What is the best treatment option for piles?

Q: I am a 27 year old woman. I have been suffering from haemorrhoids since past 5-6 years. I would describe them as third degree with the following symptoms: internal haemorrhoids with protrusion through the anus upon straining(generally during bowel movements) but no bleeding. 1. Can this third degree haemorrhoids (piles) be successfully treated by Infrared Coagulation technique? Is this technique same as "Cold Sqeezing" in India? 2. Does the doctor who uses this technique need to be a specialist or some General Medicine doctor can implement it without any risk? 3. What are the risks involved after being treated by this technique? And what care needs to be taken to avoid the risks?

A:Anal cushions usually protrude during straining. Since you have no bleeding,do you really need treatment? For small, bleeding piles we usually advise injection therapy. You do not need injection treatment because you are not bleeding. For piles that protrude and cause significant discomfort, surgery isrequired. The Cold technique is obsolete and is not advised. I have neverused the infrared coagulation technique, but I would advise against it. Youshould opt for a stapled haemorrhoidectomy as first choice (this costs aboutRupees 35-40 thousand in a private hospital), and for conventional haemorrhoidectomy if a stapled procedure is too expensive (conventional: Rs 20-30 thousand)