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All Piles

Piles in Men – Causes, Symptoms, Diagnosis and Treatment

As cushions around the anal canal, hemorrhoids are a normal component of the human anatomy and help in controlling bowel movements. They do, however, consist of many blood vessels. Excessive straining can cause them to swell and become annoying. This can lead to symptoms like bright red blood when one goes to the toilet, lumps around the anus, discomfort, and itching. 

Men are more likely to have it than women, especially those over 50.

Piles formation may result from straining while using toilets or from overexerting it when working out, but there are many options for relief and treatment. Piles in men can be initially treated with over-the-counter drugs and home remedies; however, surgery becomes necessary later.

Piles/ Hemorrhoids can affect both men and women, and it is predicted that three out of every four of us will have piles at least once. 

What Are Piles in Men and How do Men get piles?

The hemorrhoidal cushions, which are made of spongy tissue and fed with blood vessels, line our anus and help in its closure. While these are normal, they occasionally tend to develop into piles, particularly if blood accumulation causes them to enlarge. Piles are typically shaped like little, spherical, discolored lumps. These may be felt on the surface of the anus or hanging down from the anal opening.

What are the different types of piles in men?

Piles can be classified based on their location, the severity of symptoms, and the pathology that contributed to their development. Different types of hemorrhoids that affect males are: 

  • Internal piles are found deeper within the anal canal, and the patient usually complains of bright red bleeding when using the restroom. Bleeding is painless.
  • External piles, on the other hand, are those that develop closer to the surface of the anus and are frequently extremely sensitive and painful. These could feel like lumps close to the anal opening. 

A man can potentially have both internal and external hemorrhoids at the same time. 

  • Prolapsed piles are internal hemorrhoids that have come out of the anal opening and become noticeable. These are quite painful at times.
  • Thrombosed piles, which are typically external hemorrhoids with blood clots formed, are also frequently extremely painful.

Grading of Internal Piles in Men: 

Internal piles in men are graded on a four-point scale by proctologists.

  • Grade 1 refers to small swellings on the anal canal’s inner lining. From outside the anus opening, they are not apparent and cannot be felt or seen. When a fellow tries to defecate, he complains of painless bleeding. 
  • Grade 2 is more severe. When someone strains to defecate, they protrude from the anus, but they go back inside on their own. 
  • Grade 3 comes out of the anus and will not return unless the fellow pushes them back in with physical force.
  • Grade 4 prolapses and hangs there permanently, making it impossible for a fellow to push them back inside. 

Causes & Symptoms of Piles in Males

What causes piles in men? / Causes of Piles in Men

Some common causes of piles in men are listed below.  They are closely associated with elevated pressure in the anal tissues and blood vessels. 

  • Straining and constipation: Excessive straining on the toilet is a common cause of hemorrhoids in men. There are two reasons for this. One reason is that prolonged sitting on the toilet relaxes the anus, which opens the door for blood to enter the hemorrhoids. Second, straining, which is frequently brought on by constipation, can put too much strain on the veins and blood vessels surrounding the anus, causing them to swell up and bleed.
  • Inadequate dietary fiber: Hemorrhoids in men are frequently caused by a diet deficient in fiber. A man who is low in fiber is much more likely to experience constipation and overstrain himself on the toilet, as fiber helps to keep tools softer.
  • Obesity: It should come as no surprise that being overweight can increase the risk of developing piles because it puts strain on the blood vessels, which is a common cause of hemorrhoids.
  • Prolonged Sitting: Sitting for extended periods may increase the risk of piles.
  • Heavy Lifting: Men who lift large, heavy objects regularly run the risk of piles developing. This is due to the possibility of anal vein inflammation caused by the strain of lifting large weights.
  • Aging: A man’s body’s tissues, particularly those in the rectum and anus, weaken with age, increasing his risk of hemorrhoids.
  • Hereditary factors: Some people may inherit a weakness of the wall of the veins in the anal region.
  • A persistent cough
  • Increased anal tone

What are the symptoms of piles in men?

The following lists some typical signs of piles in men that are simple to recognize:

  • Bleeding During or After Bowel Movements: Hemorrhoids can cause spontaneous bleeding during or after bowel movements.
  • Lump around the Anus: An internal hemorrhoid may feel as if something is coming out from the anal opening that goes in on its own or requires manual pushing back. If it is an external hemorrhoid, there might be a lump or swelling associated with the anal opening.
  • Itching and Burning in the Anal Area: The anal area may experience burning or itching due to swollen veins.
  • Feeling of Incomplete Bowel Movement: Hemorrhoids may restrict the normal passage of stool and result in the feeling of an incomplete bowel movement.
  • Some discomfort While Sitting: Pressure on the enlarged veins in the rectum and anus may cause pain while sitting.
  • A slimy mucus discharge from the anus that might stain the undergarments, if it is a prolapsed hemorrhoid,

These symptoms can differ greatly from person to person. In addition to piles, other conditions like colon cancer, anal cancer, inflammatory bowel disease, and anal fissures (tears) may also be the cause. Therefore, do not assume that piles are the cause of any symptoms you may be experiencing; instead, seek advice from a nearby proctologist.

Piles Diagnosis in Males

You should consult with a qualified proctologist physician if you are experiencing any of the above symptoms. Based on the patient’s medical history and physical examination, a skilled proctologist can identify piles in men. By looking closely at the region surrounding the anus, he can recognize external hemorrhoids. But to recognize internal piles in men, the proctologist will perform a digital rectal examination and may opt to look inside the rectum and anal canal using techniques like sigmoidoscopy, colonoscopy, and anoscopy.

What Is the Treatment of Piles in Males? / Piles Treatment in Males

In most cases, piles in men can be cured without the need for medication or other treatments. There are several non-surgical ways to treat piles.

Home Remedies for Piles in Men

Home remedies are helpful methods for managing piles. A few natural remedies consist of:

  • Sitz Bath: This healing method involves sitting in a warm tub of water. It decreases burning and itching in the pelvic region.
  • Aloe Vera Oil: It decreases burning and itching from piles because of its inherent anti-inflammatory properties. You only need to gently massage the affected area with a small amount of aloe vera oil.
  • Coconut Oil: Like Aloe Vera oil, coconut oil can be rubbed into the anal passage to ease burning or itching sensations.

Food Modifications for Piles in Men

Another way to lessen the likelihood of piles is with food. You could do the following:

  • High-fiber foods: Eating foods high in fiber can help soften stools and ease constipation, both of which comfort hemorrhoids in men. Whole grains, legumes, fruits, vegetables, nuts, seeds, and bran are some of these foods.
  • Vitamin C: An antioxidant that can potentially strengthen blood vessels, lower inflammation, and improve immune system performance. It can also lessen the symptoms of hemorrhoids. Vitamin C-rich foods like broccoli, bell peppers, and citrus fruits are excellent additions to your diet.
  • Flavonoids: Plant compounds found in foods high in flavonoids can strengthen blood vessels and lower inflammation, which may help in piles symptoms. These foods include dark chocolate, berries, and citrus fruits.
  • Probiotics: Eat curd as part of your diet for probiotics. It has beneficial bacteria that can regulate bowel movements and enhance gut health, which can lower the risk of constipation and piles symptoms.
  • Limit Red Meat: Red meat is difficult to digest and exacerbates the symptoms of piles; instead, choose other forms of protein.
  • Avoid Processed Foods: Processed foods often contain high amounts of unhealthy fats, salt, and sugar, which can aggravate the condition by causing inflammation, digestive troubles, and other health problems. Avoid these foods to manage the symptoms of hemorrhoids.

Lifestyle Changes for Piles in Men

By making lifestyle modifications, hemorrhoids can be kept from getting worse. Hemorrhoids can be effectively relieved with these non-surgical methods. A few modifications consist of:

  • Stay Hydrated: It’s advised to maintain hydration to soften stool and facilitate bowel movements, which will lessen pressure and strain on the afflicted veins and help heal hemorrhoids.
  • Exercise: Engaging in regular exercise helps enhance blood flow throughout the body. It relieves constipation, which can play a role in the emergence of hemorrhoids.
  • Use a donut pillow or a cushioned seat pad: Certain activities, like sitting, may be particularly challenging for someone who has external hemorrhoids. Therefore, using a donut pillow or cushioned seat pad will be very beneficial.
  • Do not strain when you go to the toilet
  • Do not sit for a long time for defecation

Over-the-counter medicines for Piles in Men:

  • A fiber supplement like ispaghula husk or mild laxatives like Triphala or Haritaki powder can soften a man’s hard-to-pass stool.
  • Painkillers available over-the-counter, like paracetamol, may help reduce pile-related discomfort. Avoid taking opioid-containing painkillers, such as codeine, as they may exacerbate your constipation issues.
  • Pain and itching from piles may be reduced with the use of suppositories, ointments, and soothing creams. A wide variety of products are offered over the counter. Use these for no more than a few days at a time as they may cause skin sensitivity.

