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Choosing the Best Piles Doctors in Pune: A Guide to Expert Care

January 03, 2025 by Amit Kadam

Piles, or hemorrhoids, are a common medical condition that can cause discomfort and significantly impact daily life. Whether mild or severe, timely and appropriate treatment is essential. Pune, with its well-established healthcare system, is home to many highly skilled doctors specializing in piles treatment. This guide will help you understand what to look for in a doctor and introduce you to some of Pune’s leading piles specialists.

Why Choosing the Right Doctor Matters

Selecting the right doctor for piles treatment can make a significant difference in your recovery and overall experience. Here’s why:

  1. Accurate Diagnosis: Piles can sometimes be mistaken for other conditions like fissures or fistulas. A specialized doctor ensures an accurate diagnosis, which is the foundation for effective treatment.
  2. Expert Treatment Options: Depending on the severity, piles can be treated through medication, lifestyle adjustments, or surgical interventions. Experienced doctors are adept at identifying the most suitable approach for each patient.
  3. Minimizing Risks and Complications: A skilled doctor ensures that treatment is performed safely, reducing the risk of complications and enhancing recovery outcomes.
  4. Holistic Care: Beyond the medical procedure, an expert provides guidance on lifestyle modifications and preventive care to help manage the condition long-term.

Key Factors to Consider When Choosing a Piles Doctor

When looking for the right piles doctor, keep the following in mind:

  1. Qualifications and Experience: Seek doctors who specialize in proctology or colorectal surgery. Years of experience treating piles indicate familiarity with various cases and challenges.
  2. Modern Techniques and Technologies: Advanced methods such as laser surgery are preferred for their precision and quicker recovery times. Look for doctors proficient in these innovative approaches.
  3. Reputation and Patient Reviews: A doctor’s reputation speaks volumes. Check reviews, testimonials, or recommendations to assess their expertise and patient satisfaction.
  4. Accessibility and Aftercare: A good doctor provides not just treatment but also accessible post-procedure support to ensure a smooth recovery.

Top Piles Doctors in Pune

Here are some renowned piles specialists in Pune known for their expertise and dedication to patient care:

  1. Dr. Ashwin Porwal
    • A leading proctologist with extensive experience in treating piles using advanced techniques.
    • Known for pioneering minimally invasive procedures in India, such as stapler and laser surgeries.
    • Dr. Ashwin Porwal focuses on holistic care, combining medical treatment with lifestyle guidance for long-
      term relief.
  2. Dr. Paresh Gandhi
    • Recognized for his expertise in laser treatment for piles.
    • Dr. Gandhi has a patient-centered approach, ensuring personalized care and effective outcomes.
  3. Dr. Deepak Kulkarni
    • Specializes in managing complex anorectal conditions, including piles.
    • Renowned for his meticulous diagnostic approach and compassionate patient care.
  4. Dr. Rohit Shool
    • Skilled in both surgical and non-surgical piles treatments.
    • Dr. Shool is known for his commitment to delivering quality care and ensuring patient comfort.

How to Find the Right Doctor for You

  • Start by researching specialists in your area and checking their credentials.
  • Consult online reviews or ask for recommendations from friends and family.
  • Schedule a consultation to understand their approach and treatment plan.
  • Don’t hesitate to ask questions about their experience, methods, and success rates.

Conclusion

Choosing the best piles doctor in Pune requires careful consideration of qualifications, experience, and patient reviews. Doctors like Dr. Ashwin Porwal, Dr. Paresh Gandhi, Dr. Deepak Kulkarni, and Dr. Rohit Shool are among the many skilled specialists in the city, offering effective and compassionate care.
Take the first step toward relief by consulting a qualified doctor today and reclaim your quality of life.

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Overview of Modern Treatments for Piles

Piles, also known as hemorrhoids or Mulvyadh (Bavasir in Hindi), are swollen blood vessels in the rectal area that can cause discomfort, pain, and bleeding. With advancements in medical technology, treating piles has become more effective, minimally invasive, and tailored to individual needs. Healing Hands Clinic, a pioneer in proctology, offers state-of-the-art solutions for piles, ensuring optimal patient care and speedy recovery.

