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Piles treatment in KPHB begins with a proper check, never a guess. Moreover, bleeding, pain or a lump can point to three different problems. So, Dr. Viswanath Kamisetty examines you first and names the exact condition. After that, he explains every option in plain language.
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Medically reviewed by Dr. Viswanath Kamisetty MBBS, MD, DM (Medical Gastroenterology) Last reviewed: 13 August 2026
Piles, fissure and fistula sit in the same small area. However, they remain three separate conditions. Each one needs a different treatment plan. Also, many patients carry two of them together. Because of this overlap, self-diagnosis often goes wrong.
Bleeding worries most people the moment they notice it. Of course, they assume piles caused it. Sadly, that assumption can prove costly. After all, polyps, colitis and colon cancer cause the very same bleeding. Hence, our KPHB clinic checks you before we start any treatment.
Constipation drives all three problems in most cases. In fact, straining and long toilet visits make them worse every single day. So we treat the root cause, not merely the symptom. Otherwise, the trouble returns within a few months.
Knowing your exact condition changes the whole treatment. So here is what each one really means.
Piles are swollen blood vessels inside the anal canal. Everyone has these cushions naturally. However, they cause trouble once they enlarge or slip down. Internal piles usually bleed without any pain. In contrast, an external pile hurts badly when a clot forms inside it.
A fissure is a small tear at the anal opening. Usually, a hard stool causes it. Nerves crowd this area densely. As a result, the tear produces sharp, tearing pain. Then the muscle goes into spasm and blocks healing fully.
A fistula is a tunnel between the anal canal and the outer skin. Almost always, a perianal abscess starts it. Persistent pus discharge marks the main clue. Besides, a fistula never closes on its own. Antibiotics alone will not cure it either.
This guide helps you understand your symptoms. Still, it never replaces a proper examination.
Please note how long each symptom has lasted. Besides, notice where exactly the blood appears.
Bright red blood appears on the tissue. Sometimes it drips after a motion.
Something slips out during straining. Later, it returns on its own.
You feel damp between motions. And underclothes pick up stains.
Mucus usually causes this irritation. Often, patients mention only this symptom.
You finish the motion. Still, something feels left behind.
A hard, tender lump appears within hours. Often, a clotted external pile causes it.
Pain that outlasts the motion suggests a fissure. But repeated discharge suggests a fistula.
Many patients describe passing broken glass. Yet the tear itself stays tiny.
A burning ache continues for minutes. At times, it lasts several hours.
You hold on because of the pain. Then, the stool hardens and deepens the tear.
Wetness near the anus keeps staining clothes. Besides, it rarely settles by itself.
A painful lump builds up and bursts. Later, it returns after a few weeks.
You notice a small hole beside the anus. Sometimes, more than one appears.
Grading applies only to internal piles. Moreover, the grade decides your entire treatment plan.
Treating a symptom without its cause invites relapse. Hence, we work through these drivers together.
This remains the biggest driver of all three conditions. Hard stool tears the soft lining. Meanwhile, repeated straining swells the anal cushions until they prolapse.
Sitting with a phone keeps the cushions under pressure. Twenty minutes daily adds up quickly. In fact, we correct this habit more than any other.
Pelvic pressure rises steadily through pregnancy. Also, hormones slow the bowel down. So, piles and fissures appear commonly after delivery.
Long commutes and desk work slow your bowel. So, pressure builds in the anal veins. We see this pattern often across the KPHB and Kukatpally IT workforce.
Refined food leaves very little fibre behind. Besides, most people drink too little water. Hyderabad summers make this problem sharper still.
Every fistula starts as a perianal abscess. However, some cases keep coming back. Then we look for Crohn's disease, tuberculosis or diabetes behind them.
Not every patient needs every test. Instead, each step decides whether the next one follows.
First, we ask about the bleeding, the pain and your bowel habit. Then we examine the area briefly. Also, a nurse stays present. This step identifies most fissures and fistula openings straight away.
Next, a small scope checks the anal canal. The whole test takes under a minute. Moreover, it needs no anaesthesia. Because of proctoscopy, we grade your piles exactly instead of guessing.
Sometimes the bleeding needs a fuller answer. Then we scope the large bowel as a day-care test. You stay under sedation and go home the same day.
A simple haemogram shows whether the bleeding caused anaemia. Besides, we check sugar and thyroid where relevant. Long-standing piles cause iron deficiency more often than people expect.
An MRI fistulogram maps the tunnel clearly. Or, an endoanal ultrasound does the same job. Surgeons need this map first. Otherwise, an operation risks damaging the sphincter muscle.
Finally, you leave with a named condition and a grade. Also, you carry a written diet and bowel-habit plan. We also state clearly whether you need a procedure.