Non-Surgical Treatment for Piles in Men:

Non-surgical treatments for hemorrhoids may be explored if home remedies and medication fail to provide relief. These consist of:

  • Sclerotherapy: The hemorrhoid is injected with a liquid known as a sclerosant, such as Phenol in oil, which reduces the blood supply and causes the hemorrhoid to shrink. This results in a fibrotic reaction that scars and obliterates the blood vessels that supply the piles. In piles of Grade 1 and early Grade 2, it is advised.
  • Rubber Band Ligation: This technique involves ligating the hemorrhoid’s root with a rubber band that causes tissue death. As a result, piles start to collapse. For piles of grades 2 and 3, banding is the most used pile treatment.
  • Electrotherapy: This involves shrinking the hemorrhoid with an electrical current after it eventually falls off. Heat energy is used in diathermy and electrotherapy to destroy the piles. They seem to be as successful as infrared coagulation, and there is little chance of complications.
  • Infrared Coagulation: This technique uses infrared light to shrink the hemorrhoid. Using infrared light to burn and cut off the hemorrhoid’s circulation, this pile treatment technique reduces the hemorrhoid’s size. For first- and second-degree piles, it may be just as successful as injection sclerotherapy and banding treatment.
  • Kshar Karma Treatment for Piles in Men: This treatment involves applying a unique ayurvedic medication called Kshara in the anal passage at the location of pile masses. The application of Kshar causes the pile mass to decrease and the bleeding to stop. For males with first- and early- 2nd stage internal hemorrhoids, kshar karma treatment is recommended.

Surgical Treatment of Piles in Men

Surgery may be indicated for hemorrhoids if non-surgical treatments are ineffective. Hemorrhoids in men can be treated surgically using a variety of techniques, including:

  • Hemorrhoidectomy: This procedure removes prolapsed internal or external hemorrhoids. When banding or other methods fail to treat a grade 3 or 4 pile, surgery to remove the hemorrhoid(s) may be the only viable option. General anesthesia is used during the procedure. It can, however, be extremely painful in the days that follow the procedure.
  • Stapled Haemorrhoidectomy: Internal hemorrhoids are either pulled back into the anus or removed completely using a stapling instrument. Above the piles, a circular section of the anal canal lining is removed using a circular stapling gun. As a result, the piles are drawn back up in the anal passage.
  • Hemorrhoidal Artery Ligation: By cutting off the hemorrhoids’ blood supply, this minimally invasive treatment causes the hemorrhoids to shrink and eventually fall off. Under the guidance of ultrasonography, the small arteries supplying blood to the piles are tied or ligated.
  • Laser Surgery: To reduce the size of hemorrhoids, a surgeon uses a laser to cut off their blood supply. 
  • Ksharsutra Treatment for Piles in Men: The Ksharsutra treatment involves ligating a specialized medicated thread at the base of the pile mass. It causes the pile mass to stop receiving blood, which causes it to shed off in a week or ten days. Men with late second, third, and fourth stage internal piles are advised to undergo Ksharsutra treatment.

Why should you not delay piles treatment in men? Or Complications of Delayed Piles Treatment in Men:

Men tend to keep their medical conditions to themselves, avoid talking about their problems, and pass off their discomfort as momentary discomfort. Delaying treatment for male piles can lead to complications, however. If hemorrhoids are not treated promptly, they can result in problems like:

  • Masses of tissue hang out on the skin
  • Advancement of disease from Grade I to Grade IV
  • Rectal prolapse can be the result of continuous pressure during stools.
  • Worse Pain: Postponing pile treatment may result in worsening pain, itching, and discomfort in the affected area.
  • Excessive Bleeding: Untreated hemorrhoids can swell and become more inflammatory, which increases the risk of bleeding and anemia.
  • Extended Healing Period: Hemorrhoids that are not treated for a longer time may require a longer healing period for the affected area.
  • Thrombosis: If left untreated, hemorrhoids may thrombose, forming a blood clot inside them. This may result in extreme discomfort and require more intensive treatment.
  • Risk of Infection: Hemorrhoids have the potential to get infected leading to more pain, discomfort, and possible complications.
  • Effects on Quality of Life: Hemorrhoids can make it difficult to perform regular tasks like walking, sitting, and working out. Delaying treatment can have a lasting impact on one’s quality of life.
  • Need for Surgery: More invasive treatment options, like surgery, might be required to relieve hemorrhoids’ symptoms if they go untreated for a long time.

Prevention of Piles in Men

Early detection is key to preventing the condition’s progression and worsening of piles in men. Below are some strategies to avoid piles:

  • Healthy Food: Eating a diet high in fiber can help regulate bowel movements and prevent constipation, which helps maintain soft stool and prevent piles.
  • Weight management: By eating a balanced diet and getting regular exercise, one can reduce the strain on the veins in the rectum and anus and minimize the chance of getting hemorrhoids.
  • Active Lifestyle: Regular physical activity lowers the risk of hemorrhoids by improving blood flow and preventing constipation.
  • Avoid straining while passing stool. This can cause hemorrhoids by putting pressure to the veins in the rectum and anus.
  • Refrain from Heavy Lifting: Hemorrhoids can result from lifting heavy objects, which can put pressure on the veins in the rectum and anus. It’s important to lift objects safely and to avoid picking up too heavy objects.
  • Stay hydrated by drinking lots of liquid and minimizing caffeinated beverages like tea and coffee.

FAQs about Piles in Men

Both men and women frequently have piles. However, males are more likely than females to develop piles, based on certain medical research.

Piles or hemorrhoids are common in people 45 to 65 years of age. However, an unhealthy diet and lifestyle can also cause piles to develop in younger boys and men.

No, piles do not cause cancer and are not carcinogenic.

Foods to avoid during piles include

  • Fast food,
  • Spicy food,
  • Processed food,
  • Red meat,
  • Caffeinated beverages, and
  • Alcohol.

The duration of piles symptoms in men is not pre-determined. However, it is advised to consult an experienced proctologist for further advice if the symptoms haven’t gone away after a few days. Get in touch with Piles To Smiles for a consultation with one of our qualified proctologists.

Typically, piles in men resemble tiny, discolored lumps. They may feel like they are hanging down from the anal canal or on the anus.

When you experience symptoms such as blood before, during, or after passing stool, pain, or discomfort in the anal area, or if over-the-counter medications are not providing relief for your piles, you should consult a doctor.

Enlarged blood vessels called piles can form inside or outside the anus and rectum in males. They are the most prevalent anorectal disorder. They may result in rectal bleeding and be uncomfortable and painful with a feeling of something coming out from the anal opening.

The following are the main reasons why men get piles:

  • Constipation;
  • Straining;
  • Inadequate consumption of fiber
  • Lifting heavy weights
  • Prolonged periods of time spent on the toilet

Some of the common symptoms of piles in males are:

  • Bleeding
  • Feeling of something coming out from the anal opening during defecation.
  • Painful swelling near the anal opening
  • Itching
  • Pain
  • Sticky discharge from the anus
  • Discomfort while sitting

Certain home remedies can help lower the chance of piles developing. These include

  • Avoid constipation,
  • Eat a diet high in fiber,
  • Drink lots of liquids,
  • Abstain from alcohol, and
  • Avoid straining and prolonged sitting on the toilet seat.

A person with piles may try a variety of natural cures or even take the prescription drugs that his doctor has recommended. These options do not provide a permanent cure for piles, they only serve to prevent them from getting worse.

One of the most common misconceptions is that piles go away on their own. Over time, these will only get worse. Therefore, it is always advisable to treat Piles as soon as possible to prevent getting worse, avoid complications, and enable convenient treatment.

Ayurvedic piles treatment is the best treatment for Piles in men. The benefits of Ayurvedic treatment are:

  • Non-surgical/ minimal surgical treatment
  • Minimal blood loss
  • No stitches
  • Quick recovery
  • Improved Quality of Life
  • Cost Effective Treatment
  • No Hospitalization
  • No Bed Rest

Myth: Only older men get piles.

Fact: It is true that piles is more common in older men, but piles is not limited to this age group. Young males and boys who are sedentary and consume more junk food and less fiber may develop piles.

Although blood on toilet paper, blood dripping in the toilet, or blood on the surface of your feces are signs that you may have piles, piles do not always cause pain or other symptoms. You may feel some swelling on your anus or something protruding from the anal canal. These are just some of the symptoms of piles.

Categories
All Fissure Fistula

Can a Fissure Turn into a Fistula?

Two prevalent disorders that affect the anal region and cause discomfort and misery to people are fissure and fistula. Despite their similar sounds, these are two different illnesses with different causes, symptoms, and modes of treatment. There is a link between the two, though, which that raises the question: Is it possible for a fissure to become a fistula? To fully understand this, we need to know more about the traits of these illnesses, how they relate to one another, and their potential causes. As the best proctologist in Delhi NCR, Dr. Ravinder Sharma can offer you a thorough diagnosis and treatment for these ailments. In addition, he may address any query you might have regarding the connection between fissure and fistula.

Understanding Anal Fissure

An anal fissure is a tiny tear or cut in the lining of the anus that is usually brought on by trauma during bowel motions. All ages are affected by this widespread ailment, although adults are more likely to have it. The most common symptom of anal fissure is pain during or after bowel motions. Consequently, bright red blood frequently appears in the stool or on toilet paper. Itching, burning, or discomfort in the anal area are possible additional symptoms.

An anal fissure may occur suddenly or gradually. When given the right care and attention, acute fissure typically heals on their own in a few weeks, but Chronic fissure lasts longer and may require medical care.

Anal Fissure Causes

Anal fissure are caused by several factors:

  • Constipation: One condition that can lead to anal fissure is constipation, which induces straining during bowel movements.
  • Diarrhea: Prolonged diarrhea can irritate the vulnerable anus tissues, increasing the risk of fissure.
  • Trauma: Anal injuries, such as those sustained during childbirth or anal sex, can result in fissure.
  • Inflammatory Bowel Disease (IBD): Because of inflammation and damage to the intestinal lining, conditions including Crohn’s disease and ulcerative colitis can cause anal fissure.

