Direct answer. Piles (bawasir) are swollen cushions of veins at the anus. Early piles, grade 1 and 2, often settle with a high fibre diet, more water, less straining and short courses of medicine. Larger piles that keep bleeding, hang out or do not shrink may need a procedure or surgery. The right choice depends on the grade, which Dr Raman Garg checks at Bombay Gastro & Cancer Institute, Bathinda, Punjab, India.
What are piles, in plain words
Inside the lower rectum there are soft cushions of blood vessels that help you hold stool. When you strain on the toilet, sit for long or live with kabz, these cushions swell, slip down and bleed. That swollen cushion is a pile. People call it bawasir, mass, or khooni bawasir when it bleeds.
A farmer from Goniana Mandi who sits on a tractor seat for 10 hours, eats little salad and drinks tea all day often reaches the clinic after months of hiding the problem. Shyness delays care more than any other reason.
Symptoms and how to know the grade
- Bright red blood on the stool paper or dripping into the pan, usually without pain
- Itching or a feeling of fullness near the anus
- A lump that comes out during motion
- Mucus leak, soiled underwear
- Pain, if a lump gets clotted or if there is a fissure alongside
| Grade | What happens | Usual first approach |
|---|---|---|
| Grade 1 | Bleeding, no lump comes out | Diet, fibre, medicine, fluids |
| Grade 2 | Lump comes out during motion and goes back by itself | Diet and medicine; procedure if bleeding persists |
| Grade 3 | Lump comes out and you push it back with a finger | Procedure or surgery is often discussed |
| Grade 4 | Lump stays out all the time | Surgery is usually advised |
Blood in stool is not always piles. It can also come from a fissure (a small tear) or from conditions higher in the bowel. This is why a proper check matters, especially after 40. Read the difference in our post on piles vs fissure vs fistula and on blood in stool causes.
Treatment without an operation
- Fibre and water. 25 to 30 grams of fibre a day: daliya, oats, whole wheat roti, salad, fruit, isabgol (psyllium husk). Drink 2.5 to 3 litres of water.
- Toilet habit. Go when you feel the urge. Do not sit more than 5 minutes. Keep the phone outside.
- Warm sitz bath. Sit in warm water for 10 minutes, 2 or 3 times a day.
- Medicines. Stool softeners, creams and tablets, as the doctor advises, give relief in many grade 1 and 2 cases.
- Weight, activity, and no long sitting. Walk daily. If you drive a truck, stop every 2 hours.
This works well in early piles, but if the cause (kabz) stays, piles return. See our page on constipation treatment if hard stool is your root problem.
When operation is the better option
Surgery is not the first step for everyone. It is advised when:
- piles are grade 3 or 4 and keep coming out
- bleeding continues for weeks despite medicine and has caused anaemia
- a clot has formed and the lump is hard and swollen
- piles come back again and again after other methods
- daily life, work or sleep is affected
Depending on the case, Dr Raman Garg may suggest rubber band ligation, stapler surgery or an open surgical removal. Each suits a different type of pile, and the method is decided after examination. Most patients go home within 24 hours and many return to light work in about a week, though it varies. Read more on our piles treatment in Bathinda page.
What does piles surgery cost in Punjab?
| Item | Starting | Average | Maximum |
|---|---|---|---|
| OPD consultation | Rs 500 | Rs 700 | Rs 1,000 |
| Pre-operative blood tests, ECG and chest X-ray | Rs 1,500 | Rs 2,500 | Rs 4,000 |
| Piles surgery (stapler, open or ligation, as suited) | Rs 35,000 | Rs 55,000 | Rs 85,000 |
Note: These are typical Punjab costs for 2026. The final cost may vary after Dr Raman Garg examines you, depending on the grade of piles, type of procedure chosen, anaesthesia type, and your age and health.
Published ranges from Mohali and Chandigarh hospitals put piles surgery at about Rs 35,000 to 85,000. Metro hospitals often charge more. See the full gastro treatment cost page.
Risks and honest expectations
All surgery carries some risk, such as bleeding, infection, urine difficulty after anaesthesia, and a narrowing or leakage in rare cases. Piles can also come back if kabz and straining continue. Dr Raman Garg explains these before you decide, and follows you personally after the operation. We do not promise a permanent cure, because habits decide how long relief lasts.
Mistakes that make piles worse
- Using the same cream from the chemist for a year without an examination
- Trusting quacks and posters who promise cure without a check, since blood in stool can be a bowel growth
- Taking strong laxatives daily, which leaves the bowel dependent on them
- Avoiding the toilet visit because of shame, which hardens the stool
When to see a doctor
Same-day hospital care: heavy bleeding with dizziness or weakness, a hard painful lump you cannot push back, severe pain with fever, or no passing of stool and gas with vomiting. Call +91 82641-60001 or go to the nearest emergency room.
Book a visit soon: any blood in stool, a change in bowel habit lasting over 3 weeks, weight loss, or tiredness with paleness. After age 40, a colon check may be advised, see colonoscopy in Bathinda.
Cashless insurance
Piles surgery is covered by many health policies. BGCI is empanelled with Aditya Birla Health Insurance, Niva Bupa, Care Health Insurance, ICICI Lombard, Medi Assist TPA and almost all other major insurers and TPAs. Our insurance desk arranges pre-authorisation, see the cashless insurance page.
Patients from nearby towns
Patients from Goniana Mandi (about 20 minutes) and Bhucho Mandi (about 30 minutes) usually come for a first OPD visit and plan any procedure for a convenient day. Read about Dr Raman Garg or browse the gastro treatment hub.
OPD: Monday to Saturday, 10 AM to 5 PM. Sunday: emergency only. Call or WhatsApp +91 82641-60001. Address: Bombay Gastro & Cancer Institute, Power House Road, Near Street No. 10, Bathinda, Punjab 151001.
This article is general information; your plan is set after Dr Raman Garg examines you.