Brief Answer:
Medical Therapy may fail. Best option is surgery.

Detailed Answer:
Hello Mr XXXXXXX How are you? Thanks for writing to HCM. My name is Dr Suresh and I hope to answer your question today.
I am sorry to hear about your symptoms. Internal Haemorrhoids is a fairly common condition, especially in people who are habitually constipated. It causes painless bleeding during passing stools and can increase or decrease spontaneously depending on the bowel habits of the patient. Grade 3 Haemorrhoids indicate that the haemorrhoids are quite big and are on the verge of getting prolapsed ("coming out") to the outside (grade 4). This will be very problematic for you because, once it comes out, there is a risk of the haemorrhoid clotting or swelling up and then not going back inside. This will cause a lot of pain and may need hospitalisation to get it treated.
Treatment of heamorrhoids depend on the grade of haemorrhoid and the amount of symptoms it is causing. Since in your case, the haemorrhoids are actively bleeding and since they are grade 3, the best treatment of choice would be to get it surgically excised. Nowadays "Stapled Haemorrhoidectomy" can be easily performed and the patient can get discharged the same day without any complications. Even with a conventional "Open Heamorrhoidectomy", the hospital stay will not be more than two days.
Since you are very apprehensive about surgery, there are a couple of options available. Injection sclerotherapy can be tried where we inject a sclerosing agent around the heamorrhoid which causes clotting of the haemorrhoid. The other option is to get the haemorrhoid "banded" where a rubber band is placed over the haemorrhoid. Both these procedures can be done in outpatient setting and does not require admission to the hospital.
Regarding the blood loss during passage of stools, the best thing to do would be to avoid constipation. I would suggest plenty of fluids (4-6L per day), a high fiber diet (Lots of green leafy vegetables, bananas, Papaya, XXXXXXX etc) and any over-the counter laxative or stool softer (Lactulose, cremaffin etc). This will decrease the pressure while passing stools and also hopefully decrease the bleeding.
I would also get your blood level checked (Haemoglobin level) to rule out anaemia due to the blood loss and get treated for it appropriately.

I hope this answered your question and I hope you feel better soon. Please do not hesitate to contact me for any further details required.
Have a great day

Dr Suresh

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Brief Answer:
Consult Surgeon

Detailed Answer:
Hello Mr XXXXXXX
Thanks for getting back to me. Unfortunately medications will not work for a bleeding pile. It needs pressure to stop bleeding and so I would advise you to meet a surgeon at the earliest so he can insert a pack to stop the bleeding. Once the bleeding has stopped, then you can plan to have the definitive procedure done at a later date. There are some medications like trenaxemic acid which is given to stop bleeding but it can be taken only under medical supervision and also it may not be very helpful in a severely bleeding haemorrhoid.

Please consult a surgeon at the earliest to stop the bleeding and as always please do not hesitate to contact me for further queries.

Thank you
Dr Suresh

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Brief Answer:
Minimal Side effects

Detailed Answer:
Hello Mr XXXXXXX
I am happy that you are contemplating treatment for the piles. I can assure you that you will feel much better after the treatment. Let me get to your questions:

1: The main side effect of surgical removal of the haemorrhoids is bleeding. Sometime after open surgery the suture may slip and lead to bleeding. But this happens very very rarely and you should not be afraid. There are no side effects to banding a haemorrhoid other than a mild discomfort which eventually disappears. I have done > 100 ban dings and no patient of mine ever complained.

2: Haemorrhoids happen because of chronic constipation and rarely due to liver disease. By your history I am positive you don't have liver disease. So after treatment of the haemorrhoids, if you take care of the constipation, there should be no chance of a recurrence. As a rule I advise all my patients to drink 4-6L of liquids a day along with a banana in the night. This softens the stools and makes it easier to evacuate in the morning. Along with this over-the-counter stool softeners (isabghul, cremaffin, lactulose, etc ) are available which will have to be taken long term.

3. There is no problem in bowel movement after both surgery and banding as long as you avoid constipation.

4. There is no recuperation time after banding as it is an outpatient procedure. After an open surgical resection, it usually takes 48 hrs in the hospital and about one week at home to completely recover. A Stapled haemorrhoidectomy will take about 3 days to recover from.

5. Banding and sclerotherapy in general will have a higher recurrence rate compared to a haemorrhoidectomy. But if constipation is avoided, then this should not be a worry.

6. Haemorrhoid or pile is a surgical condition, meaning medications will work to prevent its occurrence, but once a patient has piles, nothing short of surgery can cure it, especially if the pile is bleeding. I am not familiar with homeopathic medications and so I cannot comment on its usefulness, but in general the treatment of choice for a bleeding pile will be surgical.

Hope I have answered all you questions. I do hope you start feeling better soon and please do not hesitate to write back for more clarifications.

Have a great day
Dr Suresh Raghavaiah

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