Frequently Asked Questions

Blood in stool most commonly comes from the lower gastrointestinal tract. In the majority of cases it is caused by piles (haemorrhoids), anal fissure, or both. Piles are swollen blood vessels inside or around the anal canal that bleed when irritated during passing stool. The blood is usually bright red and appears on toilet paper or in the toilet bowl. Other causes include anal fissure, polyps, and in less common cases, colorectal conditions. Any rectal bleeding lasting more than two weeks warrants a clinical examination.

Bright red blood after passing stool is usually from piles or a fissure and is not immediately life-threatening, but it should never be ignored. If the bleeding is heavy, continuous, or accompanied by dark/black stools, dizziness, or significant pain, seek medical attention urgently. Recurrent bleeding can lead to anaemia over time. Only a proper examination can determine the cause with certainty.

Bright red blood on toilet paper or in the toilet bowl after passing stool is the most classic symptom of piles. However, it can also be from an anal fissure (a small tear in the anal lining), which is equally common. The distinction matters because treatment is different. Piles bleeding is usually painless; fissure bleeding comes with a sharp tearing pain. A physical examination confirms the diagnosis within minutes.

Pain during passing stool that feels like tearing, burning or cutting is most often caused by an anal fissure — a small crack in the anal skin. Piles can also cause pain, particularly if thrombosed or prolapsed, but the sharp pain during motion is a classic fissure symptom. If pain persists for 30 minutes to 2 hours after passing stool, fissure is very likely. A proctologist can diagnose this in a single examination.

Mostly yes — bright red fresh blood from the anal area is usually from piles or a fissure. However, it is not always the case. Polyps, inflammatory bowel disease, and in rare cases colorectal cancer can also cause rectal bleeding. This is why medical evaluation is important, especially if bleeding is persistent, if there is unexplained weight loss, change in bowel habits, or you are over 40.

See a doctor immediately if: bleeding is heavy or continuous, stools appear dark or black (tarry), you feel dizzy or faint, or you have fever with anal pain. See a doctor within a week if: bleeding has occurred more than once, you notice a lump or prolapse near the anus, or symptoms have not improved with dietary changes. Do not self-treat rectal bleeding for more than 2 weeks without a proper examination.

A lump near the anus can be an external pile (external haemorrhoid), a skin tag from a previous pile, a perianal abscess, or in some cases a prolapsed internal pile. External piles are soft and may be uncomfortable but not usually hot or severely painful. An abscess is warm, red, rapidly growing, and comes with significant pain — this needs urgent care. A clinical examination takes under 5 minutes to determine which one it is.

Yes — itching around the anal area is one of the most common symptoms of internal piles. Internal piles often produce a small amount of mucus that leaks out, which causes persistent wetness, irritation and itching. Skin tags from old external piles also trap moisture and cause itching. Other causes of anal itching include fungal infection, skin conditions, and poor hygiene. A proctologist can identify the cause accurately.

Burning that lasts 30 minutes to 2 hours after passing stool is the hallmark of an anal fissure. The burning is caused by spasm of the internal anal sphincter after the tear is aggravated. Piles can also cause mild burning, but it settles quickly. If the burning is severe and prolonged, fissure is the most likely cause. Dietary changes (soft stools, high fibre, hydration) plus topical treatment usually helps, but chronic fissure needs a procedure.

Mucus or clear discharge from the anus is commonly caused by internal piles — particularly Grade 2 or 3 haemorrhoids which prolapse slightly and produce mucus. This causes persistent wetness in the underwear. If the discharge is yellow or pus-like, this suggests a fistula or abscess rather than piles, and needs urgent evaluation. The type and colour of discharge is an important diagnostic clue.

Pain specifically when sitting can come from several conditions. A thrombosed external pile (blood clot in a pile) causes a hard, very painful lump that hurts constantly when sitting. A perianal abscess also causes this. In young men, pain near the tailbone when sitting is often pilonidal sinus rather than piles — these are in different anatomical locations and require completely different treatment. Pain that worsens throughout the day with prolonged sitting is common in office workers with piles.

No — pus near the anus is never normal. Pus indicates active infection. Simple piles do not produce pus. If you see yellowish, cloudy or foul-smelling discharge near the anus, this points strongly to an anal fistula or perianal abscess. Both conditions need surgical treatment. A fistula is a small infected tunnel between the inside of the anal canal and the skin surface. It will not heal on its own with cream or antibiotics alone.

In the vast majority of cases, rectal bleeding in Pakistan is from piles or fissure — not cancer. However, colorectal cancer can also cause rectal bleeding, particularly in patients over 40, or where there is associated weight loss, change in bowel habits, or blood mixed in stool (not just on toilet paper). Cancer does not cause bright red blood on toilet paper after wiping; piles do. If you have any doubt, get examined. A proctoscopy can rule out serious pathology in a single visit.