Understanding Modern Treatments for Piles

Modern treatments for piles aim to address the root cause of the condition while minimizing downtime and discomfort. The following are some of the advanced options available at Healing Hands Clinic :

1. MCDPA Regime (Conservative Management)

For early-stage piles (Grade 1 and early Grade 2), a non-surgical approach called the MCDPA Regime is often recommended. It includes :

  • Medication: Creams and stool softeners to alleviate symptoms.
  • Diet: Personalized dietary plans designed by expert nutritionists to prevent constipation.
  • Physiotherapy: Exercises to strengthen pelvic floor muscles.
  • Ayurveda Therapy: Herbal enemas to cleanse and heal the rectal area.

This approach focuses on lifestyle changes and holistic care to prevent disease progression.

2. Laser Haemorrhoidoplasty (LHP)

Laser Haemorrhoidoplasty is a cutting-edge, minimally invasive procedure that uses laser energy to shrink the hemorrhoidal tissue. It is effective for Grades 2 and 3 piles.

LHP 360 – A Revolutionary Advancement

At Healing Hands Clinic, we offer LHP 360, an advanced modification of Laser Haemorrhoidoplasty. This technique not only targets hemorrhoidal tissue with precision but also reduces recurrence rates and promotes quicker recovery. With LHP 360, patients experience a shorter downtime and improved long-term outcomes.

3. Minimally Invasive Procedure for Hemorrhoids (MIPH)

Also known as Stapler Hemorrhoidopexy, this technique is ideal for treating Grade 3 and Grade 4 piles. It involves the use of a circular stapler to reposition prolapsed hemorrhoidal tissue to its normal position.

4. Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL)

This innovative procedure uses ultrasound to locate and ligate hemorrhoidal arteries, cutting off the blood supply to the piles. Over time, the piles shrink and resolve.

5. Open and Closed Hemorrhoidectomy

For large or complex piles, a surgical hemorrhoidectomy may be performed. While this method involves longer recovery times, it is highly effective for advanced cases. Healing Hands Clinic ensures that such procedures are carried out with utmost precision to minimize discomfort.

Why Choose Healing Hands Clinic for Piles Treatment?

Healing Hands Clinic is a trusted name in proctology, with centers across major cities in India. Here’s why it’s the go-to destination for piles treatment:

Expert Team : Internationally trained surgeons specializing in minimally invasive procedures.
Comprehensive Care: Combining modern medicine with holistic approaches like Ayurveda and physiotherapy.

State-of-the-Art Technology :Equipped with advanced tools for diagnostics and treatment.
Patient-Centric Approach: Customized treatment plans based on individual needs.

Takeaway

With advancements in medical science, piles no longer have to be a source of prolonged suffering. Whether it’s conservative management, laser therapy, or stapler surgery, modern treatments offer effective and less invasive solutions. Healing Hands Clinic stands at the forefront of these innovations, delivering excellence in piles care.

To know more or book a consultation, visit the official website of Healing Hands Clinic: https://www.healinghandsclinic.co.in/piles-mulvyadh-bavasir-treatment/.

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10 Reasons Why You Should Choose Laser Treatment Over Conventional Surgery

Recent advancements in technology have revolutionized many industries, and the medical field is no exception. One such technological innovation that has become increasingly popular in recent years is laser treatment. The benefits of laser treatment are numerous, ranging from increased precision and reduced scarring to shorter recovery times and reduced risk of infection. With these advantages, it’s no wonder that more and more healthcare professionals are turning to laser technology for a wide range of medical procedures.

In this blog, we will discuss the top 10 benefits of choosing laser treatment

Benefits of laser treatment

The need for laser treatment is widely being chosen as it is convenient and a fast process. Mentioned below are the top 10 reasons to choose a laser treatment over surgical one.

1. Reduces pain

Laser treatment is a leading-edge method that reduces pain and inflammation, offering patients rapid relief without any known side effects. The treatment delivers high-energy light waves into the affected area, stimulating the body’s cells and speeding up the healing process. Unlike traditional treatments, laser therapy is non-invasive and non-toxic, making it an ideal solution for those who seek a natural approach to pain relief. Whether you suffer from acute or chronic pain, laser therapy can help you get back to living life to the fullest.

2. Heals sprain and strain

With advances in technology, laser treatment has become an increasingly popular option for aiding in the healing of sprains and strains. This non-invasive procedure can quickly reduce inflammation and promote tissue regeneration, leading to faster recovery times and improved mobility. Patients often experience little to no discomfort during the procedure, and the benefits can be seen almost immediately. Laser treatment is a promising option for those seeking a safe and effective alternative to traditional physical therapy or medication.