Several treatments exist for piles. Your grade, your symptoms and your general health decide which one suits you.
Most patients never need anything beyond this group. We offer all three at the KPHB clinic itself.
A tiny band goes at the base of the pile. Then it shrinks and drops off within days. Suits Grade 2 and selected Grade 3 piles, without cutting or general anaesthesia.
Higher fibre, more fluids, stool softeners, topical creams and sitz baths. This suits Grade 1 and Grade 2 piles. Also, it supports every other option listed here.
An injection shrinks the swollen vessel and stops the bleeding. This suits small internal piles. Besides, it works well for patients on blood thinners.
These need an operating theatre. We confirm the grade, complete your bowel evaluation, then refer you to a colorectal surgeon with everything in hand.
Laser energy shrinks the pile from inside. Recovery runs shorter than open surgery. However, it costs more and suits selected grades only.
Also called MIPH. A stapler lifts the prolapsed piles back into place. Pain stays lower afterwards. Yet recurrence rates run slightly higher.
The surgeon removes the pile completely. This remains the most reliable option for Grade 4 and clotted piles. Recovery takes two to three weeks.
These two conditions need different treatments. Early fissures heal on medicines. Fistulas, however, always need a procedure.
Roughly nine in ten early fissures heal without surgery, provided treatment starts soon enough.
A small injection relaxes the tight muscle for a few months. That break lets a chronic fissure heal. Also, it avoids any permanent cut to the sphincter.
Stool softeners, sitz baths and a sphincter-relaxing ointment together. The ointment restores blood flow so the tear closes. Most acute fissures heal in two to six weeks.
A surgeon releases a small part of the internal sphincter. Healing rates run very high. Yet it carries a small continence risk, so we reserve it for stubborn cases.
No medicine closes a fistula. Imaging maps the tract first, because the tract decides which procedure fits.
This settles an active abscess and relieves the pain quickly. Above all, understand what it does not do. The tunnel stays open and still needs treating.
Fistulotomy opens a simple, low tract and lets it heal. A seton drains a complex tract slowly instead. Both protect the sphincter muscle.
Sphincter-sparing options for complex or high fistulas. Each closes the tract without cutting the muscle. Your imaging decides which one applies.
Piles treatment in KPHB too often begins with a guess. Someone hands over an ointment. Another quotes surgery without looking. At the same time, everyone assumes the bleeding came from piles.
We check every patient here. Where the picture warrants it, a scope follows. So, you receive a named condition and a grade, not a guess.
We perform scopes at the KPHB Colony clinic itself. So, you skip the referral chain entirely. Also, no second trip across the city becomes necessary.
Most early piles and acute fissures settle without any procedure. Hence, we discuss surgery only when the grade justifies it. It never opens the conversation.
Each check stays brief, and a nurse attends always. And you can book entirely over WhatsApp. Sunday morning slots suit patients who cannot take leave.
Consultant Gastroenterologist & Liver Specialist. Advanced Interventional Endoscopist at Gokul Gastro & Liver Care, KPHB. He also consults at Medicover Hospitals, Financial District.
Usually, yes. Grade 1 and Grade 2 piles respond well to medicines. Raised fibre, fluids, stool softeners and sitz baths work together, alongside a corrected toilet habit.
Rubber band ligation covers the next group, without cutting. Surgery suits Grade 4 and clotted piles only.
Pain gives the simplest clue. Internal piles bleed freely without hurting. But a fissure causes sharp, tearing pain that lingers for hours. Constant pus points instead to a fistula.
However, all three often occur together. So only a check confirms it.
No. Piles cause most cases. Yet polyps, colitis and cancer produce the same bleeding. So some patients need a colonoscopy first.
Dark blood, weight loss or a changed bowel habit all raise concern. Likewise, any first bleed after forty-five needs a check. Read how we investigate blood in motions.
No, sadly. Antibiotics settle the infection and reduce discharge for a while. So the fistula seems to improve. Yet the tunnel stays open.
Only a procedure closes it. First, imaging maps the tract. Also, we rule out Crohn's disease and tuberculosis.
An early fissure heals within two to six weeks. Stool softening and a relaxing ointment work together. However, a fissure lasting beyond six weeks turns chronic. Then medicines alone rarely work. So early treatment saves you months of pain.
Cost depends on what you need. A visit alone costs least. Proctoscopy, colonoscopy or a day-care procedure add to it. We explain every charge first.
Please call 90000 20315 or message us on WhatsApp.
Message us with how long your symptoms have lasted. Then we suggest the earliest suitable slot. Also, you can share reports over WhatsApp beforehand. Your consultation stays fully private.