Anal Fissure Treatment

The objectives of anal fissure treatment are to reduce discomfort, encourage healing, and stop recurrence. It might consist of:

  • Dietary changes: Eating more fiber and drinking enough of liquids will soften stool, facilitating easier bowel movements and lessening anorectal strain.
  • Topical medications: lidocaine-containing over-the-counter lotions or ointments/ other soothing ointments help lessen inflammation and pain. 
  • Sitz baths: The sphincter muscles can be relaxed and blood flow to the area enhanced by bathing the anal area several times a day in warm water for 10 to 15 minutes. This aids in the healing process. 
  • Medication: To aid with healing and relaxing the anal sphincter, a fissure specialist doctor may prescribe medications such as calcium channel blockers and nitroglycerin ointments. 
  • Surgical intervention: Injections to paralyse internal sphincter or a lateral internal sphincterotomy are two surgical procedures that may be explored if conservative methods are ineffective in treating persistent fissure. 
  • Kshar Karma Treatment for Fissure: When Fissure-in-Ano is in its acute stage, the recommended course of treatment is Kshar Karma and manual dilation of the sphincter muscles (preferably done by the patient; if it fails to relieve the spasm, then by an expert proctologist). Be extremely careful when performing this procedure to prevent overstretching the sphincter muscles. Kshar Karma is applying Kshar, a specific type of Ayurvedic medication, to the area of the fissure. This medication promotes healing and debrides the fissure.
  • Ksharsutra Treatment for Fissure: When the sentinel tag develops and Fissure-in-Ano has become more chronic, an Ayurvedic proctologist recommends Ksharsutra therapy. The ligation of a specialized medicated thread, called Ksharsutra, at the sentinel tag’s root is the treatment. Within a week or ten days, the sentinel tag sheds as a result of the blood supply being cut off. The patient can go home the same day following treatment since this is an OPD procedure. Typically, the patient can do his regular activities as usual during treatment without the need for hospitalization or bed rest.

Understanding Anal Fistula

An irregular tunnel or route that develops between the skin around the anus and the anal canal is called an anal fistula. It typically arises because of an anal abscess, a pus-filled mass in the tissues around the anus. A fistula may develop from a passage that does not heal properly following an abscess burst or is evacuated.

Anal Fistula Symptoms : 

Anal fistula symptoms might differ in severity and location. Typical signs and symptoms include:

  • Chronic pain in the anus
  • Bulges or swelling close to the anus
  • Blood or pus oozing from the anus aperture
  • Recurrent lesions in the anus
  • Rashes or itching near the anal orifice

Anal fistula causes

An infection in the anal glands, which are tiny glands found inside the anal canal, is usually the cause of anal fistula. These glands have the potential to develop an abscess, which may ultimately result in a fistula if they get clogged or infected. Other elements that raise the possibility of an anal fistula are as follows:

  • Crohn’s disease: People who have Crohn’s disease are more likely to develop anal fistula because of their persistent inflammation and intestinal lining damage.
  • Previous anal surgery: Anal glands or surrounding tissues may sustain unintentional injury from surgical operations like hemorrhoidectomy or fistulotomy, which can result in fistula.
  • Trauma: Anal fistula risk can also be raised by injuries to the anal region, such as those sustained during childbirth or anal intercourse.

Anal Fistula Treatment

The location, degree of complexity, and underlying etiology of anal fistula determine the course of treatment. It may involve:

  • Antibiotics: Antibiotics may be administered to treat an infection if an anal fistula is linked to an abscess or infection.
  • Surgical intervention is used to treat anal fistula. To preserve sphincter function and reduce the chance of recurrence, surgery eliminates the fistula tract along with any related infected or damaged tissue. A variety of surgical methods, including advanced flap repair, fistulotomy, fistulectomy, and seton placement, may be used.
  • Ksharsutra Treatment for Fistula: A medicated thread called Ksharsutra is inserted into the fistula tract as part of this treatment, and it is replaced every week or ten days until the fistula heals fully. This procedure is performed by the Ksharsutra expert. Since this is an OPD treatment, bed rest or hospitalization is typically not necessary for the patient. The patient can go about his everyday activities as usual while receiving treatment. 

Fistula-in-Ano complications such as recurrence or stool incontinence are not observed in the Ksharsutra treatment. 

Can a Fissure Turn into a Fistula?

After discussing the characteristics of anal fissure and fistula, we can now answer the query: Is it possible for a fissure to develop into a fistula? Although anal fissure and fistula are two different disorders, there may be a relationship between them.

Small anal fissures seldom become anal fistula in the absence of any underlying issues. However, the likelihood of complications like abscess and fistula may rise in cases of persistent or untreated fissure, particularly those linked to underlying diseases like Crohn’s disease. Anal tissue damage and chronic inflammation can delay recovery and put people at risk for fistula.

Surgical procedures like lateral internal sphincterotomy for chronic anal fissure can also enhance the chances of the development of fistula. This emphasizes how crucial it is to properly assess and treat anal fissure to avoid complications and encourage healing. 

Conclusion

There may be a relationship between anal fissure and fistula, even though they are treated and caused differently. Anal fistula risk may be raised by untreated or chronic fissure, as well as by some underlying medical disorders. Adequate diagnosis, treatment, and aftercare are critical for the proper management of both disorders and the avoidance of complications. If you have symptoms of an anal fissure or fistula, it is highly recommended that you consult the best fistula doctor in Delhi NCR for an evaluation and appropriate treatment.

Categories
All Piles

Kegel Exercises for piles

What are Hemorrhoids/ Piles: 

Hemorrhoids is a disease that affects almost 75% of people at some point in their lives. These are abnormally enlarged vascular mucosal cushions in the anal canal. These mucosal cushions help us to maintain anal continence but when they become swollen, enlarged, and start to cause symptoms, then they become hemorrhoids, more commonly known as Piles.

What Causes Piles?

Piles can occur randomly/ progressively over time, and they can happen to anyone; male or female, young or old. Factors that may increase the chances of getting hemorrhoids include:

  • Constipation is the foremost trigger for piles as the straining puts pressure on the blood vessels in this area.
  • Straining during bowel movements is another risk factor for piles. 
  • Prolonged sitting while defecating also increases the chances of developing Piles. 
  • Being over 50 – as you get older, your tissues get weaker, which increases your risk of getting piles
  • Being overweight
  • Pregnancy
  • Frequent heavy lifting
  • Prolonged diarrhoea

It is also thought that if people in your family have suffered from hemorrhoids, there are more chances of you suffering them too.

What are the Symptoms of Piles?

  • Bright-red, painless rectal bleeding while passing stool
  • Feeling of something coming out during defecation which may go inside by itself or need to be pushed back manually
  • Anal itching and irritation
  • Soiling due to mucous discharge or incontinence
  • A feeling of rectal fullness, discomfort, or incomplete emptying of bowel movements
  • Pain if a hemorrhoid prolapses and becomes strangulated

What are the Different Stages of Piles?

Piles are classified as either first-, second-, third- or fourth-degree. First- and second-degree piles are the most common and the least severe.

  • Stage One – Small swellings on the inside of the anus which are not visible from the outside. The patient complains of painless bleeding during defecation. 
  • Stage Two – These are larger swellings that may appear when one goes to the toilet but then disappear back inside again. Painless bleeding may or may not be there.
  • Stage Three – More severe small lumps that are visible from the outside of the anus and hang down, but they need to be pushed back inside. 
  • Stage Four – Most severe type of piles. Large lumps that hang down outside the anus. They cannot be pushed back inside.

“Among these, 1st and 2nd-degree piles can be easily managed by diet and lifestyle changes along with Kegel exercise for Piles”, opines Dr. Ravinder Sharma; a leading proctologist in Delhi NCR who practices at Piles To Smiles. He further says Kegel exercises benefit a lot in 3rd and 4th degree hemorrhoids also. 

Kegel Exercise for Hemorrhoids

Gynecologist Dr. Arnold Kegel in the 1940’s developed this exercise to strengthen the pelvic floor and smooth muscle along the anal canal up to the sphincter to prevent urinary continence and prolapsed hemorrhoidal tissues.

Kegel exercises are the simple act of contracting, holding, and then relaxing the pelvic floor muscles to strengthen the muscles and improve blood circulation These muscles are also sometimes called the “Kegel muscles”. They support the bladder and rectum and help control urine flow and the process of defecation. 

Regular pelvic floor exercises can help prevent and treat hemorrhoids by improving circulation, reducing inflammation, and increasing the tone and strength of the pelvic floor muscles. 

How do Kegel Exercises Help in Piles?

Many patients with chronic anal fissures and hemorrhoids experience an over-tightening or spasm of their pelvic floor muscles that help with defecation. Specifically, the puborectalis muscle which forms a U-shaped sling around the rectum oversees relaxing for stool to pass.

  • Kegel Exercise for Piles helps to prevent hemorrhoids by increasing blood flow to the anal region and improving blood circulation. 
  • Kegels strengthen anal muscles. Strong anal muscles provide good support for internal hemorrhoids and prevent existing ones from enlarging or protruding!
  • If you are suffering from piles, Kegels can help to tighten tissues and control leaking around the hemorrhoid problem areas.

And contrary to popular belief, kegel exercises can be done by both men and women!

How to do Kegel Exercises for Hemorrhoids?

Before beginning, always remember these points on how to do Kegel exercises:

  • Make sure you start on an empty bladder.
  • Ensure you are exercising the correct muscles.
  • Squeeze for a count of 5 seconds and relax for a count of 5 seconds in the beginning which can be increased up to 10 seconds later.
  • Try for a minimum of 10 and a maximum of 15 repetitions each time.
  • Ideally, do the exercises at least thrice a day in the beginning.