3.Treats injuries superficially

Laser treatment has been proven to be an effective way to repair superficial injuries such as wounds and ulcers. In fact, laser treatment is becoming increasingly popular as a treatment option for a wide variety of conditions. This non-invasive procedure is fast, efficient, and requires little or no downtime. By using a precise laser beam to target damaged tissue, healthcare professionals can stimulate the body’s natural healing response and promote more rapid recovery.

4.Improves local blood circulation

Laser treatment has proven to be an effective and immediate solution to improve local blood circulation. This non-invasive procedure applies top-of-the-line technology that is designed to stimulate the affected area with concentrated light energy. This helps to activate microcirculation, accelerating the process of healing and reducing inflammation. Patients often report feeling relief and improvement in their symptoms following laser treatment sessions.

5.Causes no blood loss

Laser treatment has revolutionized medical practices, especially for procedures requiring surgery. Another reason for this is the reduction in blood loss during treatment. With traditional surgical methods, large incisions are required, leading to significant blood loss, which in turn impacts recovery time. However, with laser treatment, incisions are minimal, significantly decreasing the amount of blood lost during the procedure.

6.Short stays in hospitals

This minimally invasive method involves a very short hospital stay, as the laser energy promotes faster healing and lesser scarring. Laser treatment has been successfully used to treat a range of conditions, from skin diseases to cancerous tumours. It is known to have fewer side effects and complications compared to traditional surgical methods, making it a preferred option for many patients. Furthermore, the precision of lasers makes them highly effective for targeting specific problem areas while sparing surrounding healthy tissues.

7.Safer alternative to surgery

It has been found to be a safe and effective method for treating many conditions when surgery is not necessary. Laser treatment involves a minimally invasive approach that carries low risk compared to traditional surgery while achieving similar results. Patients who desire reduced downtime, lower risk of complications, and a quicker recovery often choose laser treatment over surgery.

8.Less expensive

While surgery is still a necessary option in many cases, laser treatment is often less invasive, less painful, and less expensive. This is because there is no need for incisions or extensive healing. Instead, the laser beam is used to target the area requiring treatment, reducing the risk of complications and shortening the recovery time for patients.

9.Minimally invasive

Laser treatment has become a popular method for performing minimally invasive procedures through a small hole in the skin. As patients continue to seek out less invasive treatment options, laser technology has rapidly evolved to meet these demands, offering a safe and effective solution for a wide range of conditions. Whether you’re seeking treatment for a benign lesion or a more serious medical condition, laser treatment is a promising option worth exploring.

10.No Recurrence

Laser technique has been able to bring down the recurrence rate for wounds to less than 1% compared to an industry standard of 20-25% which is also taken care of with continuous followup. Defined laser energy is used to circumferentially vaporize and cure the problem while sparing the muscle around it.
Laser is quick, precise, and the post-procedure healing is excellent.

Conclusion

Over the years, it has gained popularity thanks to its non-invasive nature and effectiveness in treating a range of conditions. The FDA has cleared its use and there is ample evidence from extensive studies to support its efficacy. Patients have reported significant improvements in pain and mobility, making it a viable option for those seeking to augment their existing treatment protocols.

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Cutting Edge | How to cure fistula permanently?

Pune colo-rectal surgeon Dr Ashwin Porwal has developed the minimally invasive DLPL technique to treat complex fistulas

For 12 long years, US-based Julie Rogers suffered from a Grade 5 super complex fistula. Her personal health challenges made her seek a series of treatments that unfortunately did not offer long-term relief. She had no idea what to expect though when she arrived in Pune in July where Dr Ashwin Porwal and his team’s “healing hands” performed the Distal Laser Proximal Ligation (DSPL) procedure and freed her from pain.

There are various kinds of fistula and Dr Porwal’s patients vouch for a cent per cent cure. Take for instance Pune’s Dr Saloni Joshi who developed an obstetric fistula – a hole between the birth canal and bladder and/or rectum caused by prolonged obstructed labour – but was cured completely.

WHAT IS A COMPLEX FISTULA?

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. “Fistula-in-ano is one of the most commonly encountered surgical problems with the prevalence of average 2/10,000,” says Dr Porwal, founder of Healing Hands Clinic in Pune and a noted colorectal surgeon who specifically designed the Distal Laser Proximal ligation procedure for highly complex anal fistulas.

The condition has been known since ages and different management techniques for it have been suggested in medical literature. But it continues to be one of the most challenging clinical problems in anorectal surgery.

