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Hemorrhoids, usually known as piles, are caused due to swollen veins around the anus or in the lower rectum. Every year, almost 10 million people in India suffer from this disease due to numerous factors such as stress, insomnia, constipation, and a growing inclination towards fast food. Studies suggest that every second individual in this world experience piles between the age of 45-60 and many women experiences it during their pregnancy. 

Some of the symptoms to diagnose piles include extreme itching, irritation, painful bowel movements, and blood in stools. Although the risk factors are still not determined, some of them may include straining during a bowel movement, complications from chronic constipation, and sitting for a longer period. Hemorrhoids can also be passed on genetically, so if you have a family history of piles, it’s most likely that you may develop them too.

Diet plays a vital role in treatment of piles; people who consistently consume a fibre rich diet are less likely to get the disease than the ones blindly following the junk food culture. The studies suggest that people these days need to inculcate good food habits to combat problems like hemorrhoids.

If you’re experiencing extreme pain or any of the symptoms mentioned above, then consulting your primary physician must be the first step. Your doctor generally can diagnose piles during routine physical examination. The doctor will check the area around your anus for

  • lumps or swelling,
  • internal hemorrhoids that have fallen through your anal opening, called prolapse
  • external hemorrhoids with a blood clot in a vein
  • anal fissures—a small tear in the anus that may cause itching, pain, or bleeding
  • Leakage of stool or mucus
  • Skin irritation etc.

The doctor will perform a digital rectal exam to examine external hemorrhoids, however, diagnosing internal piles may include an examination of your anal canal and rectum. Doctor examines your anus through a tube fitted with a light at its end, called a proctoscope. An endoscopy can also be recommended for a detailed evaluation and to rule out any other digestive tract disorders.

Piles may not show symptoms in many individuals at all times. You can often alleviate the mild pain and inflammation of hemorrhoids with home remedies. If detected at an early stage, it can be cured with just medication and simple lifestyle changes. However, if the symptoms are severe and pain is unbearable, the following medical treatment options for piles can assist you in curing them.

  • In majority of the cases, it resolve on their own. However, some anti-itching topical agents can significantly minimize the discomfort in patients.
  • Several OTC (Over-the-counter) products, such as painkillers and topical anti-inflammatory agents can help in minimizing redness and swelling surrounding the anus.
  • Taking laxatives (substances that loosen stools and increase bowel movements), upon doctor’s advice can help a patient with constipation for easy defecation.
  • In the later stages, surgery is a must and there are various surgical procedures available for the treatment of piles.

As mentioned above, some of the home remedies for the treatment of piles include eating high fibre foods such as fruits, vegetables, and whole grains, using topical treatments, and doing regular pelvic floor exercises. For continuous bleeding or painful hemorrhoids, your surgeon might advise other minimally invasive procedures available. Although only a small section of individuals suffering piles require surgery if any other procedure hasn’t been successful, your surgeon may recommend one of the following:

  • Haemorrhoid removal: In this procedure, you will be given general anaesthesia to combat pain. Incisions are made in the tissue surrounding the haemorrhoid. Then the swollen vein is tied off to prevent bleeding and the haemorrhoid is removed.
  • Haemorrhoid stapling: This procedure is used to treat prolapsed hemorrhoids. A surgical staple fixes the prolapsed haemorrhoid back inside your rectum while cutting off the blood supply so that the tissue will shrink and be reabsorbed. Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy.

Summing up, taking utmost care of yourself post-surgery should be your priority. Maintaining a healthy lifestyle including a balanced diet is paramount. Though you can expect some pain post a haemorrhoid surgery too but with proper treatment and following all the necessary doctor guidelines will gradually reduce the impact of the pain on your road to recovery. On the other hand, if you haven’t diagnosed piles yet then it is important to know that Hemorrhoids don’t always come with symptoms, so you may not realize you have them but in case you start experiencing any discomfort like itching or difficulty in passing stool and your personal attempts to treat them don’t show positive results then it’s better to let your doctor know. 