How to do Pelvic floor exercises for Piles?

You can practice your Kegels sitting/ standing or lying down. But in the beginning, it will be helpful to exercise while seated in a firm chair

  • Step 1 – Lie down on the back or sit in a comfortable position.

Relax your abdomen and buttocks since you do not want to exercise those muscle groups so you should not contract these muscles.

  • Step 2 – Start contracting your anal muscles as if you are stopping yourself to pass gas or stopping a bowel movement.
  • Step 3 – Hold this contraction position for 5-10 seconds as per your comfort.

Breathe freely: Do not hold your breath, but breathe freely during the exercise.

  • Step 4 – release for 10 seconds.

It might help to think of these muscles as an elevator. As you contract (squeeze) them, the elevator slowly rises to the top. As you gently release the tension on your muscles, imagine the elevator returning to ground level.

  • Step 5 – Repeat the exercise 5 times but only use half of your strength.
  • Step 6 – squeeze the muscles and relax them repeatedly as fast as possible.
  • Step 7 – continue the exercise as long as you can.
  • Step 8 – The standard recommendation is to perform Kegels three times a day. Later you can increase it up to 10-15 times a day. 

Best Positions to do Kegel exercises for hemorrhoids:

  • Sitting in a comfortable chair.
  • Lying down on your back.
  • Standing in an empty area.
  • Kneeling, on the floor, on all fours.

When should I do the Kegel exercises for Piles?

Performing Kegel exercises has no age. One is recommended to begin practicing them as early as possible. These exercises may be performed any time during the day or night and while you are in any position- sitting, standing, or lying down. Also, since they do not require any special positioning, you may do them while working, driving, eating, or watching television.

You can do pelvic floor exercises discreetly at just about any time.

  • When you are stopped at a red light
  • In the waiting room at the midwife or doctor’s office
  • Drive-throughs such as the bank, dry cleaners, and pharmacy etc.

When can I start doing the Kegel exercises for post-pregnancy Piles?

The Kegel exercises to avoid post-pregnancy Hemorrhoids can be safely started 3 weeks after your delivery. It is a good idea if you practice the Kegels Exercise for Piles throughout your pregnancy. It will help avoid hemorrhoids during and after pregnancy. 

Where should I do pelvic floor exercises for Piles?

Until you are comfortable doing Kegel exercises, choose a quiet spot to practice, like your bathroom or your bedroom, so you can concentrate. Once you know how, you can do these exercises anywhere― at your desk, in the car, waiting in line, at the kitchen counter, etc. To help ensure that you will be consistent, make it a habit to do your Kegels Piles exercise in a particular place or during a certain activity, such as brushing your teeth, doing the dishes, or driving to work.

As your muscles get stronger, start practicing hemorrhoid Kegels Exercise while sitting and standing, too. This will put more weight on the muscles, boosting your workout and improving your control. 

How do I know if I am doing hemorrhoids Pelvic floor exercises correctly?

It is important to identify and squeeze the correct group of muscles. In the beginning, you may sit on the toilet and insert your well-lubricated finger into the rectum. Then tighten the muscles of the sphincter and feel them contracting around your finger. Do not contract your abdominal, thigh, or buttocks muscles while performing the exercise.

When should I expect improvement in my symptoms?

When you are trying to strengthen any muscles, it is important to be patient. If you have ever tried to get in shape more quickly by lifting too much weight or running too many miles, you know that trying to hurry the process can backfire.

If you are doing the exercise correctly, you should feel the pelvic floor muscles lifting. It may be difficult to contract these muscles for 10 repetitions, but as your muscle tone improves, it will become easier. If you repeat the exercise a few times daily, you should see an improvement in just a few weeks. For continued benefits, make pelvic floor exercises a permanent part of your daily routine.

How long do I have to do the Kegels exercises for Piles?

The more you do the exercises the better. Also, the longer you can hold the contraction the better. Like any type of exercise, Kegel exercises only work as long as you do them. Once you stop, the muscles will become weak again and Piles problems might return.

Make doing your Kegels a lifetime habit, and stay motivated by focusing on the improvements you experience in your Hemorrhoids.

Precautions for doing Kegel Exercise for Hemorrhoids:

  • When performing Kegel exercises, do not hold your breath or strain.
  • Always keep the other muscles relaxed – especially the abdomen and thigh muscles.
  • Some amount of soreness in the pelvic area is possible. But if it is more than usual, that could be because it is overdone. Consult your proctologist.
  • Sometimes it is difficult to locate the right set of muscles. Check with your proctologist to help you understand the correct set of muscles.
  • Kegel exercises are not meant to show off like bicep muscles. Do not constantly keep straining the muscles to make them stronger. Relaxation of the muscles is equally important with the squeezing movement. Do not skimp the relaxation part.

Other benefits of practicing Kegels exercise:

  • During pregnancy Kegels exercise helps support the increasing weight of the growing baby
  • Pregnant women who perform Kegels exercises often find they have an easier birth. Strengthening the pelvic floor muscles during pregnancy can help develop the ability to control muscles during labor and delivery. Kegels exercises also minimize the chances of requiring an episiotomy – a cut (incision) through the area between the vaginal opening and the anus. This procedure is done to make the vaginal opening larger for childbirth.
  • Practicing pelvic floor exercises during pregnancy will also minimize instances of urinary incontinence or leakage when laughing, sneezing, coughing, or carrying something heavy.
  • Post-delivery bladder control: After a cesarean section or even a normal delivery, many women experience issues with bladder control. Kegel exercises after delivery will help with better control and quicker recovery.
  • Better healing: The pelvic muscles are strained and often damaged during delivery. These muscles heal better with Kegel exercise after delivery.
  • Pelvic organ prolapses: Kegel exercises help with pelvic organ prolapse. This happens especially in the case of vaginal delivery that has lasted for long hours.
  • Although Kegel exercises are most familiar to women experiencing urinary leakage after childbirth, these exercises are an equally effective tool to help men improve bladder control. 
  • The exercises help treat prostate pain and swelling resulting from prostatitis in men
  • Kegels exercises help men to achieve strong erections and control premature ejaculation and women to have a stronger orgasm.
  • Experience better intercourse sensation: There is always some amount of laxity in the vaginal canal post-delivery. Kegel exercises after delivery can improve the vaginal tone. This directly translates to better sensations for your partner during intercourse.
  • Kegels may increase your sexual satisfaction by increasing the blood flow to genitals. 

Kegels exercise for Piles – Not the Silver Bullet: 

Contrary to popular belief, Kegel exercises are not the be-all and end-all solution for hemorrhoids. If these methods do not provide any relief and the condition and symptoms keep on prevailing, you should consult with a proctologist for proper diagnosis and treatment.

At Piles to Smiles, You can book an appointment for top proctologist in Delhi NCR. 

 
Categories
Piles

Hemorrhoids/ Piles during/after pregnancy – Causes, Symptoms, Diagnosis & Treatment

Piles in Pregnant Women – Hemorrhoids During Pregnancy

Hemorrhoids, commonly known as piles, are swollen hemorrhoidal cushions inside the anal canal or in the skin surrounding the anus. They develop when the hemorrhoidal cushions (which are normal structures in every human being) inside the anal passage become swollen and inflamed resulting in bleeding during defecation and/ or protrusion of pile mass during defecation. There might be some painful swelling near the anal opening. Piles after delivery are very common in pregnant women, especially during the third trimester and 1st month after delivery. This is due to the excess pressure on the hemorrhoidal cushions placed by the enlarged uterus. 
 
Hemorrhoids/ Piles during/ after pregnancy can be very problematic and disturbing. Contact Piles To Smiles to get optimal care for piles during pregnancy. 

Causes of Hemorrhoids/ Piles During Pregnancy

Some of the most common causes of hemorrhoids during pregnancy are explained below- 
  • Increased Pressure on the Hemorrhoidal cushions: The pressure on the pelvic area and the lower abdomen increases significantly due to the added weight of the fetus. The pressure makes it difficult for the veins to circulate blood properly, due to which the blood starts to pool and causes swelling in these hemorrhoidal cushions. The blood volume also increases during the pregnancy to support the fetus’s growth. The added volume further increases the amount of blood pooling in the veins. 
  • Hormonal Changes: Progesterone levels increase during pregnancy which causes the veins to relax. Relaxation of blood vessels, halts the blood circulation in the hemorrhoids, leading to bleeding/ swelling/ protrusion of Pile mass during defecation. 
  • Too much straining during defecation: Straining during defecation is another factor that increases pressure in the lower abdomen and the anal region which may lead to the development of Hemorrhoids/ Piles during pregnancy.
  • Constipation: Around 16% to 39% of women get constipated during pregnancy due to the increase in progesterone levels, fetus size, iron supplements, and/or lifestyle habits. Due to constipation, the patient is more likely to strain or push hard to pass stools which can cause bleeding/ swelling/ protrusion of Pile mass during defecation.
  • Poor Dietary Habits: Eating foods that are low in fiber content increases the risk of constipation, which ultimately leads to hemorrhoids/worsens the existing condition. 
  • Inactive Lifestyle: during pregnancy, movements are restricted, as many women are advised to take rest. Which results in constipation which later leads to piles during pregnancy. 
All these factors can directly contribute to the development of hemorrhoids/ piles during pregnancy. 

