Treatment of Haemorrhoids (Piles) in Pakistan: A Surgeon’s Honest Guide

By Prof. Dr. Zahid Mahmood — General, Laparoscopic & Laser Surgeon

Haemorrhoids — known to most people as “piles” or bawaseer — are one of the most common problems I see in my clinic, and one of the most misunderstood. Almost half of all adults will experience them at some point in their lives. Yet in Pakistan, thousands of patients suffer in silence for months or even years, too embarrassed to see a doctor, or misled by advertisements promising a “guaranteed permanent cure.” The truth is simpler and far more hopeful: haemorrhoids are very common, rarely dangerous, and almost always treatable — often without an operation at all. This article explains your real options, in plain language.

What exactly are haemorrhoids?

Inside the anal canal we all have small cushions of tissue rich in blood vessels. When these cushions become swollen and enlarged — usually from years of straining, constipation, a low-fibre diet, prolonged sitting, or pregnancy — they become haemorrhoids. The typical symptoms are bright red bleeding after passing stool, a feeling of a lump, itching, discomfort, or a swelling that comes out during motion.

Doctors describe piles in four grades: first-degree (bleeding only), second-degree (come out but go back on their own), third-degree (come out and must be pushed back by hand), and fourth-degree (stay out permanently). The grade matters, because it decides which treatment is best for you.

First and most important: make sure it really is “just piles”

This is the single most important message in this article. Not all rectal bleeding is caused by haemorrhoids. The very same symptom — blood after stool — can also be an early sign of colon or rectal cancer, especially in patients over 40 or with a family history. Every year I meet patients who assumed their bleeding was “only piles” and treated themselves for months, when a five-minute examination could have caught something serious early. A proper check-up by a qualified surgeon is not just about comfort — it can be about safety. Please never assume; always get examined.

The treatment ladder — from simple to surgical

Good treatment almost always starts with the simplest, safest option and only moves further if needed. Here is the full range available in Pakistan today.

1. Lifestyle and diet — the foundation of every cure

Most early haemorrhoids improve dramatically with simple changes, and this is where every patient should begin:

Eat more fibre — vegetables, fruit, whole wheat chapati, oats and isabgol (psyllium husk), which is cheap and very effective here.
Drink plenty of water throughout the day.
Avoid straining and don’t sit for long periods on the toilet.
Treat constipation early — hard stool is the main culprit.

Creams, ointments and suppositories from a pharmacy can relieve pain and itching, but they soothe symptoms rather than cure the underlying problem.

2. Office (OPD) procedures — no operation, no admission

When simple measures are not enough, several quick procedures can be done right in the clinic, without anaesthesia or hospital admission:

Rubber band ligation (banding): a tiny elastic band is placed at the base of the pile, cutting off its blood supply so it shrinks and falls off within a few days. This is one of the most effective and widely used treatments for second- and third-degree piles.
Injection (sclerotherapy): a special solution is injected to shrink the swollen vessels — useful for early, bleeding piles.

These take only a few minutes, and you can go home and return to work the same day.

3. Modern minimally-invasive treatments

For larger or more troublesome piles, newer techniques offer surgery with much less pain and faster recovery:

Laser haemorrhoidoplasty: laser energy is used to gently shrink the piles from the inside through a tiny opening, with no large cuts and no stitches. Recovery is quick and postoperative pain is usually far less than with old-fashioned surgery — one reason it has become popular in Pakistan.
Doppler-guided haemorrhoidal artery ligation (HAL): a small ultrasound probe locates the exact arteries feeding the piles, which are then tied off. It is precise, effective, and has a low recurrence rate.
Stapled haemorrhoidopexy (PPH): a stapling device lifts and removes the prolapsing tissue. It causes less pain and quicker recovery than open surgery, though piles can occasionally return.

4. Surgical removal (haemorrhoidectomy)

For advanced, fourth-degree, or mixed piles — or when simpler methods have failed — the surgical removal of the piles remains the most complete and durable cure. Done properly by an experienced surgeon and with modern pain control, it has an excellent, lasting result. In most cases it is a day-case or overnight procedure, followed by a couple of weeks of recovery with warm sitz baths, stool softeners and pain relief.

A word of caution for Pakistani patients

Across our cities you will see banners and advertisements promising a “guaranteed, painless, permanent cure for bawaseer” from unqualified hakeems and unregistered clinics. Please be very careful. I have treated patients who suffered serious infections, burns, permanent anal narrowing, and even incontinence after untrained hands used unregulated injections or chemicals. Haemorrhoid treatment is safe only in trained, qualified hands. There is no shame in this condition, and there is no need to hide from it — but do choose the right person to treat it.

The bottom line

Haemorrhoids are common, treatable, and nothing to be embarrassed about. In the great majority of cases, the cure is simple and painless. The mistake is not having piles — it is ignoring the symptoms, self-treating, or trusting the wrong person. If you have bleeding, a lump, or discomfort, come and get properly examined. A short visit today can give you both relief and peace of mind.

To book a consultation with Prof. Dr. Zahid Mahmood, please call 0300 413 0159.

This article is for general awareness and does not replace a personal medical consultation. Please see a qualified doctor for advice about your own condition.

Treatment of Haemorrhoids (Piles) in Pakistan: A Surgeon’s Honest Guide

Treatment of Haemorrhoids (Piles) in Pakistan: A Surgeon’s Honest Guide

What exactly are haemorrhoids?

First and most important: make sure it really is “just piles”

The treatment ladder — from simple to surgical

1. Lifestyle and diet — the foundation of every cure

2. Office (OPD) procedures — no operation, no admission

3. Modern minimally-invasive treatments

4. Surgical removal (haemorrhoidectomy)

A word of caution for Pakistani patients

The bottom line

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