Various surgical interventions have had variable success. The surgical management of complex fistula is usually aimed at the permanent elimination of the suppurative process by drainage of sepsis and removal of fistula tracts while maintaining sphincter integrity.

Recently, the Indian Journal of Colo-Rectal surgery has concluded that minimally invasive, sphincter-saving DLPL surgery is safe and effective treatment for complex fistula‐in‐ano. “This is a minimally invasive sphincter saving surgery for complex fistulas. Basically it addresses the intersphincteric space which is the root cause of complex fistula,” says Dr Porwal, who has performed 4,661 such surgeries till date. In Julie’s case, an inflammatory bowel disease (Crohn’s disease) led to the fistula developing between one loop of intestine and another.

WHAT IS THE DLPL SURGERY?

Dr Porwal explains that the DLPL is based on two principles. One is debridement, which is a procedure for treating the wound on the skin. Inefficient debridement is one of the causes of recurrence in fistula. This is achieved in a minimally invasive way by using a laser, which takes care of the fibrosis associated with complex fistulas. The debridement is thorough and deep with the use of a laser, which can be easily negotiated within the Intersphincteric space and supralevator space.

“The other principle is the efficient drainage from the fistula in the first two to three weeks which is the key to success in curing it after surgery,” he says.

DLPL is performed under the guidance of a 3D EndoAnal Imagine machine which can identify hidden fistula tracts and micro abscess in real time during surgery. That is the key in getting assured results with surgery. It also minimises the risk of damage to sphincter muscles.

Widening of the external opening serves that purpose while superficial incision over the internal opening helps in proper drainage in the initial three weeks after surgery. This is achieved by timely follow-up planned at five days, two weeks, four weeks and six weeks. “That is the reason why DLPL is associated with a negligible recurrence rate,” Dr Porwal says.

There is no need for daily dressing with DLPL and the patient can resume work in about five days. There is also no risk of incontinence as sphincter muscles are not incised, says Dr Porwal, who has trained over 250 surgeons in the country and worldwide.

 

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DLPL laser technique brings down incontinence, recurrence rate in highly complex anal fistula patients

DLPL laser technique

Long-term follow-up of 683 operated patients shows a 99% success rate

Whether he would lose bowel control was one thing that weighed heavily on Ankit’s mind prior to undergoing surgery for anal fistula. “It has been more than two years now. I am completely fine post-surgery,” said Ankit, a software professional.

Ankit was part of an observational study comprising long-term follow-up of 683 operated patients with complex anal fistula for 30 months.

The study has shown that a minimally-invasive laser surgery technique can cure patients with complex anal fistula without causing bowel/anal incontinence – a known postoperative complication. The surgical technique also significantly reduces the recurrence rate which is very high in patients with anal fistula.

“Anal fistula is often considered a dilemma because of postoperative incontinence and recurrence rate. Using a distal laser proximal ligation technique (DLPL) – a minimally invasive sphincter-saving surgery, we could address anal incontinence and recurrence in 99% of our operated patients,” said Pune-based colorectal surgeon Dr. Ashwin Porwal.

Dr. Porwal’s study got published in a reputed index journal – Indian Journal Of Colorectal Surgery – recently.

Patients with anal fistula harbor apprehension of developing anal or bowel incontinence post-surgery. The bowel incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. It can significantly impact the quality of life.

“The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged. The DLPL technique deals with the root cause of complex fistula that is the internal opening and inter-sphincteric abscess,” Dr Porwal said.

DLPL is specifically designed for highly complex anal fistulas. “That’s why it has a 99 % success rate even in patients with type 4 complex anal fistula,” Dr. Porwal said.

Core principles of the DLPL technique are accurate diagnosis based on a 3D endoanal imaging probe, adequate debridement of the fistula tract with a radial Laser fiber, efficient drainage of the abscess in the first three weeks post-surgery, and excellent post-operative wound care.

“Follow-up after surgery is the key to success. A minimum of three follow-ups are required. First at 2nd week, then 5th week and finally at 8 weeks,” he said.

When probed why the study did not compare DLPL results with other laser treatments meant for anal fistulas, Dr. Porwal said, ” Ours is the only published study till date on highly complex anal fistulas with use of laser. Most of the studies – available for laser treatment in fistula – are for moderate cases but not specific to type 4 or highly complex cases.”

Every study has certain limitations. “In our case, it was a single-center study. But very soon we are planning to do a multiple center study. Adequate training of the surgeons is a must before that,” Dr. Porwal said, adding, “To date, we have operated on more than 5,500 cases of complex fistula. Very soon we will be publishing the results of our long-term follow-up study of operated patients for five years.”