Causes of Hemorrhoids/ Piles after Pregnancy or Causes of Postpartum Hemorrhoids/ Piles:

  • Straining and pushing during childbirth:  During pushing to deliver the baby, blood is forced into the veins around the anus. This causes the veins to become filled with blood that may clot and cause a thrombosed hemorrhoid. The longer the straining—particularly if it is for more than 20 minutes, the greater the chances of developing hemorrhoids.
  • An instrumental delivery (where an instrument, such as forceps, is used to assist delivery): can also increase the chances of developing postpartum hemorrhoids.

While those who have a vaginal or instrumental delivery, are more likely to develop postpartum hemorrhoids, hemorrhoids after c-section delivery can also develop; the delivery does not need to be complicated for a hemorrhoid to result.

  • Baby’s size can be another factor: Giving birth to a newborn weighing 8.4 pounds or more may increase the chances of getting postpartum hemorrhoids.
  • Constipation is also common after giving birth. In many women, this could be caused by a combination of changing hormones, pain medication, dehydration, or a fear of pain from their hemorrhoids or episiotomy site (a surgical cut made between the vagina and anus as a woman gives birth).

Symptoms of Postpartum Hemorrhoids

How will I know I have hemorrhoids after pregnancy? 
 
Hemorrhoids can be located internally or externally and sometimes switch between protruding out of or going back inside the anal passage. Symptoms of hemorrhoids after pregnancy include:
  •  Bright red bleeding from the anus during defecation
  • Feeling of something coming out from the anus which may go inside by itself or need to be pushed back manually
  • Pain/ irritation/ discomfort might be there as long as the pile mass remains outside.
  • There might be mucous discharge when the Pile mass is outside. 
  • Sitting/ standing/ movement may be very difficult because of the protruding Pile masses.
  • Painful swelling near the anus 

If any of these symptoms arise during pregnancy, it’s crucial to get in touch with an experienced proctologist to take the necessary measures to manage the condition.

Types of Hemorrhoids during/ after Pregnancy:

Depending upon the location of blood in hemorrhoidal cushions hemorrhoids during/ after pregnancy can be of the following types:
  • External hemorrhoids: These develop under the skin around the anus and are visible as they are located outside the anus. External postpartum hemorrhoids are the most common.
  • Internal hemorrhoids: These develop inside the anus and therefore are not visible. They can cause bleeding and later protrusion of Pile mass.
  • Prolapsed hemorrhoids: These form internally but protrude outside and remain outside until one tries to push them inside. Initially, these can be pushed back inside but if they remain outside for a longer period, it will become difficult to push them back. 
  • Thrombosed hemorrhoids: These occur when a blood clot forms within a hemorrhoidal cushion, obstructing the blood flow and leading to painful swelling. Thrombosed hemorrhoids can exist internally or externally.

How are hemorrhoids during pregnancy diagnosed?

Hemorrhoids during pregnancy are common enough that an experienced proctologist will likely know if someone is having hemorrhoids by the symptoms she tells. To be sure, a proctologist may:
  • Take a closer look at the anal region. An experienced proctologist can easily spot external hemorrhoids.
  • Do a digital rectal examination. He may insert a gloved finger inside the anus to feel for any internal hemorrhoids.
  • Do an anoscopy or sigmoidoscopy. They allow a proctologist to see inside the patient’s anal passage.

How to prevent Hemorrhoids/ Piles during/ after Pregnancy:

Here is something that can be done to prevent hemorrhoids/ Piles during/ after Pregnancy:
  • Take the pressure off your hemorrhoids: There is nothing one can do about the added pressure from the fetus that is putting strain on the body, but you can change your habits so that you are reducing the strain that you can control. Here are some tips:
    • Do not remain standing or sitting for too long. Instead, lay on your side to take pressure off your pelvic area and bowel.
    • When you do sit, use a donut pillow.
    • Do not strain or linger too long on the toilet while defecating. Instead, focus on relieving your constipation.
  • Avoiding constipation: Constipation often involves more straining to pass a bowel movement, increasing the risk of hemorrhoids during/ after pregnancy. To avoid constipation, ensure your diet is full of fiber-rich foods—such as vegetables, whole grains, and magnesium—and fluids. You may take a stool softener if needed after consulting your obstetrician.
  • Eat a high-fiber diet: Try to soften your stools by eating foods that are high in fiber. High-fiber foods include vegetables like broccoli and green peas, fruits like pears, legumes like lentils and black beans, as well as whole grain cereals and breads.
  • Increase liquid intake: liquid intake in any form should be encouraged. Liquid content in feces makes it soft and easy to move in the intestine.
  • Get some exercise: Try to move around more, even if it is just a short walk. Exercise helps prevent constipation. Check with your doctor before you start any exercise program during pregnancy or after giving birth. 
  • Avoid straining during bowel movements, and do not resist the urge to pass stools. Consider using a footstool to elevate the feet while sitting on the toilet. 
  • Do not delay: delaying defecation even after having an urge for defecation leads to the absorption of fluid from stool which makes it hard. So never delay/ suppress an urge to defecate to prevent pregnancy Piles. 
  • Add Kegel exercises into your daily routine to encourage healthy circulation in your anus and rectum.
  • Keep the anal region clean and dry to prevent irritation and itching. Use soft wipes to clean the area instead of soaps or cloth. 
By following these tips and instructions, women can reduce the risk of developing or progression of piles during/ after pregnancy. 

How Long Do Postpartum Hemorrhoids Last?

According to Dr. Ravinder Sharma, a leading proctologist in Delhi NCR, postpartum hemorrhoids can look very “large and alarming” right after birth but should shrink quite a bit over the next few days. They are typically most problematic for 5-7 days after childbirth but improve noticeably by two weeks postpartum. 

Proctologists agree that, while some postpartum hemorrhoids may last longer and require treatment. However, some women may experience skin tags afterward. This happens when the blood within the hemorrhoid is reabsorbed by the body, but the skin remains stretched.

When should I consult an experienced Proctologist?

You should consult a nearby proctologist if:
  • You notice any bleeding during a bowel movement. 
  • You are experiencing pain in your anal area that does not get better with at-home treatments.
  • You are experiencing painful swelling near the anus.
  • You are feeling that something is coming out during defecation which needs to be pushed back manually. 
  • You are thinking of trying over-the-counter laxatives, stool softeners, creams, oils, or supplements. Your doctor should approve any medications you take when you are pregnant.

Treatment Options for Piles During Pregnancy

There are several treatment options for women who develop piles during pregnancy. The general methods used for treatment are explained below – 
  • Lifestyle modifications, including eating habits and exercising, to alleviate the symptoms. These changes include improving dietary habits and engaging in physical activities. The diet should include fiber-rich foods, such as wheat bran, prunes, apples, pears, lentils, whole wheat bread, broccoli, tomato, citrus fruits, beans, etc. These foods improve water retention in the colon and make the stool soft to ensure they do not rub against the hemorrhoidal cushions and cause inflammation.
  • Avoid the intake of processed foods that have higher fat, sugar, and refined carbohydrates, as they increase the risk of constipation. 
  • Along with diet, the woman should also exercise regularly to improve blood circulation throughout the body and prevent blood from pooling in the rectal area. 
  • Kegel exercises are known to be helpful in pregnant women to prevent and manage piles after delivery. 
  • Use warm soaks/ Sitz Bath: A sitz bath is a small plastic tub filled with warm water that you soak in to soothe your anal region for about 10-15 minutes. It will help ease the pain and discomfort from hemorrhoids and childbirth.
  • Hemorrhoid cushions or donut pillows comfort while sitting. 
  • Non-surgical procedures, such as rubber band ligation or Kshar Karma for women. 
The most suitable treatment method is recommended by the proctologist after a thorough diagnosis of the patient’s condition. 

Is Surgery Recommended for Pregnancy Piles?

Surgery is generally not recommended for hemorrhoids during pregnancy unless the condition is very severe and other treatments have not been effective. 

The risks of piles surgery during pregnancy are very high. It can cause excessive bleeding, infection, and even premature labor. Due to this, proctologists suggest watchful waiting and lifestyle modifications to manage the condition until childbirth. Once the woman delivers the baby, surgical treatment will be considered if the piles are still problematic after delivery. 

The decision to undergo surgery during pregnancy is made by the doctor after considering the potential benefits and risks of the procedure to the woman and her child. The different types of surgical/para-surgical treatments that can be performed to treat Postpartum piles include:
  • Rubber Band Ligation: This is a para surgical treatment which involves ligation of rubber ring at the root of Pile mass. Generally, it is considered a very safe treatment option for Piles after giving birth. 
  • Ksharsutra Treatment: In this treatment; Ksharsutra – a medicated thread is ligated at the root of Pile mass. It is also another safe treatment option for hemorrhoids after delivery.  
  • Hemorrhoidectomy: This is a surgical procedure in which the hemorrhoidal tissues are removed using a scalpel. It is an invasive procedure with considerable risks and post-op complications. 
Book an Appointment to consult with the best Proctologist in Delhi NCR to manage Piles/ Hemorrhoids during pregnancy or Postpartum Hemorrhoids.
 
Categories
All

What is Proctology & Who is a Proctologist ?

What is Proctology? 

Similarly, to most medical notions, the word proctology is derived from the Greek, and contains the words proktos, which means “anus” or “hind parts”, and logia, which is known as “science”. 

Dr. Ravinder Sharma, a leading proctologist explains “Proctology is a highly specialized area of general surgery dealing with the prevention, diagnosis, and treatment of rectum, colon, and anus disorders. Hemorrhoids, fistula, fissures, polyps, and pilonidal sinus are a few diseases that are included in this domain. It involves treating anorectal diseases via medicines or various procedures.”

