessary. In this blog, we will explore the hemorrhoid grading system, explain the criteria for piles surgery, and guide you on when to consult a doctor for persistent or severe symptoms.
Understanding the Four Grades of Hemorrhoids
The hemorrhoid grading system helps classify the severity of piles and guides the best course of treatment for each stage:
- Grade 1 Hemorrhoids: Mild symptoms, no prolapse. These may cause itching, discomfort, or minor bleeding during bowel movements but remain inside the anal canal.
- Grade 2 Hemorrhoids: Prolapse during bowel movements, retract spontaneously. These may protrude from the anus while straining but go back inside on their own.
- Grade 3 Hemorrhoids: Prolapse and require manual repositioning. These are more painful and require pushing back into the anal canal.
- Grade 4 Hemorrhoids: Permanently prolapsed, cannot be pushed back. Often accompanied by severe discomfort, bleeding, and risk of thrombosis or infection.
Internal vs External Hemorrhoids Stages
- Internal hemorrhoids occur inside the rectum and follow the grading system mentioned above.
- External hemorrhoids develop under the skin around the anus and are typically more painful, especially if thrombosed (clotted).
Both internal and external piles can become prolapsed and may require surgical treatment depending on their severity and symptoms.
Related Post
Top Post
Treatment for Piles by Stage
Non-Surgical Treatment for Early Stages
Grade 1 and Grade 2 Hemorrhoids usually respond well to conservative treatments:
- High-fiber diet
- Increased water intake
- Sitz baths
- Over-the-counter ointments and suppositories
- Prescription medications like topical steroids or flavonoids
These stages typically do not require surgery unless symptoms persist or worsen.
Surgical Treatment for Advanced Hemorrhoids
When conservative management fails, especially for Grade 3 and Grade 4 hemorrhoids, surgery becomes the recommended treatment. These stages often involve persistent pain, bleeding, and prolapse that significantly impact quality of life.
When Is Surgery Needed for Piles?
Here are the common piles surgery indications and criteria:
- Hemorrhoids that cause daily bleeding despite treatment
- Prolapsed hemorrhoids that do not respond to non-surgical options
- Grade 3 hemorrhoids surgery: When manual repositioning becomes frequent and uncomfortable
- Grade 4 hemorrhoids surgery: Permanently prolapsed and irreducible, often with pain or clots
- Hemorrhoidectomy for grade 3 or 4 hemorrhoids: Recommended for long-term relief
- When conservative management fails: No relief despite weeks of medications and lifestyle changes
- Persistent pain, itching, or fecal soiling
Common Surgical Options for Hemorrhoids
- Hemorrhoidectomy: Complete surgical removal of hemorrhoids. Often used for grade 3 or 4 hemorrhoids.
- Stapled Hemorrhoidopexy: Removes a ring of tissue to reduce blood flow and reposition the hemorrhoids.
- Laser Surgery for Piles: Minimally invasive, quicker recovery, less bleeding.
- Rubber Band Ligation: For grade 2 or early grade 3 hemorrhoids.
When to Operate Piles: Key Decision Factors
- Recurrent prolapse
- Severe or chronic bleeding
- Failure of outpatient treatments
- Complications like thrombosis, infection, or strangulation
- Patient's quality of life significantly affected
A personalized consultation with a piles specialist doctor in Indore can help determine the best time to proc