Dr. Jaya Maheshwari, a senior member of the Indian Association of Gastrointestinal Endosurgeons (IAGES) Jaipur was the first surgeon outside Pune to get trained under Dr. Porwal in 2014. “I have performed DLPL technique on more than 200 patients with highly complex anal fistula by now with a similar success rate of 98-99 %,” Dr. Maheshwari said.

BOX

Why the study?

The surgical management of complex fistula carries a greater risk of incontinence, due to the involvement of the anal sphincter muscles

There are many surgeries performed for complex anal fistulas, but their success rates are variable

There is no single technique that can be called a gold standard in managing complex cases

The surgery with good-postoperative healing, with minimal or no functional loss, and less recurrence is need of the hour

This study was conducted to evaluate the efficacy of a novel technique, DLPL surgery, in the treatment of complex anal fistula

This study aimed to objectively assess the impact of operative treatment using the DLPL technique on quality of life-related to anal incontinence, recurrence

The study design

The study Included 683 operated patients of highly complex anal fistula with the DLPL technique between January 2013 and December 2017 with a minimum long term follow up of over 30 months

Most of the patients were working in the IT industry

Most of the patients were discharged the next day of surgery

The average time required to resume normal activities was less than a week

The overall success rate of the DLPL technique was 98.98% with a minimum long-term follow-up period of 30 months

Complete healing time was average 10 weeks for most of the cases

The study has concluded that the DLPL technique is minimally invasive,sphincter-saving, and has a negligible recurrence rate

Download PDF

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Path-breaking Laser Technique for Fistula Treatment

With the medical field flourishing at a steady rate, healthcare has been witnessing a radical change in the way we approach treatment of various diseases. A lot of these advancements are further supplemented by unparalleled medical expertise and that is exactly whatsuper-speciality Proctology centre Healing Hands Clinic offers to all its patients. Proctology is a branch of medicine that deals with anorectal conditions like Piles, Fistula, Constipation, Fissure, Pilonidal Sinusamongst others. Healing Hands is India’s first chain of Proctology clinics offering cutting edge treatment options to patients suffering from these ailments. Each clinic is a state-of-the-art centre headed by an expert Laser surgeon with considerable experience in treatment of aforementioned conditions.

Of all anorectal disorders, an Anal Fistula is undoubtedly the most challenging to treat as recurrences are quite common. In this condition, an abnormal communication develops between the rectum/anal canal and the outer skin. This is where the expertise and experience of surgeons at Healing Hands comes in handy. Founded by renowned surgeon Dr Ashwin Porwal, all the procedures done at Healing Hands are Laser based, well-researched and backed by sound medical knowledge. For Simple Fistula, a technique called FiLaC – Fistula Laser Closure is used. For Complex and Recurrent Fistula, an innovative, sphincter-saving technique called DLPL – Distal Laser Proximal Ligation is used.These Laser based techniques ensure complete recovery and have a negligible chance of recurrence. Besides, they have a reputation of faster healing, minimal complications and a quicker return to normalcy for the patient. Statistics so far state thaton an averagethere is about 30% chance of recurrence in treated cases of Fistula. However, at Healing Hands, the numbers are at a mere 2% which clearly exhibits a sturdy success rate of the surgicalexpertiseoffered at this holistic clinic.In fact, Healing Hands is well known worldwide for treatment of highly complex and recurrent cases.All operated patients are thoroughly followed up until complete cure.

DLPL technique that was developed by Dr Porwal is an innovative procedure for complex and recurrent cases. The sphincter muscles remain safe and the patient does not run a risk of post-operative loss of control over motions (incontinence). Healing Hands Clinic has published a research paper on a series of 100 patients with Complex High Fistulas treated with DLPL in which there was not a single case of recurrence or Incontinence.

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Anorectal Problems And How You Can Solve Them – Healing Hands Clinic, Your One-Stop Shop For All Your Proctological Solutions

What is an anorectal problem?

An anorectal problem is an internal condition that causes pain in the lower portion of the rectum. In the modern world, it is often used to describe an internal condition that causes problems with the bowel, including hemorrhoids, diverticula, and anal fissures. They can be related to either an injury or a disease and can be diagnosed through clinical evaluation.

Who is a proctologist, and what is proctology?