Who is a Proctologist?

A proctologist is a medical doctor specializing in diagnosing and treating disorders of the colon, rectum, and anus. 

What does a Proctologist do?

Proctologists treat many conditions of the lower digestive system which includes the colon, rectum, anal canal, and perianal area. These conditions are:

  • Hemorrhoids – Swollen veins that can occur internally and externally around the anus
  • Fistula-in-ano – infected tunnel between the skin and anus
  • Peri-Anal Abscesses – Formation and accumulation of pus in the area surrounding the anus
  • Fissure-in-ano – small tear in the lining of the anus
  • Pilonidal Cysts/ Sinus – Swelling with a collection of pus at the tailbone that contains hair
  • Anal skin tags – non-cancerous skin growths.
  • Rectal Prolapse – a condition when the rectum slips out through the anal opening
  • Bowel Incontinence – inability to hold stool resulting in slippage of feces unconsciously.
  • Inflammatory Bowel Disease – Crohn’s and Ulcerative Colitis
  • Irritable bowel syndrome (IBS) –  A chronic condition that causes bloating, pain, constipation, and diarrhea.
  • Colon polyps – Small, benign clumps of growths in the colon that have the potential to turn cancerous.
  • Colon, rectal, and anal cancers – Cancers that originate in these regions.
  • Sexually transmitted infections (STIs)  Infections in the genital and anal area include:
  • Chlamydia
  • Syphilis
  • Gonorrhea
  • Genital herpes
  • Condyloma (warts)

When should you consult with a proctologist?

Often people search for the Best Proctologist near me online as they are too embarrassed to tell anyone, even their doctor, about their issues with the anus. Here are the main health conditions that require consulting an expert proctologist:

  • Bowel difficulty
  • Uncomfortable sensations/ itching/ burning or pain around the anus or rectum
  • Bleeding or other discharge from the anus/ near anus
  • Warts or bumps in the anal region
  • Change in bowel habits or changes in the stool
  • Difficulty controlling bowel movements, like fecal incontinence
  • Existence of warts, bumps, or foreign bodies near the anal area
  • Persistent constipation
  • Screening for a colonoscopy (Starts at age 45 or younger if any bleeding, family history of polyps or colorectal cancer)
  • Any other changes to the anus and rectal area that are concerning. 

People with excessive weight, as well as people with prolonged sitting, or systematic lifting of weights, should periodically consult a specialist proctologist for preventive purposes.

People who have undergone proctologic surgeries are also advised to visit a medical examination. 

Proctologists perform different procedures to correct the colon, rectum, or anus. Anyone with these diseases and symptoms can see the best proctologist in Delhi NCR for estimation, diagnosis, and treatment.

Diagnostic and treatment procedures performed by Proctologists

An experienced Proctologist uses diagnostic procedures and treatment options for patient’s health and quality of life. 

Diagnostic Procedures

Diagnostic procedures are to identify conditions affecting the rectum and anus. These broadly refer to a variety of rectum and colon examinations:

  • External examination
  • Digital Rectal examination
  • Anoscopy
  • Proctoscopy
  • Sigmoidoscopy
  • Colonoscopy
  • Ultrasound of abdominal cavity
  • X-ray and endoscopic examination
Treatment Options

The treatment option varies depending on the specific condition and its severity. Non-surgical options include medications, lifestyle changes, and physical therapy. Minimal Surgical options include Kshar Karma, Ksharsutra Treatment, Rubber Band Ligation, Sclerotherapy, Open Hemorrhoidectomy, Closed Hemorrhoidectomy, Closed Lateral Internal Sphincterotomy, Incision and Drainage, etc. Here Kshar Karma and Ksharsutra are specialized ayurvedic treatments that are designed by our best ayurvedic proctologist according to the disease condition of the fellow. 

We at Piles To Smiles, have the best proctologist in Delhi, who can help you with prevention, diagnosis, and ayurvedic treatment of Anorectal health problems.

How to find the best proctologist near me in Delhi NCR?

Here are some important things to consider when looking for an experienced proctologist:

  • Is the proctologist Govt.-certified?
  • Is he licensed to practice?
  • Can you have a consultation to get to know your nearby proctologist prior to having any procedures done?
  • What are their locations and hours?
  • If you’re having particular symptoms or procedures, what’s the doctor’s previous experience with disease and conditions?
  • Does your experienced proctologist make you feel safe and secure?
  • Does he answer your questions honestly, and 
  • Is he subtle in addressing your concerns?

If the answers to the above question come to be “satisfactory” then he is the best proctologist for you. 

How our Best Proctologist for hemorrhoids treats at Piles To smiles: 

The relationship between patient and proctologist is cardinal. Due to the nature of proctological examination and treatment, establishing trust and ensuring patient comfort is vital. Dr. Ravinder notes, “Our approach always prioritizes patient dignity and comfort.”

Proctological exams can cause anxiety for many patients. Our top-rated Proctologists are trained to manage these anxieties, ensuring patients are informed and comfortable throughout their treatment. “Clear communication and empathy are key in alleviating patient fears,” says Dr. Ravinder.

Proctologists often face the challenge of discussing sensitive and potentially embarrassing issues especially when a female patient requests to be treated by the best female proctologist in Delhi. “It requires tact and sensitivity to discuss such personal health matters with female patients. Our gender comes later first we are Proctologists and you will find we are handling you as gently as if taken care of by the best female proctologist only” explains Dr. Ravinder.

Children and Adolescents frequently suffer from anorectal symptoms. Pediatricians commonly treat these with medications. Evaluation by a pediatric proctologist is recommended when the symptoms are severe or become chronic. Our best proctologists in Delhi are equally trained in pediatric proctology.

At Piles To Smiles, with our best proctologist in Delhi, we aim to provide non-surgical or Minimal surgical treatment for anorectal health issues, allowing you to concentrate on your recovery while we handle the rest.

Prevention and Management of Proctological Conditions

There are a few ways to prevent and manage proctological conditions. Making lifestyle changes is often the first step in managing these conditions. For example, losing weight can help reduce the risk of developing hemorrhoids if the fellow is overweight. Other changes include eating a high-fiber diet, exercising regularly, and avoiding constipation. If lifestyle changes alone cannot manage the condition, our experienced proctologist may recommend medical management. Minimal Surgery is sometimes necessary to treat proctological conditions. These include Kshar Karma, Ksharsutra Treatment, Rubber Band Ligation, Sclerotherapy, Open Hemorrhoidectomy, Closed Hemorrhoidectomy, Closed Lateral Internal Sphincterotomy, Incision and Drainage etc.

These treatments are usually minimally invasive and with less pain. Recovery is quick, letting the patient get back to his daily routine soon. For the best care, look for the best proctology center in Delhi with experienced proctologists.

Book an appointment at Piles To Smiles for the best proctology treatment in India. 

 
Categories
All Fistula

Why Ksharsutra for Fistula-in-Ano

Ksharsutra Treatment is more convenient and more effective than surgery in patients suffering from Anal Fistula*
*Indian Council of Medical Research (ICMR)

कृशदुर्बलभीरूणां नाड़ी मर्माश्रिता च या |
क्षारसूत्रेण तां छिन्दयात् न तु शस्त्रेण बुद्धिमान् ||
i.e.
An intelligent surgeon prefers Ksharsutra treatment over any surgical intervention to treat a patient suffering from Fistula/ sinus or other similar problem who is emaciated/ weak/ fearful/ timid/ whose fistula or sinus is in vulnerable area.
सुश्रुत संहिता चि. स्था . 17/29 (Sushruta Samhita Chi. Stha. 17/29)

Till date many treatment modalities have been tried to treat Fistula-in-Ano with varying rate of success. So for a patient suffering from Fistula-in-Ano; it becomes very difficult to decide which treat to adopt.

Here we are listing few advantages with Ksharsutra treatment for Fistula-in-Ano over other treatments:

Predictably ZERO recurrence: Fistula-in-Ano is notorious enough to recur again and again even after being treated by the bestest of surgeon. Because of its high recurrence rate there is an idiom “If you want to defame a surgeon refer him a patient suffering from Fistula-in-Ano. Even the latest treatments like Laser/ VAAFT etc. have pretty high recurrence rate of 25-30% after treatment.
Whereas Ksharsutra treatment assures complete recovery from Fistula-in-Ano and usually recurrence of Fistula-in-Ano is not reported after Ksharsutra treatment. Ksharsutra treatment is found successful in complicated Fistula-in-Ano where multiple surgeries have failed.
Ayurved is the best to correct diet and lifestyle: unhealthy dietary habits and lifestyle is one of the main causative factor for Fistula-in-Ano and everybody is aware about the fact that Ayurved is the best health science when it comes about correcting unhealthy dietary habits and lifestyle.

No Complications: Due to damage to sphincter muscles partial or complete stool incontinence (difficulty or inability to hold stool) is observed after surgery for Fistula-in-Ano whereas sphincter muscles remain intact in Ksharsutra treatment for Fistula-in-Ano and complication of stool incontinence is not reported.

Done under local Anesthesia: Ksharsutra treatment is done under local anesthesia which is the safest route of anesthesia so complications associated to spinal/ general anesthesia like back ache/ head ache/ affected brain activities/ urine retention etc. are not seen in Ksharsutra treatment for Fistula-in-Ano.