Piles are an extremely common problem these days due to lifestyle changes. So if you have been experiencing extreme trouble due to this disease, then visiting your primary care physician should be your first step. Piles are usually self-diagnosable with some common symptoms such as itching, bleeding, and discomfort especially during bowel movements or when sitting. Your doctor might be able to observe external piles while diagnosing internal ones might require examination of your anal canal and rectum. It is of crucial importance to have a correct diagnosis before you decide to undergo any treatment for piles.

If detected at an early stage, haemorrhoid can be treated with just medication and lifestyle changes such as consumption of high-fibre diet to prevent constipation, taking OTC (Over-the-counter) medicines such as creams (Hydrocortisone – a medication used to treat redness, swelling, itching, and discomfort), painkillers, etc. Majority of the piles go away without any treatment, however, many patients require surgical treatment of piles due to extreme discomfort and severe condition. The nature of the treatment in piles depends upon the stage of the underlying condition. There are various surgical procedures available to treat this problem, however, as far as medical treatment is considered, the following options can help in treating piles:

  • Some anti-itching topical agents can significantly minimize the discomfort in patients.
  • Several OTC products, mainly painkillers and topical anti-inflammatory ointments can help in minimizing redness and swelling surrounding the anus.
  • Taking laxatives (stool softeners), upon your doctor’s advice can help a patient with constipation for easy defecation.

For constant bleeding or severe pain, your physician might suggest one of the other minimally invasive procedures available including:

  • Rubber Band Litigation:  A procedure in which the piles is tied off at its base with rubber bands, cutting off the blood flow to it. This treatment is only for internal piles.
  • Sclerotherapy (Injection): Your doctor injects a chemical solution into the haemorrhoid tissue to shrink it. While this procedure causes very little or no pain, it might be less effective than rubber band ligation.
  • Coagulation (infrared or laser): This treatment is for internal piles. The technique uses a laser or infrared light to harden and shrivel the internal piles.

The two most common surgical treatments for piles include Haemorrhoidectomy and Stapling. Amongst these two surgical interventions, removal of piles using haemorrhoid/piles stapler has been reported as the best outcome so far in terms of performance, safety, and ease of recovery. Only a small percentage of individuals with piles require surgery. However, if other methods have been ineffective or you have large piles, your doctor might recommend one of the following:

Haemorrhoidectomy: Haemorrhoidectomy refers to the surgical removal of internal or external haemorrhoid. The patient is usually kept under general anaesthesia. This method is considered to be the most effective way to treat severe or recurring haemorrhoid.

In this method, piles are diagnosed and removed using a sharp instrument or laser and the wounds are then closed by stitching. Post-surgery, the patients are advised to take sitz bath – a therapy done by sitting in warm water, avoid becoming constipated and use mild painkillers. As every procedure comes with minor complications, the potential complications in haemorrhoidectomy include:

  • Pain in the operated area
  • Urinary tract infection
  • Urinary retention (difficulty urinating)
  • Faecal incontinence (leakage from the bowel)
  • Faecal impaction (constipation for a long time)

Stapling: This method is an alternative to haemorrhoidectomy and is also used for prolapsed piles. The procedure includes stapling the last section of the large intestine, which reduces blood supply to the piles and causes them to slowly shrink. It also lowers the likelihood of haemorrhoids prolapsing. Stapling generally involves less pain than the other procedure and allows an earlier return to your regular activities.

Opting for a right treatment option completely depends on the severity of the condition and should be considered after consulting with your doctor. Post the surgery, it’s highly expected to have some light bleeding and yellow fluids from your anus. These signs may keep going from 1 to 2 months post the procedure. After 1 to 2 weeks of surgery, you should be able to return to your normal life. However, taking care of yourself post piles surgery should be of utmost importance. You can expect mild pain after the surgery. You can aid in your own recovery by consuming a high fibre diet, staying hydrated, and using a stool softener after consulting your doctor.