Proctology is the branch of medicine that focuses on the study of the pelvic floor (rectum/anus). It is the name given to the entire field of pelvic medicine, which is concerned with the care of the pelvic organs (rectum/anus) and their functions. It includes an anorectal examination, which is used to detect the presence of an internal disorder. Proctology is the study of the anorectal region. It is a medical specialty that deals with the external and internal parts of the body, including the prostate, bladder, and rectum.

A proctologist is a medical professional who is trained to operate on the inside of the body, particularly the rectum, and the outside of the body, especially the prostate. The term proctologist means a physician or surgeon who has trained in this specialty. In a medical sense, proctology is a subspecialty of surgery and is a specialization of medicine.

A common mistake patients make is going to the wrong kind of doctor :

Patients often go to the wrong doctor instead of a proctologist. This is often because the doctor who is trained to perform the examination does not know what is wrong and does not have the necessary skills to help the patient. This is especially true for patients who have experienced rectal pain and bleeding. There are several methods of diagnosing rectal pain and bleeding. It is important that one always visits a proctologist if they suspect they have an anorectal problem.

Patients often visit fake doctors or ‘quacks’ in the hope that they can get a quick fix to their problems. This often causes more harm than good,

Common symptoms of anorectal problems

● Bleeding from the rectum
● Constipation
● Anal pain
● Lumps
● Problems with passing stool
● Abscesses

What Healing Hands Clinic is the best choice for you

Our clinic tackles your problems differently right from the get-go. We pride ourselves on inpatient care. Our clinic is the best choice because we provide the best possible care for your problems. We diagnose the problem and offer you the best treatment. Our medical professionals are trained to detect and treat any type of anorectal problem. Our doctors are the best-trained in the diagnosis and treatment of anorectal problems.

Here is what makes us different :

1. You are welcomed and made comfortable when you arrive
We pay attention to your comfort and care throughout your appointment-making process

2. You are assigned a caring buddy.
A care buddy is a trained assistant doctor who will be your point of contact while you heal. In fact, they will be in touch with you for up to 5 years after your procedure to ensure you are doing well.

3. A proctologist is assigned to you.
A super specialized doctor is assigned to take care of your case. They will grade the severity of your illness. Our doctors will treat you with in-house medication that is herbal and causes minimal side effects to the body.

4. Painless proctoscopy
In the event that you need a proctoscopy, we promise it will be painless. Most proctoscopies, if done elsewhere, will tend to hurt. However, we have ensured that we created a method to conduct this procedure as painlessly as possible.

5. Recurrences are negligible
In anorectal cases, recurrences are common. However, we ensure that the margin for recurrences is negligible. In the extremely unlikely event that some sort of problem does recur (within five years of the procedure taking place), we treat it for free.

Overall our physicians are the best choice for your anorectal procedure. We have built a comprehensive network of physicians and specialists who treat your problem. We are really the best choice for all your proctological procedures, and we ensure that you will have the smoothest possible with us.

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Emergency Surgeries during Covid

One of the challenges in health care during the ongoing covid-19 pandemic has been emergency surgeries. In a time wherein there was no clear guideline, managing emergency surgeries was a huge challenge. There were papers from the western world suggesting 25% morbidity in surgeries during the covid pandemic. The guidelines on pre-op testing for covid 19 were not clear.

There is tremendous fear amongst patients to seek immediate medical consultation during the ongoing pandemic. As a result of this most of the patients are presenting at the hospital in late-stage or severe pain.

This was noticed in the majority of the patients during the lockdown period. This was noticed in patients suffering from piles & fistula.
“Almost all the piles’ patients presented with severe pre-rectal bleeding or in severe pain,” says Dr Ashwin Porwal.
They were operated on with minimally invasive Laser Haemorrhoidoplasty under universal precaution.

“Many patients of Fistula in Ano presented with abscess due to late presentation. They were operated under emergency with minimally invasive DLPL laser surgery for fistula”, says Proctologist Dr Ashwin Porwal at Healing Hands Clinic.

There were 4 cases of Fourniers gangrene with uncontrolled diabetes with early sepsis. Emergency ambulance pick-up was arranged for such patients during the lockdown. Early surgery could prevent severe sepsis with faster recovery, Says Surgeon Dr Paresh Gandhi.

“All patients were operated under spinal anaesthesia to decrease the risk of transmission due to covid pandemic”, says anaesthetist Dr Nitin Nachane.