No Hospitalization/ Bed rest: Ksharsutra treatment is an OPD treatment and done under local Anesthesia so usually hospitalization or bed rest is not required in Ksharsutra treatment for Fistula-in-Ano.
Minimal pain and other complications: Ksharsutra treatment for Fistula-in-Ano does not involve any cutting of tissue so complications like pain/ bleeding/ frequent infection etc. are not seen in Ksharsutra treatment for Fistula-in-Ano. A little bit of burning sensation or irritation is felt by some of the patients when ksharsutra is changed which is manageable by sitz bath (warm water tub bath)/ application of some anesthetic gel or taking painkiller medicines etc.

No frequent hospital visit: Surgery for fistula-in-Ano may require daily packing and dressing of the wound which requires frequent hospital visit. Whereas Ksharsutra treatment for Fistula-in-Ano involves replacing of older Ksharsutra by a new one at a week or 10 days interval. Patient is not expected to visit hospital in-between this time period.

Daily routine not affected: a patient can continue his normal routine activities as usual during Ksharsutra treatment for Fistula-in-Ano which is not possible in surgery for fistula-in-Ano.

Cost Effective: cost incurred in Ksharsutra Treatment for Fistula-in-Ano is always less than surgery for Fistula-in-Ano. One more thing; Ksharsutra treatment involves payment of small amount at intervals whereas surgery involves payment of big amount in single installment.

Keeping all above said points we can conclude that Ksharsutra treatment is the best treatment for Fistula-in-Ano available till date. So a patient suffering from Fistula-in-Ano should opt for Ksharsutra Treatment for complete recovery..

Categories
All

Why Prefer Piles To Smiles?

मातरं पितरं पुत्रान् बांधवानपि चातुरः |
अप्येतानभिशंकेत वैद्ये विश्वासमेती च ||
विसृजत्यात्मना आत्मानं न चैनं परिशंकते |
तस्मात् पुत्रवदेवैनं पालयेदातुरं भिषक् ||

The patient doubts even his parents, offspring and relatives but has faith in his doctor. He surrenders his body in the doctor’s hand and has no doubt about him. It is, therefore doctor’s duty to treat and look after him as his own son.

– सुश्रुत संहिता (Sushruta Samhita)

Piles to Smiles Clinic has been established with a vision to provide affordable treatment without compromising quality of treatment.

Here we wish to share some distinctive features of Piles to Smiles Clinic:

  • Expertise to treat Ano Rectal Problems: At Piles to Smiles Clinic; we are providing treatment exclusively for Ano Rectal health problems and we are capable of handling complicated Ano rectal problems like 4th stage internal hemorrhoids/ infected hemorrhoids/ high anal fistulas/ fistula with multiple branches/ recurrent anal fistula etc.
  • Integrative approach: At Piles to Smiles Clinic; we have clubbed age old Ayurved principles of healing with modern technology to make treatment more effective and convenient.
  • Ready to adopt new treatment modalities: we are continuously in process of improving the outcome of treatment offered by us. For this; we keep on organizing and attending different training programs to enhance our skills. To improve outcome of treatment; we are always ready to adopt new treatment modalities in the larger interest of patients.
  • 24 hours support: you can approach our doctors any time. We assure you to provide best possible solution for your concern so that your hospital visits could be minimized.
  • Proper guidance to patients: At Piles to Smiles Clinic; patients are being properly guided regarding diet and lifestyle to be adopted for fast recovery from piles/ fistula/ fissure etc. as well as for preventive purpose.

Besides this; we also train patient’s attendant regarding how to take care of minor concerns regarding patient problem so as to minimize hospitals visits and associated inconvenience.

  • Affordable treatment: We are of strong belief that it is meaningless how much effective treatment is if it is not affordable by patient. So we are always adopting newer measurements to make our treatment more and more affordable with out compromising quality of the treatment.
  • Providing Free consultation and treatment to economically weaker section of society, associating with different NGOs, taking necessary steps to minimize hospital visits of patients etc. are part of these measurements.

Because of all these unique features and our sincere efforts towards fulfilling our social responsibilities; it is not a wonder that we are getting maximum number of patients through words to mouth.

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Why Ayurved For Ano Rectal Problems?

या हि उदीरणं शमयति नान्यं व्याधिं करोति च |
सा क्रिया; न तु या व्याधिं हरति अन्यं उदीरयेत् ||

i.e.

That is the ideal treatment which does not cause any complication while treating a disease not that which results in other disease while treating one.
– सुश्रुत संहिता (Sushruta Samhita)

Here are some reasons for any body suffering from any Ano rectal health problem to prefer Ayurved over other health systems:

Ayurved is Best

It is a well known fact that most of ano rectal problems are resultant of unhealthy dietary habits and life style.

Ayurved is best to guide about healthy dietary habits and lifestyle so it is obvious to get best results in treating Ano rectal problems in Ayurved.

No complication: It is a common practice now a day to hear that a persons is suffering from a health problem because he was taking medicines from some other health problem and as a side effect of those medicines he is now suffering from this problem.

On the other hand; usually Ayurvedic medicines and Ayurvedic treatments are quite safe and free from any side effect so it is always safe to prefer Ayurved over other health systems in general and for Ano rectal problems in particular.

Complete eradication of Problem: Ayurved always advocates to treat any health problem from roots so that it will not recur in future. Ano rectal health problems are notorious enough to recur again and again even after being treated by most advanced treatment option.

So it is always advisable to get treated for any ano rectal problem in Ayurved to avoid its recurrence.

No Hospitalization required: in Ayurved Ano rectal problems are treated without or with minimal surgery.

Most of the para surgical treatments advised for Ano rectal problems like Kshar karma, Kashrsutra can be performed as an OPD treatment so usually hospitalization is not required for Ayurvedic treatment of Ano rectal problems.

Minimal or no bed rest: Usually bed rest is not required in Ayurvedic treatment of any Ano rectal problem.

In most cases; a patient can continue his normal routine activities as usual during Ayurvedic treatment.

Cost effective treatment: in most cases; Ayurvedic treatment is more economical than other health systems and anybody can afford treatment.

In nutshell; it can be ascertained that Ayurved should be preferred over other health systems for treatment if any health problem in general and for Ano rectal problems in particular.

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Constipation – Causes & Home Remedies

US department of Health & Human Services defines constipation as less than three bowel movements in a week. However, it is always better to have a bowel movement daily preferably in morning.

It becomes very important to know causes and some home remedies for constipation as it makes a person prone to many health problems likehe morrhoids, Fissure-in-Ano, Fistula-in-Ano etc.

Signs of constipation:

  • Hard, dry, or lumpy stool
  • Difficulty in passing stool
  • Feeling of incomplete bowel movement after passing stool
  • Painful passage of stool
  • Need for straining to pass stool
  • Passing less stool than usual
  • Pain in abdomen
  • Nausea
  • Bloated abdomen

Causes of constipation:

  • Lack of fibres in diet: people with high intake of fibres are less likely to suffer from constipation.
  • Deficient fluid intake: deficiency of fluids makes stool hard
  • Slow movement of stool in large intestine: when stool passes too slow in large intestine; relatively large amount of water gets absorbed from it making the stool harder
  • Physical inactivity: low level of physical activity may lead to constipation.
  • Medication: certain medicines like opioid painkillers, anti-depressants, anti-convulsants, antacids, diuretics iron supplements etc. increase the risk of constipation.
  • Ageing: as people age; prevalence of constipation increases.
  • Change in routine: when there is a change in daily routine (specially sleeping pattern) like when you are travelling there are more chances for constipation
  • Overuse of laxatives: certain laxatives are habit forming. So, if a fellow uses laxatives over a long time; he may suffer from constipation
  • Delaying the urge for defecation: it will lead to long stay of faeces in the rectum and hardening of stool.
  • Colorectal problems: constipation could be a primary symptom of colorectal cancer.
  • Other conditions: constipation could be suggestive for other health problems like hypothyroidism etc.

Complication of constipation:

Constipation is not life threatening but it might be suggestive of some more serious underlying pathology like colorectal cancer etc.

Some common complications of constipation include:

  • Anal fissure i.e., a tear in anal canal which makes bowel movement very painful
  • Haemorrhoids: swollen and inflamed blood vessels of anus
  • Rectal bleeding which might be few drops to profuse bleeding making a fellow anaemic.
  • Fecolith i.e., impaction of faeces in rectum and anus leading to a mechanical obstruction.
  • Lethargy and reduced quality of life

Alarming sign: Sudden onset of obstipation i.e., inability to pass faeces as well as flatus is a medical emergency as it may be because of blockage in intestine and need urgent medical attention.

Home remedies for constipation:

  • Increase Fiber intake: high fibrous diet especially rich in indigestible fibers is very beneficial to relieve constipation.
  • Increase liquid intake: liquid intake in any form should be encouraged. Liquid content in faeces makes it soft and easy to move in intestine.
  • Warm milk in night: warm milk added with some sugar before going to bed gives soft consistency to stool.
  • Warm water in morning:  1-2 glasses of warm water activates intestine and help in easy bowel movement.
  • Use of Haritaki: with its mild laxative property; Haritaki is very beneficial relieving constipation.
    • Haritaki with jaggery: is taken before meal to improve digestion and help relieving constipation.
    • Haritaki/ Triphala with buttermilk: In the same way, Haritaki/ Triphala powder could be taken with buttermilk with similar efficacy to relieve constipation.
  • Takra or Buttermilk: Takra is compared with nectar for its health benefits on human body. It improves the digestive system and helps relieving constipation.
  • Shunthi with jaggery: Like the Haritaki powder Shunthi powder taken with jaggery is also effective in easing constipation.
  • Isabgol/ Psyllium husk: is a very good source of indigestible fibers. It helps retaining good amount of water in faeces and relieves constipation.
  • Don’t delay: suppressing urge for defecation allows faces to harden so never postpone going for defecation.
  • Active lifestyle: sedentary lifestyle is another causative factor for constipation so active lifestyle helps getting rid of constipation.
  • Physical exercise: Do regular exercise like walking, running, yoga etc.