Now and then, you may have come across the term ‘piles’ but it’s a topic that you usually don’t want to discuss with your loved ones. It often doesn’t cause any major obstacles, however, if they do cause any bleeding or unpleasant pain, it’s time to seek proper medical care. Many people have piles but the symptoms are not always obvious. They are most common among adults aged 45 to 65 but this does not mean that young people and children cannot get them. Women are more likely to get them during pregnancy. Let us now dig deeper into getting a better understanding of piles, its symptoms and treatment options available.

What is Piles?

Piles are inflammation of tissues in the anal pathway (canal through which we pass stools). They are a collection of blood vessels, tissues, muscles or fiber. In simple words, they are lumps inside and around your bottom (anus). The size of piles can differ from person to person, and they may be internal or external. Internal piles are usually in the range of 2 cm – 4 cm above the opening of the anus, whereas external piles appear on the outside boundaries of the anus. In some rare cases, people may develop external and internal piles at the same time. Piles are also categorized by their size and severity.

What are the signs and symptoms of Piles?

Small internal piles are normally innocuous. However, larger piles may cause mucous discharge, soreness, irritability, and itch. The most common sign of piles is bleeding post passing stools. Sometimes there are no symptoms at all and you may not even realize that you have one. Nonetheless, a piles patient may experience:

  1. A hard and painful mass which is present around the anus.
  2. Feeling of bowels being full, even after passing of stools.
  3. Noticing bright red blood after passing stools, on the toilet paper or toilet pan.
  4. Itching and inflammation of the anal area.
  5. Pain while passing stools.

More severe symptoms of piles include:

  1. Excessive bleeding from the anus.
  2. Possibilities of severe infection.
  3. Inability to control stool passage.
  4. Anal Fistula (a small tunnel that develops between the end of the bowel and the skin near the anus).
  5. Strangulation where the blood flow stops in the piles causing infection and even formation of a blood clot.

What are the causes of Piles?

Piles are caused due to the increase of pressure in the lower portion of the rectum. Due to increase in pressure, the blood vessels surrounding the back passage (anus and rectum) get stretched, get swollen or form a lump, which is referred to as piles. Also, some are tend to develop for no apparent cause but there are specific circumstances that may certainly increase the chances of one developing piles such as:

  • Long term constipation leading to straining during a bowel movement or prolonged sitting in the toilet. Passing large stools increase the tension in and around the veins.
  • Long term diarrhoea/Chronic diarrhoea; Sitting on the toilet pot for too long can weaken pelvic muscles and increase pressure on you rectum and anus.
  • Frequent lifting of heavy objects – Straining and holding your breath while lifting weights could cause the veins near your anus to become swollen and possibly push through your anus, resulting in the disease.
  • Pregnancy – Piles are common during pregnancy. This is apparently due to pressure impacts of the baby lying above the rectum and anus, and also the effect that the change in hormones during pregnancy can have on the veins. However, this occurrence during the pregnancy often go away after the birth of the child.
  • Being obese – Being overweight increases the risks of developing piles.
  • Unnatural sexual intercourse.
  • Regular consumption of diet poor in fibre content.
  • Cancer in the colon – Some symptoms may include bleeding from the bottom, itching, and pain around the anus.
  • Prior surgery in the rectum area.
  • Injury in the spinal cord.

Your physician can normally detect piles after carrying out a physical checkup. They will check the anus of the person with suspected piles. The session will then be followed up with questions related to your medical history. In the case of internal piles, a digital rectal examination (DRE) or the use of a proctoscope (an instrument used to examine the anal cavity, rectum, or sigmoid colon) is required. A colonoscopy (an exam used to detect changes or abnormalities in the large intestine and rectum) may also be recommended if symptoms of the patient indicate some other digestive disease. 

