Q: I have bleeding while passing stools, should I be worried about it?
A: Blood in stools is an extremely common aliment and can be seen among people of all ages. On one hand it can occur in large amounts and thus appear very alarming to the patient while on the other hand it can occur in small amounts and thus be ignored by the person. But one thing is very certain are that none should be ignored.
Q: What is the cause of such symptoms?
A: The most common cause of blood in stools is piles. It can also occur because of fissures. The other less common reasons for blood in stools are cancer of the large bowel, colitis and traumatic ulcers.
Q: I am having severe pain while passing stools. Can it be due to piles?
A: In most cases bleeding due to piles, though is bright red in color and is very alarming, is generally painless. Only in rare cases where the piles is very advanced and prolapsing can it be associated with pain. If you are having very severe pain, then it is probably due to anal fissure and not piles.
Q: What is the difference between fissure and piles?
A: Fissure is an injury or cut in the anal canal caused by the passage of hard stools. It is generally associated with significant pain in most cases and bleeding in some cases. Piles on the other hand, are essentially enlarged blood vessels in the anal canal, which bleed during passage of hard stools. Both occur due constipation and passage of hard stools. However both are different entities and hence the treatment is different.
Q: Can piles present with pain?
A: Yes, in some cases where it is very advanced and prolapsing.
Q: Are there any other causes of blood in stools?
A: Less commonly this can be due to colitis or tumors or cancers of the colon or rectum.
Q: What should I do if I have blood in stools?
A: You report to a surgeon, preferably a GI Surgeon, and should under go an internal examination to ascertain the cause.
Q: Would I need to undergo any investigation?
A: In most cases the cause of the problem can be ascertained once the Surgeon does an internal examination. In some cases a colonoscopy may be required to rule out colon cancer.
Q: If I have piles or fissure would I require an operation?
A: Most cases of piles or fissure if detected early can be treated with medicines and would not require any operation or surgery. However patients would continue to have problems with medicines will need to undergo an operation for complete cure.
Q: Is the treatment for piles and fissure the same?
A: Both are different diseases and hence the treatment for both is different.
Q: What sort of operation would I need to undergo for these aliments? Is it a complex procedure?
A: Surgery for these ailments is not a major one and can be performed as an out patient procedure or with a single day admission in the hospital. There is a lot fear among patients that surgery for these ailments is difficult, painful and requires long periods of leave from work. However, this is not so.
Q: What is the surgical treatment for fissure?
A: Surgery for fissures is a very simple procedure and does not require hospital stay. The patient can coming in the mornings, get operated and go home the same day after a few hours. The pain is relived almost instantaneously and the patients can join back to work the very next day. In other words only one day off from work is required.
Q: Is there any other alternative treatment for fissures?
A: Injection of botulinum toxin can be given for temporary relief, but this is an expensive procedure with inferior results and high possibility of recurrence.
Q: What is the surgical treatment for piles?
A: Surgery for piles is currently performed by stapler gun. The advantage of this method as compared to the previous conventional method is that pain is much less. Whereas in the convention type of surgery there was significant pain and patients could join back to work only after 2 to 3 weeks; with the current stapler treatment of piles, patients can join back to work on an average in about five days time. With this stapler method there are no stitches and no external wounds. No dressing is required. Similarly with regards to hospital stay, most patients are discharge on the same day of surgery.
Q: Can all cases of piles, which require surgery, be treated with stapler?
A: Yes, most cases can be safely treated with the stapler method. However, patients with very advanced disease, those who have huge prolapsing piles, would need to undergo the conventional surgery. In which case pain is more and more time is required for recovery.
Q: Are these treatments safe? What are the risks of complications?
A: These newer treatments are completely safe, with negligible chances of untoward complication.
Q: In case someone has colitis, what is the treatment?
A: For patients with colitis or to be more precise ulcerative colitis, again the treatment is with medicines. Surgery is required only in certain specific situations where the bleed is excessive or not responding to medicines.
Dr. Sanjoy Mandal
MBBS (AIIMS), MS (AIIMS), DNB, MRCS(Ed), MCh
Consultant GI Surgeon
(Advanced laparoscopic Surgery and Oncosurgery)
Director, Department of GI Surgery
Medica Superspecialty Hospital, Kolkata