“Open 3D mesh repair was preferred over the laparoscopic repair for obstructed hernia considering the greater risk of transmission during the covid pandemic”, says Laparoscopic Surgeon Dr Deepak Kulkarni.

Many of the outstation patients who were operated on in early March for complex fistula couldn’t come for follow up due to lockdown. They developed premature closure of the wound. Which eventually developed into pus leading to an abscess. Evaluation under anaesthesia was performed on all such cases to drain the pus. This normally would not have happened if the follow-up dressing was not skipped.

Contracting Covid from asymptomatic patients is always a risk amongst health care workers. To minimise this strict universal precaution were taken. As a result of this none of the hospital staff contracted covid 19.

Universal Precautions for Covid
1.PPE kits were used for OT staff
2.Social distancing was maintained throughout from consultation to surgery.
3.Sanitisation was practised from door to door
4.Daily sanitisation of Rooms and hospital
5.Private rooms were allocated to all patients.
6.Only one attendant per patient was allowed
7.Patients were trained to use the mask in the right way.
8.Screening of all patients before entering the waiting room. History of travel, cough, fever was ruled out. Temperature and SPO2 check for all the patients on admission

Source: Healing Hands Clinic

One such case with uncontrolled diabetes presented in a very late stage due to lockdown.
The patient was suffering from a complex recurrent fistula for the last 1 year.
Excessive sitting at one place and limited activity due to lockdown was the possible cause for his recent increase in blood sugar levels. He started having pain in the buttocks 5 days before coming to us in an emergency. He self-treated the condition considering it as piles. Severe pain with fever prompted him to visit us. He underwent emergency FiLaC surgery for fistula and the abscess was drained. He took a longer time for the healing.

Questions & Answers
1.Why patients with piles and fistula who did not seek medical care during lockdown are taking a long time to heal now?

Answer : Usually 70% of patients coming to us for piles are treated with medicines and diet as they are diagnosed in an early stage. But now they are presenting in the late stages of the diseases with symptoms like severe pain or bleeding. Once the piles are in grade 3 or grade 4, medical management has a limited role. We are offering them Laser Surgery for same.
Patients with fissure who will normally respond to medications in 2 weeks are now taking minimum of 4-6 weeks for recovery with medications.
Patients suffering from Fistula are presenting in severe pain or fever due to abscess. Such patients need emergency surgery. But because of the active infection, healing is slow after surgery. Few complex cases might take 2-3 Months for complete healing after complex fistula surgery. Few patients need weekly follow up after fistula surgery but they are scared to travel due to lockdown. All these factors delay the healing and recovery time.

2.How seeking medical care in time helps in faster recovery?

Answer : Early diagnosis is the key to medical success and good quality of life. If piles are diagnosed in grade one or early grade 2 they can be cured with a specialised kit called PILOKIT which is 15 days course. It consists of innovative pilospray for instant relief without touching the sore anus. Pilotab for inflamed piles and Constitab for constipation.
Also, the uncomplicated fistula will heal very fast with laser surgery.

3.What are the various types of complications that patients with piles and fistula land up with when they delay treatment?

Answer : Patients in grade 3 and grade 4 piles will land up in severe per rectal bleeding with drop-in Haemoglobin. We saw many patients in bleeding who were having comorbid cardiac conditions and were taking blood thinners.
Few patients with abscess in existing fistula presented with early sepsis due to uncontrolled diabetes.
Few patients presented in severe sepsis with a morbid condition Called as Fourniers gangrene.

4.Is there any subset of patients who could have recovered with conservative treatment but now they had to undergo surgery as the disease progressed due to delay in seeking medical care during a lockdown ?

Answer : Most the patients with Acute fissure if treated in time are cured with medications.
But untreated fissure with severe pain or when it gets complicated into abscess or fistula will need surgery.

Dr Ashwin Porwal
Consultant ColoRectal Surgeon
Founder Healing Hands Clinic

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Complications rise among piles patients in shutdown

Complications rise among piles patients in shutdown

A sizable number of people with piles and fistula are taking longer to get cured as most of them are delaying medical care in the wake of the coronavirus triggered lockdowns, resulting in complications.

“Usually, 70% of patients with piles are treated with medicines and dietary changes as they get diagnosed in an early stage. However, owing to the extended lockdown in the wake of the Covid-19 pandemic, a sizable number of patients are presenting in late stages of the disease with symptoms like severe pain and bleeding,” said consultant colorectal surgeon Ashwin Porwal of Healing Hands Clinic.