While piles can be hurting and weakening, they do not pose any ongoing threat to health and can be self-managed up to an extent. However, if the complications are serious and causing unpleasant pain and hindrances in your day to day activities, then proper and immediate medical attention is suggested.

Studies show that heart disease is the leading cause of death worldwide. And, aortic stenosis is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. It is also often referred to as a disease of the elderly however a lot of young adults have also been diagnosed with aortic stenosis. The disease can occur in a single valve or in a combination of the four valves.  Usually, aortic stenosis is most common in heart’s aortic valve and mainly occurs due to the buildup of calcium deposits that narrows the valve.  When it comes to the treatment for aortic stenosis, it completely depends on the severity of the patient’s condition. Suggesting a valve replacement surgery or advising patients with medication and lifestyle changes completely depends on the doctor. But, it is important to understand that no pill can cure aortic stenosis completely but there are few medications that may help in lowering down the risk and complications involved. Let us now look at the treatment choices available for treating aortic stenosis along with its cost in India.

Treatment of Aortic Stenosis

Aortic stenosis is a progressive disease, which means it will get worse with time. Due to this, aortic stenosis is measured as mild, moderate, or severe stages depending on how damaged your aortic valve is. Treatment options for aortic stenosis generally range from simple medications such as statins or surgical repair or replacement of the diseased aortic valve. No pill can cure aortic stenosis, but medication like statins can help you lower your cholesterol which can control your symptoms and lower the risk of heart attack and stroke for some time. However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. Although, medication may be appropriate only for a person for whom surgery is not an option or for someone who’s aortic valve condition is in a very mild stage without any major visible symptoms.

In most of the cases, aortic stenosis treatment requires surgical treatment to protect the heart from further damage. Generally, surgery for aortic stenosis treatment depends on each patient’s unique requirements and factors responsible for their condition. Two of such major surgical treatment options for aortic stenosis include aortic valve replacement and Balloon/surgical Aortic Valvuloplasty (BAV).

  • Aortic valve replacement: In this procedure, your diseased aortic valve will be replaced with the mechanical valves made of metal or with valve tissue from pigs, cows or human donors using traditional open-heart surgery or Transcatheter Aortic Valve Replacement (TAVR).  Undergoing a TAVR surgery is a better treatment option as it is a minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.
  • Balloon/surgical valvuplasty (BAV): It is a less invasive procedure because it is done by inserting a long flexible tube with a deflated balloon on its tip into the blood vessel from the groin. When the tip reaches the valve, the balloon is inflated which helps to open up the stenotic or stiffed heart valves and increase the blood flow through the heart.

Why consider India for aortic stenosis treatment?

According to doctors, aortic stenosis treatment in India can be obtained at highly economical rates as compared to the Western world. Due to low treatment cost and a high level of expertise for cardiac diseases including aortic stenosis, India has become a leading destination for medical tourism in the world. Generally, the treatment cost for aortic stenosis in India depends upon multiple factors such as the selected treatment procedure, used technology, the severity of the disease, location, pre- and post-operative care demanded and other selected services. However, irrespective of any procedure selected for aortic stenosis treatment such as a SAVR, TAVR or balloon valvuplasty, the cost is less than the hospitals in western countries. People visiting India for treatment are not only from neighbouring countries like Bangladesh, Afghanistan and Nepal but also from far off countries like Kenya, Nigeria, Iraq, Yemen, Kazakhstan, Iran, Uganda and Oman. In India, aortic stenosis treatment is preferably carried out at a number of well-renowned multi-specialty and super-specialty hospitals located across a number of metropolitan cities of India such as Mumbai, Delhi, Chennai, Hyderabad, Pune, etc. These hospitals offer world-class facilities and doctors who are well-versed in performing these surgeries, even in the most challenging situations.

According to global standards, the cost of aortic stenosis treatment in India ranges from a few thousand rupees a month. As per an estimate of 2016, the mean cost for TAVR procedure in the US were 69,592$ vs 58,332$ for SAVR. As compared to these estimates, TAVR cost in India is roughly half (34,900$) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the western world.

