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The second degree - internal hemorrhoids protrude on defecation but returns spontaneously thereafter. Here,
use of rubber band ligation could be used. The procedure consist of tying
base of an internal hemorrhoid to cut off its circulation. About ten days later,
hemorrhoids painlessly fall off.
The third degree piles are protrusion seen outside
anus. Fourth degree piles are those irreducible and remain persistently prolapsed. For both of these types of piles, surgery is needed. You can expect a lot of pain and discomfort at
lower part of
anal canal as here
skin is richly innervated with nerve fibers.
Now, there's an alternative to painful surgery with a procedure called 'Stapled Hemorrhoidectomy'. Here a cuff of rectal mucous membrane and hemorrhoidal tissue is excised above
sensitive part of
anal canal, using a stapling instrument. It does not leave a large or raw wound, hence less painful.
This procedure is more expensive but has become popular over
last three years. However, it cannot be performed on all cases of hemorrhoids such as external hemorrhoid and those with excessive skin tags.
Piles are preventable and symptoms can be controlled if managed at an early stage without resorting to medication or surgery. A diet high in fiber can prevent constipation and excessive straining associated with it. My advice is to start now, unless you want to accumulate "a pile of misery" any time soon!.

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