There is an old saying that perfectly captures why piles remain so widely undertreated: “The common people call them piles, the aristocracy call them haemorrhoids, the French call them figs — what does it matter, so long as you can cure them?” — John Ardene, 1307–1392.
Seven centuries later, the condition is just as common, and the reluctance to talk about it remains almost as old as the disease itself. But here is the truth: piles, clinically known as haemorrhoids and commonly called Mulvyadh or Bavasir in India, are estimated to affect at least 50% of the population at some point in their lives. That is one in every two people. If you are dealing with piles, you are far from alone and you no longer have any reason to suffer in silence.
At Healing Hands Clinic, founded by dedicated proctologist Dr. Ashwin Porwal, over 50,000 patients have been successfully treated for piles. The clinic holds the record for the maximum number of Stapler surgeries performed across Asia, introduced India’s first Laser Haemorrhoidoplasty (LHP), and today treats more patients with laser for piles than any other centre in the world. If that is not reason enough for hope, read on.
What Are Piles?
Piles (Mulvyadh / Bavasir) are the swelling of blood vessels near the anal opening. When pressure on these blood vessels increases for any reason they enlarge and swell, forming lumps that are occasionally felt at the anal opening. These swollen, inflamed vascular cushions are what we know as haemorrhoids.
In their normal state, these vascular cushions help maintain continence and cause no discomfort whatsoever. It is only when they become engorged and displaced that symptoms appear — and depending on how far the condition has progressed, those symptoms can range from a mild inconvenience to a life-altering daily ordeal.
What Causes Piles?
Understanding what causes piles is the first step toward preventing them and avoiding recurrence after treatment. The most common causes include:
- Constipation — the single most common cause of piles. Chronic constipation means repeated, prolonged straining during bowel movements, which dramatically increases pressure on the anal blood vessels and gradually weakens their supporting tissue.
- Hard stools and straining — even in the absence of full-blown constipation, habitually passing hard stools causes the same cycle of trauma and engorgement.
- Faulty toilet habits — sitting on the toilet for extended periods, such as reading or scrolling through a phone, sustains pressure on the anal region far longer than necessary and is a surprisingly significant contributing factor.
- Family history — a genetic predisposition to weaker vascular walls or connective tissue in the anal region increases risk considerably.
- Pregnancy and childbirth — the growing uterus exerts sustained pressure on pelvic blood vessels during pregnancy, while the physical effort of vaginal delivery can trigger or dramatically worsen existing haemorrhoids.
- Lifting heavy weights — repeated heavy lifting raises intra-abdominal pressure sharply, placing the anal vasculature under stress.
- Obesity — excess body weight creates chronic elevation of intra-abdominal pressure, subjecting the haemorrhoidal vessels to continuous strain.
Recognising the Symptoms
One of the reasons piles are so commonly mismanaged at home is that their symptoms can be vague and easy to dismiss — at least in the early stages. The symptoms to watch for include:
- Painless bleeding while passing stools — typically bright red blood on toilet paper or in the toilet bowl. This is the hallmark early sign of internal haemorrhoids, and any rectal bleeding deserves professional evaluation.
- Feeling a lump outside the anus — the sensation or actual presence of a soft protrusion at the anal opening, particularly after a bowel movement. In early stages this reduces on its own; in later stages it requires manual reduction or remains permanently prolapsed.
- Pruritus ani (itching around the anus) — persistent anal itching caused by mucus secretion from the inflamed haemorrhoidal tissue irritating the perianal skin.
- Faecal soiling of undergarments — mucus leakage from prolapsed haemorrhoids can cause persistent dampness and soiling, causing significant embarrassment and discomfort.
- Thrombosed haemorrhoid — if a blood clot forms within a haemorrhoid, it results in a severely painful, acutely swollen lump that worsens dramatically with bowel movements and sitting. This requires urgent medical attention.
How Are Piles Diagnosed?
The good news about diagnosis is that it is far simpler and less daunting than most patients expect. A medical history review followed by a visual examination of the anus is usually sufficient to identify piles. A digital examination and Proctoscopy in which a small scope is gently inserted to examine the inside of the anal canal is performed to confirm the diagnosis and accurately determine the grade of the condition.
At Healing Hands Clinic, Video Proctoscopy provides a real-time, magnified view of the anal canal, allowing the specialist to assess the haemorrhoids comprehensively and in complete comfort. Occasionally, a Barium study or Colonoscopy may be advised if your doctor needs to rule out any other cause of bleeding.
