1. Symptoms are due to prolapse, thrombosis, and vascular bleeding; therefore, creams have little role in treating hemorrhoidal complaints.
2. Bathing in tubs with warm water universally eases painful perianal conditions,as it causes relaxation of the sphincter mechanism and decreases spasm.
3. Bulk laxatives and treatment of bowel infection. Many patients see improvement or complete resolution of their symptoms with the above conservative measures. Aggressive therapy is reserved for patients who have persistent symptoms after one month of conservative therapy.
4. Treatment is directed solely at symptoms and not at the hemorrhoids' appearance. Many patients have been referred for surgery because they have swollen prolapsed hemorrhoids or large external skin tags. When questioned, the patients are asymptomatic. It has been said, "You can't make an asymptomatic patient feel better." Treat hemorrhoids only if they cause problems. Similarly, patients often ask when they should have surgery. Remind them that their hemorrhoids do not bother anyone else, and they should opt for aggressive treatment only when symptoms become bothersome and are not responding to non operative treatment. At our centre more then 90% patients are treated without surgery and have very good long term results.
The treatment choices for piles include :
Infra Red Coagulation (IRC)
Cryosurgery (cold probe)
Rubber band ligation
Scalpel (standard) surgery