If even after taking these measures you are still suffering from constipation; you need to consult a doctor..

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All Fistula

Top 10 treatments for Fistula-in-Ano

Fistula-in-Ano is an inflammatory tract with an external (Secondary) opening in the area around the anus and an internal (Primary) opening in the anal canal/ rectum. This tract is lined by unhealthy tissue. To date ,different treatment options have been tried to treat Fistula-in-Ano with varying success rates.

  1. Seton: Seton is a non-absorbable nylon or silk suture that is placed in the fistula tract. The main purpose of seton is to keep the tract patent so that pus discharge is easy and the patient does not experience swelling and pain. Alternatively cutting seton is also used. Seton is tightened at regular intervals to cause pressure necrosis (death of tissue) in the belief that it will cut the intervening tissue and finally Fistula will be healed without surgery.
    • Pros of Seton: it provides easy passage for pus discharge by keeping the opening patent and the patient does not feel swelling and pain. In some cases, cutting seton is successful in treating Fistula-in-Ano specially
    • Cons of Seton: 100% persistence in seton treatments when it is draining seton[1]. Necrosis of tissue is the concept behind the working of cutting seton. It does not debride the unhealthy tissue so the success rate of seton in treating Fistula is not very good (about 20% failure), and long term incontinence may exceed 30% [2].
  2. Fistulotomy & Lay open technique: In this treatment; a probe is passed through the fistula tract and overlying tissue is divided by a knife. In this way; Fistula is laid open and it is treated as an open wound.
    • Pros of Fistulotomy & Lay open technique: it could be a good choice for simple fistulas i.e. a single no-recurrent fistula that crosses less than 30% of the external sphincter/ fistula is not anterior in women i.e. towards vagina/ there is no history of impaired continence
    • Cons of Fistulotomy & Lay open technique: incontinence (partial or complete loss of control over the passage of stool) in about 1/4 to 1/3 of patients i.e. 25-35% cases. [3]
  3. Fistulectomy with primary sphincter reconstruction: In this treatment; an incision is given from the internal opening to the anal verge. From there the external opening is excised i.e. cut out. Then fistula tract is excised till the external sphincter muscles.
    • Pros of Fistulectomy with primary sphincter reconstruction: No special wound care is employed, the wound can be showered starting on the first day after the operation, the patient can walk, and physical exercises should be restrained for 4–6 weeks.
    • Cons of Fistulectomy with primary sphincter reconstruction: Incontinence in approx. 23% cases [1]
  4. Fibrin Sealant: In this treatment; first of all; the tract is debrided. After debridement the tract i irrigated with saline or hydrogen peroxide to further cleanse the tract. The sealant is slowly injected at the internal opening and allowed to set. Once the clot stabilizes at the primary opening, the sealant is injected to obliterate the entire tract. The clot is allowed to solidify for 5–10 min.
    • Pros of Fibrin Sealant: Operative procedures are typically performed as an outpatient. Oral and/or intravenous antibiotics are not necessary for this procedure. Fibrin sealant injection carries essentially no risk of incontinence as there is no division of the sphincter muscle. Additionally, there is very little postoperative pain, the procedure is easily repeatable, and most importantly it does not preclude any further surgical options later in the patient’s treatment.
    • Cons of Fibrin Sealant: The total recurrence rate was 36.95% (17/46). The long-term overall success rate was 63.04% [4]
  5. Fistula Plug: Placement involves identifying the fistula tract with a standard fistula probe followed by curettage. Once the probe has been placed through the tract, the plug can be tied to the probe and pulled through the tract. The plug is trimmed at the level of the mucosa internally and sutured in place with an absorbable suture. The external end of the plug is also trimmed at the level of skin. It is advised that some space be left at the external opening to allow for drainage of the tract, and for this reason the plug is not sewn in distally. Depending upon the material used in plug it can be Biologic Fistula Plug or Synthetic Fistula Plug.
    • Pros of Fistula Plug: Plugs seem to be better therapeutic options because they do not require ligation of the fistula or division of the sphincters, so there is decreased risk of incontinence. Plug placement is not particularly technically demanding.
    • Cons of Fistula Plug: success rates varying from 24%-88%[5] i.e. to say Fistula plug fails in about 12-76% of cases and recurrence is reported.
  6. Advancement flap: In this treatment, the internal opening is visualized and the fistula tract is probed. Careful attention should be paid to identifying any additional tracts, as undrained tracts will contribute to failure of the flap. Beginning from below to the internal opening, a partial-thickness flap is raised. As the flap is developed, the width is gradually increase so that the base is at least twice the width of the apex of the flap to ensure adequate blood supply to the flap. Dissection of the flap continues until the flap crosses the internal opening without excessive tension. The fistula tract is curetted to remove granulation tissue and debris. The internal opening is closed. The tip of the flap, containing the internal opening, is excised. The flap is then sewn into place. It is an Endorectal advancement flap. When the skin is used as the flap and extended to the internal opening; it is termed a Dermal advancement flap.
    • Pros of Advancement flap: Endorectal flap can be used in special situations such as Crohn’s disease and rectovaginal fistulas. Dermal flap is particularly useful in the presence of coexisting anal pathology such as anal stenosis or Crohn’s disease.
    • Cons of Advancement flap: the reported success rate is widely variable, ranging from 24% to 100%.[5] The main problem with flap procedures is the high recurrence rate of 30 to 50% [1]
  7. Ligation of Intersphincteric Fistula Tract (LIFT): In this treatment; first of all; the Fistula probe is introduced through the tract. Then comes dissection of groove between two sphincter muscles and the identification of the fistula tract. Suture ligation of fistula tract is done above and below followed by division of the fistula tract; if the tract is quite long, a segment of the tract is excised. LIFT wound is closed loosely, and external opening of the tract is enlarged to facilitate drainage.
    • Pros of Ligation of Intersphincteric Fistula Tract (LIFT): The beauty of the LIFT is not only in its initial healing rates, but that the procedure itself, even when unsuccessful, may predispose a patient to subsequent healing without risk of incontinence.
    • Cons of Ligation of Intersphincteric Fistula Tract (LIFT):76.5% mean success rate [5] Successful fistula closure was achieved in 57% of the patients [6]
  8. Video Assisted Anal Fistula Treatment (VAAFT): VAAFT works on the principle of “putting an eye” on the probe and exploring the tract from the inside under direct vision. The fistula tract is cleaned/ the waste material removed and the internal opening closed.
    • Pros of Video Assisted Anal Fistula Treatment (VAAFT): VAAFT’s main innovation is the possibility to explore the fistula tract from the inside “under vision” evaluation that includes, in addition to the main tract, secondary tracts, and abscess cavities. The fistuloscopy minimizes the risk of rupture of the fistula and plays a fundamental role in understanding the course of a complex fistula.
    • Cons of Video Assisted Anal Fistula Treatment (VAAFT): Quite expensive  overall success rate of 73.5%. [5]
  9. Fistula Laser Closure(FiLaC): The FiLaC procedure is performed using a ceramic diode laser platform. The laser fiber is introduced into the fistula tract via the external orifice until the internal orifice is found. The fiber delivers laser energy causing shrinkage of the fistula tract around the fiber.
    • Pros of Fistula Laser Closure(FiLaC): Relatively low chances of incontinence.
    • Cons of Fistula Laser Closure(FiLaC): Quite expensive overall success of 81% which further decreases to 71% when Crohn’s disease is also there [5]
  10. Ksharsutra Treatment: First of all Fistula tract is defined by probing or MRI fistulogram. With the help of a probe with an eye; Ksharsutra is placed in the fistula tract. Medicine present in Ksharsutra debrides the fistula tract and induces healing from the inside. This medicine works for 5-7 days so the old ksharsutra is replaced by a new one at a week or 10-day time period until the fistula heals completely.
    • Pros of Ksharsutra Treatment: Complications like incontinence are not reported and the success rate of treatment is 96.77% in Ksharsutra treatment for Fistula-in-Ano. [7]
    • Cons of Ksharsutra Treatment: This treatment takes time. Out come of treatment largely depends on surgeon’s ability to define the tract.


  1. Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A. Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis. 2018 Jul;33(7):911-918. doi: 10.1007/s00384-018-3042-6. Epub 2018 Apr 12. PMID: 29651553.
  2. https://www.medscape.com/answers/190234-82310/what-is-the-efficacy-of-seton-placement-for-the-treatment-of-fistula-in-ano-anal-fistula
  3. https://link.springer.com/chapter/10.1007/978-1-4614-9014-2_9
  4. Maralcan G, Başkonuş I, Gökalp A, Borazan E, Balk A. Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study. J Korean Surg Soc. 2011;81(3):169-175. doi:10.4174/jkss.2011.81.3.169
  5. Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015;21(1):12-20. doi:10.3748/wjg.v21.i1.12
  6. Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010 Jan;53(1):43-6. doi: 10.1007/DCR.0b013e3181bb869f. PMID: 20010349.
  7. Dr., P.S., & Prof., M.S. (2010). Efficacy of Kshar Sutra (medicated seton) therapy in the management of Fistula-in-Ano. World Journal of Colorectal surgery, 2, 6.

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