The Four Grades of Piles – Why Grading Matters
Piles are classified into four grades, and the entire treatment strategy at Healing Hands Clinic is built around this grading system. There is no blanket approach every patient is treated according to the precise severity of their condition.
- Grade 1 — Haemorrhoids are internal and cause painless bleeding. There is no prolapse at this stage. The blood vessels are engorged but remain within the anal canal.
- Grade 2 — Haemorrhoids prolapse out of the anus during straining or bowel movements but return spontaneously on their own once straining stops. Bleeding and discomfort are common.
- Grade 3 — Haemorrhoids prolapse and do not return on their own. They must be manually pushed back into place with a finger. Symptoms are more persistent and significantly affect daily life.
- Grade 4 — Haemorrhoids are permanently prolapsed and cannot be reduced manually. A blood clot may form within the prolapsed tissue (thrombosis). This is the most advanced stage and requires prompt surgical intervention.
Knowing your grade is the single most important step toward getting the right treatment.
Grade-Wise Treatment at Healing Hands Clinic
Grade 1 — MCDPA (Non-Surgical Treatment)
For Grade 1 piles where there is bleeding but no prolapse, Healing Hands Clinic offers the MCDPA protocol — a conservative, entirely non-surgical approach developed by Dr. Ashwin Porwal himself. The aim is to halt and reverse the early disease without any surgical intervention. MCDPA combines five pillars:
- Medication — creams such as Anoac and stool softeners to reduce inflammation and ease bowel movements.
- Constac — a herbal laxative preparation formulated by Ayurvedic doctors at Healing Hands & Herbs. Constac provides relief from acidity, bloating, hard stools, and sluggish digestion without the dependency risk of chemical laxatives.
- Diet — personalised dietary counselling by a qualified nutritionist to identify and correct imbalances in the patient’s eating habits and chart a diet conducive to healthy, regular bowel movements. The clinic particularly recommends the incorporation of cow’s ghee, citrus fruits, and curd, while advising patients to avoid processed, packaged, preserved foods, and excess sugar.
- Physiotherapy — targeted pelvic floor physiotherapy to strengthen the muscles of the anal and pelvic region, improving circulation and supporting haemorrhoidal tissue.
- Ayurveda therapy — approximately six sessions of Basti, an enema with medicated herbal oils drawn from the Ayurvedic Panchakarma tradition, to soothe the anal region, reduce engorgement, and promote natural healing.
For many Grade 1 patients, MCDPA delivers lasting relief without any procedure or operation.
Grade 2 and Early Grade 3 — Laser Haemorrhoidoplasty (LHP)
For Grade 2 and early Grade 3 piles with reducible prolapse, Laser Haemorrhoidoplasty (LHP) is the treatment of choice at Healing Hands Clinic.
Healing Hands Clinic brought the Leonardo Laser to India and performed the country’s first Laser Haemorrhoidoplasty. Today, the clinic treats more patients with LHP than any other centre in the world, and has trained surgeons from across the globe in this technique.
The procedure is elegant and minimally invasive. No cuts or incisions are made anywhere. Through the natural anal opening, a laser probe is passed and laser energy is applied using a special radially emitting fibre. The controlled emission of laser energy causes vaporisation of the engorged haemorrhoidal mass, leading it to shrink and retract. Simultaneously, fibrotic reconstruction generates new connective tissue that re-anchors the mucosal lining to the underlying tissue, preventing prolapse from returning.
The entire procedure takes approximately 20 minutes under short general anaesthesia.
Advantages of LHP :
- No cuts, no open wounds, no external stitches
- Less post-operative pain compared to other procedures
- Excellent healing with no cuts or sutures to manage
- No sense of urgency (no need to rush to the toilet) after the procedure
- No risk of rectal stenosis (narrowing of the anal canal)
- Patients return to normal activities significantly sooner
The clinic’s advanced modification LHP 360 targets haemorrhoidal tissue from all 360 degrees, further reducing recurrence rates and improving long-term outcomes compared to standard LHP.
Grade 3 and Grade 4 — MIPH (Stapler Surgery)
For advanced Grade 3 and Grade 4 piles with irreducible prolapse, MIPH — Minimally Invasive Procedure for Haemorrhoids (also known as PPH — Procedure for Prolapse and Haemorrhoids or Stapler Haemorrhoidopexy) is the gold standard.
