Which is better, piles surgery vs non-surgical treatment?

Question

Hello doctor,

My wife (age 33 years) has been suffering from piles-related issues for the last 10 years. It occurred after her delivery (in 2003) and was harmless at that time. We have an eleven-year-old daughter.

Recently, she started experiencing pain and itching while going to the toilet. Also, she could notice blood in stool (occasionally). So, we decided to visit a hospital, and there she had a couple of tests, including rectal scanning.

After the investigation, the doctor informed us that she has been affected by second-degree piles, a skin tag, and a fissure, and hence, laser surgery is inevitable. We are really worried. Is there any alternate treatment without surgery?

Presently, an ayurvedic specialist (who is located near our village) has prescribed a few medicines (mentioned below) for reducing the pain and itching, but not for a cure. Hamamelis virginiana ointment at night (to be used on the affected area), ayurvedic medicine for internal intake like Arsohari lehyam, and a smooth laxative.

Could you please advise us with proper guidance? Is there any doctor to whom we can consult for a second opinion? My wife is a thyroid patient. Looking forward to your valuable suggestion.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It seems like your wife has second-degree hemorrhoids, which have also led to her fissure.

The good news is that it can be managed medically. The first line of management is medical management.

Itching is a very common manifestation, which is also known as pruritus. There are certain guidelines:

First, she needs to take regular laxatives and have a high fibre diet. Medicines like psyllium or mild laxatives such as lactulose will be helpful. It can be taken once at bedtime.
She can apply a local ointment like Proctosol-HC. This will reduce the pain and itching in the affected area. If that is not available, topical hydrocortisone can be applied. This will reduce her pain.
Strikingly enough, one thing that I missed in your history is a sitz bath. I am not sure if your wife has ever heard of it. Often, this is enough to treat piles. The patient is supposed to sit in warm water for 15-20 minutes around 3-4 times a day, preferably around bowel movement time. It reduces the pain, swelling, and associated pruritus to a large extent.
The ointment can also be applied in the fissure spot, after proper cleaning of the area. The area also has to be kept as dry as possible.
In later stages, if the local doctor feels it is necessary, medicines like nitroglycerin or CCBs (calcium channel blockers) can be applied directly to the affected spot.

Before all this, you need to go and get yourself examined by a good, reputable general surgeon in your area. Ayurveda is outside my field of expertise, and I am not convinced about you using ayurvedic medicines to treat hemorrhoids at this stage.

There are other various possibilities like rubber band ligation, sclerotherapy, cryotherapy, etc. The doctor who examines her may advise a colonoscopy to find out the status of the fissure. My final advice to you is that her condition is treatable, and you need not worry. She needs to be under a good surgeon. There are various other modalities, which can be decided based on her local findings.

Hope this was helpful.

Kindly revert in case of further queries.

Thank you.