Piles are diagnosed through a clinical examination. A proctologist takes a history of your symptoms, then performs an external inspection of the anal area and a proctoscopy — a quick, 2-minute procedure using a small tube with a light that allows visualisation of the internal anal canal. This confirms the grade of piles (Grade 1 to 4). The procedure is not painful. No blood tests or imaging are needed for basic piles diagnosis.

The key distinction is pain. Piles usually cause painless bleeding, itching, and a feeling of fullness. Fissure causes severe, sharp, tearing pain during and after passing stool — patients describe it as passing glass. Fissure bleeding is small in amount and comes with intense burning that persists for up to 2 hours. Both can coexist in the same patient. Treatment is different for each: piles require haemorrhoidal treatment, fissure requires sphincter relaxation or laser sphincterotomy.

Internal piles generally do not cause severe pain. They cause discomfort, heaviness, and itching. However, a thrombosed pile — where a blood clot forms inside the pile — causes sudden, intense pain that can make sitting and walking very difficult. Prolapsed piles that become strangulated (Grade 4) are also extremely painful. If you have sudden severe anal pain with a hard lump, seek urgent care as this can be a thrombosed pile or abscess.

For Grade 1 and early Grade 2 piles, these measures genuinely help: high-fibre diet (fruits, vegetables, isabgol/psyllium husk), drinking 8 glasses of water daily, avoiding straining during toilet, sitz baths (sitting in warm water for 10 minutes), and avoiding spicy food during flare-ups. Topical creams can reduce itching and discomfort. However, home management does not treat the underlying piles — it manages symptoms. For Grade 2 and above, a clinical procedure gives permanent relief.

Grade 1 piles often improve significantly with dietary and lifestyle changes. Grade 2 piles can sometimes be managed with rubber band ligation (a non-surgical clinic procedure) without formal surgery. Grade 3 and Grade 4 piles almost always require a procedure — either conventional surgery or laser treatment. So the answer depends entirely on the grade. Getting examined first is always the right step, because treatment decisions should be based on grade, not assumptions.

Yes — laser piles surgery (Laser Hemorrhoidopexy (LHP)) is a well-established, safe procedure. It is minimally invasive, meaning there are no cuts or stitches on the outside. It is done under local or sedation anaesthesia. Complications are rare — less than 5% of cases report any minor issue. The main advantages over conventional surgery are significantly less pain, faster recovery (3–5 days vs 4-6 weeks), and same-day discharge. It has no radiation — the laser is a surgical light energy tool, not an X-ray device.

The laser procedure itself takes 20-40 minutes. Patients go home the same day. Return to desk work takes 3–5 days. Full tissue healing takes 4-6 weeks, though most patients feel normal well before that. For rubber band ligation, the procedure takes 10-15 minutes per pile and may need 2-3 sessions spaced 4-6 weeks apart for multiple piles. Conservative management (diet + medication) for Grade 1 typically takes 4-8 weeks to show meaningful improvement.

Piles treatment cost in Karachi varies by grade and treatment type. Medication and dietary management costs a few thousand rupees. Rubber band ligation costs approximately Rs 10,000-25,000 per session. Laser piles surgery (LHP) typically ranges from Rs 150,000 to Rs 180,000 depending on the grade and number of piles. This includes the procedure, anaesthesia, and follow-up visits. The cost should always be confirmed at consultation as it depends on individual clinical assessment.

For piles, fissure, fistula, and related anorectal conditions, you need a proctologist — a surgeon who specialises specifically in these conditions. Dr. Abdullah Iqbal (MBBS, FCPS) at Karachi Piles Clinic is Pakistan’s first laser proctologist, having performed more than 5,000 laser procedures for piles, fissure, fistula and pilonidal sinus. The clinic is located on Shaheed-e-Millat Road, Karachi Memon Society, Karachi. Open Tuesday, Thursday & Saturday, 5:00 PM to 8:00 PM. Call or WhatsApp 0333-2877351.

For piles, the correct specialist is a colorectal surgeon or proctologist — a surgical specialist. A gastroenterologist is a physician (non-surgeon) who handles stomach, intestine and bowel conditions — they do not perform the procedures needed to treat piles. A general surgeon can handle piles but may not have the specialist training in laser techniques. A dedicated proctologist who focuses exclusively on anorectal conditions will give you the most accurate diagnosis and the widest range of treatment options.

Karachi Piles Clinic on Shaheed-e-Millat Road is a dedicated anorectal clinic — the first of its kind in Pakistan. Unlike general surgery clinics, every patient who comes here has a piles, fissure, fistula or related condition. This means the doctor sees these cases exclusively every day, and has the equipment and experience to diagnose and treat correctly the first time. Laser procedures (LHP, FiLaC, Sinus Laser Closure, laser sphincterotomy) are all available here.