The procedure was originally conceived in 1994 by world-renowned colorectal surgeon Dr. Antonio Longo of Italy and has since become the most widely used technique globally for advanced haemorrhoids. Dr. Ashwin Porwal received direct, hands-on training in this procedure from Dr. Longo himself has gone on to become one of Asia’s foremost practitioners of the technique.
The procedure uses a circular stapler introduced through the natural anal opening. The mucosa responsible for haemorrhoidal prolapse is circumferentially excised, and the prolapsed haemorrhoids are simultaneously pulled back up to their normal anatomical position and stapled there. This removes the prolapsed tissue and cuts off the blood supply feeding the haemorrhoids, causing any remaining tissue to shrink over the following weeks. The procedure takes approximately 25–30 minutes under short general anaesthesia.
Advantages of MIPH :
- No external cuts or stitches
- Minimal blood loss
- Minimal pain, easily managed with standard painkillers
- Sphincter function is completely preserved voluntary control over bowel movements is maintained
- Faster recovery patients can typically return to work by the 5th day
- Safe for diabetics, heart patients, and senior citizens
- Recurrence rate of 8% with standard MIPH brought down to less than 1% with Dr. Porwal’s Horizontal Mucopexy modification
Dr. Porwal’s Horizontal Mucopexy modification is a refinement he developed from his own extensive surgical experience. He presented this research “Stapler Haemorrhoidopexy alone vs Stapler Haemorrhoidopexy plus Mucopexy for Grade 3 Internal Hemorrhoids” at the 3rd Biennial ECTA Conference in Singapore in November 2013. He was also selected as an international speaker at the World Congress of Coloproctology in Rome in 2011, presenting a paper on “Piles and Constipation in Indian Scenario”, and at the ESCP Conference in Barcelona in 2014 on “Stapler Haemorrhoidopexy Successful results from a case series of 3000 patients treated at a single centre in India.”
Healing Hands Clinic has performed the maximum number of Stapler surgeries across Asia over 18,000 successful MIPH procedures to date.
What to Expect After Treatment
After a piles procedure at Healing Hands Clinic, recovery is smooth and well-supported. Patients are normally able to drink water shortly after the procedure and eat as soon as they feel hungry. Most can get out of bed within a few hours of surgery.
Bowel movements typically resume within 2–3 days of the operation. There may be mild discomfort initially and a sense of urgency the need to rush to the toilet which gradually settles over the following weeks. A small amount of blood loss after each bowel movement is normal in the early recovery period. Maintaining hygiene and keeping the operative site clean is important.
Prescribed laxatives are usually recommended for 2–4 weeks post-procedure. A high-fibre diet and increased fluid intake are essential throughout the recovery period. Patients can return to normal work by the 5th day post-surgery and resume all normal physical activities as they become comfortable.
When to Seek Urgent Help
While recovery is generally smooth, patients should seek help promptly if any of the following occur after treatment:
- Fever above 100°F
- Increasing pain, swelling, redness, or discharge at the operative site
- Severe or uncontrolled bleeding
- Constipation lasting more than 3 days
Why Choose Healing Hands Clinic?
Healing Hands Clinic is a certified centre of excellence for Proctology, providing avant-garde treatment for piles, fissure, fistula, constipation, rectal abscess, and pilonidal sinus. With over 40 centres across India including Pune, Mumbai, Bengaluru, Hyderabad, Nashik, Ludhiana, Ahmedabad, Surat, Latur, Chh. Sambhajinagar, Belagavi, Mysore, Gurugram, Lucknow, Mohali, and Raipur as well as an international centre in Dubai, expert piles care is available wherever you are.
Each centre is staffed by internationally recognised surgeons and equipped with state-of-the-art facilities. The clinic holds NABH accreditation, the first proctology clinic in India to receive it and maintains a 4.9-star Google rating across thousands of patient reviews. Both male and female specialist doctors are available at every centre, ensuring every patient receives care in a setting where they feel completely comfortable.
Take the First Step – From Piles to Smiles
You don’t have to normalise pain, bleeding, or embarrassment. Whether you are at Grade 1 or Grade 4, the right treatment matched precisely to your condition is available at Healing Hands Clinic. Thousands of patients have already made the journey from piles to smiles. Your good morning is waiting.