These numbers along with the quality of treatment provided in India and effectiveness of TAVR are clearly responsible for a spike in the numbers of international patients. This means that the trend has clearly changed in the past decade in terms of treating a faulty valve and allowing individuals to live those additional years with greater quality of life or in an improved health state.

Today, the healthcare industry is simmering with innovation and new ideas. Transformation is happening at an astonishing pace and redefining the way in which patients are treated for any health-related issues. New-age technologies have boosted the success rate and are also turning out to be less invasive as compared to older methods. Especially, when it comes to treating hip pain and improving patient’s quality of life, hip replacement surgery is one of the most advanced and successful procedures in today’s medical space. Traditionally, Orthopaedic surgeons use to prefer a total hip replacement surgery by incising back or on the side of your hip. However, in recent times, surgeons prefer incising a cut in the upper part of the front thigh. This approach is called an anterior approach or anterior hip replacement. These surgeries may likewise be called small mini, modified, minimally invasive, or muscle-saving surgeries. The procedure involves replacing a damaged hip joint with an artificial hip that can be of metal or ceramic.

Though there are various approaches to the hip that can provide an exemplary outcome, over the past several years, the anterior approach has become more popular because of its minimally-invasive technique. Also, it lowers the risk of complexity before, amid and after the surgery. However, adopting this technique is highly preferred in patients with arthritis, but can also be used for patients undergoing THR due to any other reason like hip fracture, disorders that cause unusual bone growth (bone dysplasias), etc. A lateral or posterior hip replacement surgery and anterior hip replacement approach vary in certain ways but both the approaches share the same objective. Both the approaches are devised to provide adequate pain relief from the hip joint and allowing the patient to perform their normal chores with great comfort. Now let’s take a look at some benefits of Anterior Total Hip Replacement.

Benefits of anterior Total Hip Replacement

  • Compared to ancient science, after anterior THR, a patient suffers from less pain without causing much damage to surrounding tendons and muscles, which leads to a rapid and smooth recovery.
  • The patient will no longer need to be kept under observation post-surgery and can be allowed to go home immediately as per doctor’s advice.
  • Once the surgery is completed, it allows an option for the patient to walk out of their bed and cover small distances independently using any walking aid as soon as it’s comfortable.
  • The patient can also navigate through stairs with ease and comfort. While pursuing the stairs, lifting the stronger leg first onto the steps and starting with the weaker leg when coming back down through the stairs helps in preventing dislocation of the new implant. It is common for the patients to use cane, walker or any other equipment for walking assistance immediately after the surgery.
  • With the lateral or posterior approach, patients have to avoid bending and even sitting with their legs crossed for 6 – 8 weeks as this could result in hip dislocation. But with anterior approach patients are not restricted from any of these activities.

Life after anterior Total Hip Replacement

After implementing a successful anterior THR surgery, patients are able to bear weight on their new hip and can walk easily using any walking aid as per their support. The only thing that patients need to make sure is that their home stairs have a guardrail or banister installed, as to avoid any temptation of walking up or down the stairs unsupported. However, patients will need a personal trainer to restore the strength and movement in their joints and surrounding muscles. Mostly it will take up to 4-6 weeks to gain ample strength for the movement and performance of the daily routine activities. One can resume work after anterior THR, as it allows the majority of patients to start working after a month but we would recommend waiting for up to 3 months if it involves physical labour. Patients can expect their lifestyle to be a lot like how it was before having surgery but without the pain.

Summing up, anterior hip replacement by far is less painful and leads to a faster recovery of mobility and strength compared to a lateral or posterior approach. However, the recovery process still involves distinct phases to ensure the tissue is healing properly which will allow optimum functionality. It is important for every patient to know that every case is unique and the progression will completely depend on their unique set of circumstances. But, an anterior hip replacement approach is mostly likely to add more quality to a patient’s life.