Once the haemorrhoids (piles) are in grade III or IV stages, medical management has a limited role.

“Most of these patients with progression of piles are being treated with laser surgery when medication and lifestyle modifications could have been enough to do the trick if they had approached us early,” Porwal said.

Similarly, patients with an anal fissure, a small tear or crack in the lining of the anus, who normally respond to medications in two weeks are now taking a minimum of 4-6 weeks for recovery with medications. “Patients with fistula, a tunnel that runs from inside the anus, are also approaching us after developing severe pain or fever due to abscess (collection of pus). Quite a few of them even required emergency surgery,” Porwal said.

Many of the outstation patients who were operated in early March (before the lockdown) for complex fistula couldn’t come for follow up due to the lockdown.

“They developed premature closure of the wound, which developed into pus leading to an abscess. This would not have happened if the follow-up dressing was not skipped,” laparoscopic surgeon Deepak Kulkarni said.

Healing is slow in such patients even after surgery.

“Patients need weekly follow up after surgery. But the frequent lockdowns made them reluctant to venture out for follow up, delaying the healing and recovery,” said anaesthetist Nitin Nachane.

Contracting Covid-19 from infected but asymptomatic patients is always a risk for healthcare workers as much as other patients.

“To minimize this, strict universal precautions are being taken. Post-surgery, patients are put on immunity-boosting medications like Curcumin and vitamin D for two weeks. None of our patients have developed Covid-19 during hospital stays and even after the surgery so far,” Porwal said.

Experts also stressed against indulging in self-medication amid Covid-19 infection fears.

“It is always better to reach out to the medical practitioner via online or video chats or simple call,” an expert said.

Reference

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Pruritus Ani: The Embarrassing Itch

Itching of the skin around the anus can be agonizing especially if one is stranded in a public place with no escape in view. More often than not the cause behind this itch is easily addressed. Occasionally however, persistent severe itching can cause psychological stress to the sufferer and needs in-depth evaluation.

What is Pruritus ani?
Pruritus ani is defined as chronic, moderate to intense itching of the skin around the anal opening.
It affects 1-5% of the population and is more commonly found in men. Once itching occurs, it can lead to a vicious itch-scratch-itch cycle.

Causes of Pruritus ani

• Fecal Contamination

Prolonged contact of the skin with fecal matter can cause irritation with resultant pruritus. Inadequate cleansing can leave stool and sweat residue which acts as irritant. Most of these individuals have loose stools or mucous seepage. Abnormal anal sphincter relaxation can also cause soiling. This kind of itch is usually relieved by washing the area. However, underlying pathology, if any, needs to be addressed.

• Anorectal disorders

Anorectal conditions like Hemorrhoids (Piles) and Fissure can precipitate peri-anal itch. External hemorrhoids that are large can interfere with post-defecation cleansing. Internal hemorrhoids, on the other hand, can cause mucous seepage or fecal soiling and resultant pruritus. Anal Fissures can also cause itching due to inflammation. Anal Fistula or Fistula-in-ano with an external opening in the region, can lead to discharge of pus or fecal matter and consequent itching.

• Infections

Fungal infections are common in the area, especially among diabetics who are prone to Candidiasis. Infection with threadworms/pinworms is also common, especially among children. Viral infections can also cause pruritus

• Allergy

Chemicals found in creams, wet wipes, soaps etc. can cause Allergic Contact Dermatitis.

• Skin conditions

Psoriasis, lichen sclerosis, Paget’s disease, peri-anal Bowen’s disease etc. can also can pruritus ani.

• Other factors

Certain foods like caffeinated drinks, spices, peanuts, tomatoes etc. can cause peri-anal itching. Relief is attained within 2 weeks of stopping the causative food.
Aggressive cleaning can cause dryness of the skin and thus itching.
Psychological factors like anxiety, stress or depression maybe associated with pruritus ani.
Similarly, aggressive cleansing can cause dryness in the area and itching.

Dealing with Pruritus ani

To get rid of peri-anal itching, the underlying cause needs to be addressed. One should wear loose, cotton clothing, especially at night, which gives an opportunity for ventilation. Following a bowel movement, the area should be gently cleaned with water or simple tissue moistened with water or with peri-anal wipes. One should avoid the use of soaps in the area. Associated symptoms, if any, point to an underlying pathology. Anorectal conditions like piles, fissure and fistula are treated by a Proctologist. Peri-anal skin conditions, infections and allergies are treated by a Dermatologist.